Etiology of Bacterial Meningitis Among Children <5 Years Old in Côte d’Ivoire: Findings of Hospital-based Surveillance Before and After Pneumococcal Conjugate Vaccine Introduction

Abstract

Background Bacterial meningitis remains a major disease affecting children in Côte d’Ivoire. Thus, with support from the World Health Organization (WHO), Côte d’Ivoire has implemented pediatric bacterial meningitis (PBM) surveillance at 2 sentinel hospitals in Abidjan, targeting the main causes of PBM: Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus). Herein we describe the epidemiological characteristics of PBM observed in Côte d’Ivoire during 2010–2016. Methods Cerebrospinal fluid (CSF) was collected from children aged &lt;5 years admitted to the Abobo General Hospital or University Hospital Center Yopougon with suspected meningitis. Microbiology and polymerase chain reaction (PCR) techniques were used to detect the presence of pathogens in CSF. Where possible, serotyping/grouping was performed to determine the specific causative agents. Results Overall, 2762 cases of suspected meningitis were reported, with CSF from 39.2% (1083/2762) of patients analyzed at the WHO regional reference laboratory in The Gambia. In total, 82 (3.0% [82/2762]) CSF samples were positive for bacterial meningitis. Pneumococcus was the main pathogen responsible for PBM, accounting for 69.5% (52/82) of positive cases. Pneumococcal conjugate vaccine serotypes 5, 18C, 19F, and 6A/B were identified post–vaccine introduction. Emergence of H. influenzae nontypeable meningitis was observed after H. influenzae type b vaccine introduction. Conclusions Despite widespread use and high coverage of conjugate vaccines, pneumococcal vaccine serotypes and H. influenzae type b remain associated with bacterial meningitis among children aged &lt;5 years in Côte d’Ivoire. This reinforces the need for enhanced surveillance for vaccine-preventable diseases to determine the prevalence of bacterial meningitis and vaccine impact across the country.

Invasive Haemophilus influenzae Infections after 3 Decades of Hib Protein Conjugate Vaccine Use

“…Data on pediatric bacterial meningitis have been generated in 26 Sub-Saharan African countries by the WHO's Invasive Bacterial Vaccine-Preventable Diseases Surveillance Network (IB-VPD) (146)(147)(148)(149)(150)(151)(152)(153)(154). During 2011 to 2016, 1,670/49,844 (3.3%) meningitis cases in children aged ,5 years were laboratory confirmed, of which H. influenzae (232/1,670 [13.9%]) was the least common organism identified (146).…”

“…While most were Hib infections, cases of Hia, Hic, Hie, and NTHi were also reported. Interestingly, Boni-Cisse et al noted that NTHi had become a significant cause of meningitis in Côte d'Ivoire (154).…”

Evaluation of pneumococcal meningitis clusters in Burkina Faso and implications for potential reactive vaccination

“…This analysis adds to the growing literature regarding pneumococcal meningitis in the context of PCV implementation in West Africa [8] , [20] , [21] , [23] , [24] , [25] , [27] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , from a country with nationwide population-based surveillance data with routine pneumococcal serotyping [15] , [16] , [18] . Following the successful introductions of Hib vaccine and MACV, the epidemiology of bacterial meningitis in the meningitis belt is changing and S. pneumoniae is increasingly recognized as causing a high proportion of remaining disease [9] .…”

“…Numerous countries in sub-Saharan Africa, including neighboring Ghana, struggle to control pneumococcal meningitis burden and outbreaks, even in the context of high coverage with pneumococcal conjugate vaccine (PCV) [8] , [20] , [21] , [22] , [23] , [24] , [25] . Unlike for meningococcal meningitis, there is no formal epidemic definition or outbreak response guidelines for pneumococcal meningitis [26] .…”

Simultaneous detection of Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae by quantitative PCR from CSF samples with negative culture in Morocco

“…A suspicion of bacterial meningitis requires urgent care at hospitals; often on admission a rapid antibiotic therapy is administered to reduce mortality and morbidity. And the frequent Acta Microbiologica et Immunologica Hungarica etiology of bacterial meningitis in the most countries are Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae [1]. In many developing countries, the surveillance of bacterial meningitis is hampered by limited use of bacterial culture in peripheral laboratories and high frequency of negative cultures [2].…”