Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine

Abstract

Background Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). Methods From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. Results A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. Conclusions Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in 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).…”

“…There were 9 cases of Hib meningitis, with the number declining by year, with only 1 case in 2015, while 2/2 cases of Hic occurred in 2012 and 5/7 cases of Hie were in 2015 (151). In Nigeria, 19/153 (12%) pediatric bacterial meningitis cases were due to H. influenzae (150). Serotyping was performed on 16/19, with Hib being the predominant serotype (11/16, 69%).…”

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] .…”

Etiology of Pediatric Meningitis in West Africa Using Molecular Methods in the Era of Conjugate Vaccines against Pneumococcus, Meningococcus, and Haemophilus influenzae Type b

“…The sentinel sites participating in the PBM network are pediatric teaching and referral hospitals. The six sentinel sites included in this study were in Senegal (Dakar), 16 Ghana (Kumasi and Accra), 17 Togo (Lome), 18 Nigeria (Enugu), 19 and Niger (Niamey), 20 all countries at risk of meningitis epidemics. 21 The sentinel sites in Niger and Senegal fall within the hyperendemic region of the meningitis belt.…”