Neisseria meningitidis and Streptococcus pneumoniae as leading causes of pediatric bacterial meningitis in nine Mexican hospitals following 3 years of active surveillance

Abstract

Objectives: Meningococcal meningitis is reported as a rare condition in Mexico. There are no internationally published studies on bacterial causes of meningitis in the country based on active surveillance. This study focuses on finding the etiology of bacterial meningitis in children from nine Mexican Hospitals. Methods: From January 2010 to February 2013, we conducted a three years of active surveillance for meningitis in nine hospitals throughout Mexico. Active surveillance started at the emergency department for every suspected case, and microbiological studies confirmed/ruled out all potentially bacterial pathogens. We diagnosed based on routine cultures from blood and cerebrospinal fluid (not polymerase chain reaction or other molecular diagnostic tests), and both pneumococcal serotyping and meningococcal serogrouping by using standard methods. Results: Neisseria meningitidis was the leading cause, although 75% of cases occurred in the northwest of the country in Tijuana on the US border. Serogroup C was predominant. Streptococcus pneumoniae followed Neisseria meningitides, but was uniformly distributed throughout the country. Serotype 19A was the most incident but before universal implementation of the 13-valent pneumococcal conjugate vaccine. Other bacteria were much less common, including Enterobacteriaceae and Streptococcus agalactiae (these two affecting mostly young infants). Conclusions: Meningococcal meningitis is endemic in Tijuana, Mexico, and vaccination should be seriously considered in that region. Continuous universal vaccination with the 13-valent pneumococcal conjugate vaccine should be nationally performed, and polymerase chain reaction should be included for bacterial detection in all cultures – negative but presumably bacterial meningitis cases.

The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations

“…In Japan and Southern Africa (Mozambique) meningococcal serogroup Y (MenY) [35], and meningococcal serogroup W (MenW) predominated [36], respectively. The emergence of MenW and MenY was evident in some countries worldwide [11,14,16,29,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

Meningococcal Disease in Children: Eleven Years of Active Surveillance in a Mexican Hospital and the Need for Vaccination in the Tijuana Region

“…Based on our findings in Tijuana, Mexico, we performed a National Mexican Network based on active surveillance for meningitis in children from nine hospitals: This study proved that by using active surveillance, MD was present mostly in the north part of the country, with 75% of cases in Tijuana [6].…”

“…Only one patient had the tetravalent (A, C, Y, W) meningococcal conjugate vaccine, but this child developed a serogroup B related MD. Median days of illness prior to admission was of two (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). At admission, 47 (92.15%) had meningitis, 24 (47%) purpura, 4 (7.84%) conjunctivitis and 2 (3.92%) pleural effusion (both patients with pleural effusion had a serogroup Y related MD).…”

“…Furthermore, from January 30 th March/30 th 2013, we dealt with an outbreak of MD, with 19 culture-confirmed cases and 7 deaths [5] and also published a National active surveillance study in nine Hospitals throughout the country, proving that MD is present in the north part of Mexico [6]. However, Health Authorities still hesitate to vaccinate against MD in the region.…”

An outbreak of serogroup C (ST-11) meningococcal disease in Tijuana, Mexico

“…Active surveillance for IMD it is being done only at the General Hospital of Tijuana (GHT), which is the only one in the city with both human and material resources for proper isolation and identification of N. meningitidis from sterile samples. Accordingly, we have previously published reports and presented at international meetings that IMD in children under 16 years old is present in similar numbers in Tijuana as in San Diego and is locally the leading cause of BM in children [Chacon-Cruz et al 2011a, 2011b, 2012b, 2013. Furthermore, these studies led to national active surveillance in 10 Mexican hospitals, which confirms that IMD is endemic in children from Tijuana but infrequent in other hospitals within the country [Chacon-Cruz et al 2012a].…”