Burden of Meningitis and Other Severe Bacterial Infections of Children in Africa: Implications for Prevention

Abstract

Apart from meningococcal disease in the sub-Saharan meningitis belt, the incidence and impact of life-threatening bacterial diseases in children across Africa have not been quantified. The clinical and epidemiological data on pneumococcal, Haemophilus influenzae type b (Hib), and other forms of bacterial meningitis, as well as data on other severe bacterial infections throughout the continent were scrutinized. Pneumococci were the leading causative agents of nonepidemic meningitis and other bacteremic diseases, followed by Hib. Meningococcal diseases were less common. Mortality rates associated with pneumococcal, Hib, and meningococcal meningitis were 549 (45%) of 1211 patients, 389 (29%) of 1352 patients, and 104 (8%) of 1236 patients, respectively; sequelae occurred in 50%, 40%, and 10% of cases. At 0-4 years of age, the estimated incidences of Hib meningitis and all classic Hib diseases were 70 and 100 cases per 100,000 population per year, accounting for approximately 90,000 and 120,000 cases per year, respectively. Including older age groups and, especially, nonbacteremic Hib pneumonia in the estimates of Hib disease in Africa increased the overall numbers manifold; the numbers of pneumococcal infections were even greater. The only realistic way to combat these severe infections efficaciously would be through widespread vaccination, starting with Hib conjugates.

Naturally Acquired and Conjugate Vaccine-Induced Antibody to Haemophilus influenzae Type b (Hib) Polysaccharide in Malian Children: Serological Assessment of the Hib Immunization Program in Mali

“…1 Circa 2000, Africa had one of the highest regional burdens of Hib meningitis, with an incidence rate of~60 -70/100,000 in children 5 years of age 2,3 and a case-fatality rate of~29%. 2 The burden is highest in infants and toddlers, 4-18 months of age; Hib uncommonly affects children 1 month or over 5 years of age. 1 In the absence of immunization, the period of highest susceptibility commences as maternal antibodies begin to wane at~4 months of age and before children naturally acquire bactericidal antibodies against Hib.…”

Bacteremia among Children Admitted to a Rural Hospital in Kenya

“…The local incidence of infections such as meningitis and pneumonia has been estimated, often in relation to vaccine studies. 2 However, there are almost no estimates of incidence, mortality, or hospital burden for the majority of pathogenic bacterial species. Most data are from a few urban referral centers, [3][4][5][6][7][8][9] with very little recent data from the rural areas 10,11 where most people in sub-Saharan Africa live.…”

Indicators of Acute Bacterial Meningitis in Children at a Rural Kenyan District Hospital

“…Half of all childhood deaths from meningitis worldwide occur in sub-Saharan Africa. 1,2 For primary care workers with limited training and facilities, the Integrated Management of Childhood Illness (IMCI) guidelines advise referral of all children with general danger signs or a stiff neck as potential meningitis cases. 3,4 In practice, a simplified set of IMCI signs (lethargy, unconsciousness, seizures, or a stiff neck) are reported to be 98% sensitive and 72% specific for meningitis among children with a suspected invasive bacterial infection at the outpatient level.…”