BackgroundAn outbreak of pneumococcal meningitis among non-infant children and adults occurred in the Brong-Ahafo region of Ghana between December 2015 and April 2016 despite the recent nationwide implementation of a vaccination programme for infants with the 13-valent pneumococcal conjugate vaccine (PCV13).MethodsCerebrospinal fluid (CSF) specimens were collected from patients with suspected meningitis in the Brong-Ahafo region. CSF specimens were subjected to Gram staining, culture and rapid antigen testing. Quantitative PCR was performed to identify pneumococcus, meningococcus and Haemophilus influenzae. Latex agglutination and molecular serotyping were performed on samples. Antibiogram and whole genome sequencing were performed on pneumococcal isolates.ResultsEight hundred eighty six patients were reported with suspected meningitis in the Brong-Ahafo region during the period of the outbreak. In the epicenter district, the prevalence was as high as 363 suspected cases per 100,000 people. Over 95 % of suspected cases occurred in non-infant children and adults, with a median age of 20 years. Bacterial meningitis was confirmed in just under a quarter of CSF specimens tested. Pneumococcus, meningococcus and Group B Streptococcus accounted for 77 %, 22 % and 1 % of confirmed cases respectively. The vast majority of serotyped pneumococci (80 %) belonged to serotype 1. Most of the pneumococcal isolates tested were susceptible to a broad range of antibiotics, with the exception of two pneumococcal serotype 1 strains that were resistant to both penicillin and trimethoprim-sulfamethoxazole. All sequenced pneumococcal serotype 1 strains belong to Sequence Type (ST) 303 in the hypervirulent ST217 clonal complex.ConclusionThe occurrence of a pneumococcal serotype 1 meningitis outbreak three years after the introduction of PCV13 is alarming and calls for strengthening of meningitis surveillance and a re-evaluation of the current vaccination programme in high risk countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1914-3) contains supplementary material, which is available to authorized users.

Streptococcus pneumoniae is increasingly recognised as an important cause of bacterial meningitis in the African meningitis belt. The World Health Organization sets guidelines for response to outbreaks of meningococcal meningitis, but there are no current guidelines for outbreaks where S. pneumoniae is implicated. We aimed to evaluate the impact of using a similar response to target outbreaks of vaccine-preventable pneumococcal meningitis in the meningitis belt. Here, we adapt a previous model of reactive vaccination for meningococcal outbreaks to estimate the potential impact of reactive vaccination in a recent pneumococcal meningitis outbreak in the Brong-Ahafo region of central Ghana using weekly line list data on all suspected cases over a period of five months. We determine the sensitivity and specificity of various epidemic thresholds and model the cases and deaths averted by reactive vaccination. An epidemic threshold of 10 suspected cases per 100,000 population per week performed the best, predicting large outbreaks with 100% sensitivity and more than 85% specificity. In this outbreak, reactive vaccination would have prevented a lower number of cases per individual vaccinated (approximately 15,300 doses per case averted) than previously estimated for meningococcal outbreaks. Since the burden of death and disability from pneumococcal meningitis is higher than that from meningococcal meningitis, there may still be merit in considering reactive vaccination for outbreaks of pneumococcal meningitis. More outbreak data are needed to refine our model estimates. Whatever policy is followed, we emphasize the importance of timely laboratory confirmation of suspected cases to enable appropriate decisions about outbreak response.

As the world begins to transition beyond the urgent phase of the pandemic response, countries are increasingly looking to "mainstream" their COVID-19 management comprising of vaccination and case management into routine healthcare. Access to routine healthcare was severely limited across much of 2020 and 2021, with the greatest impact noted in lower-income settings [1].Population health undoubtedly has been negatively impacted, and countries are even more unlikely to reach Sustainable Development Goal targets by 2030. Policymakers, therefore, need up-to-date evidence to plan healthcare delivery and direct their limited resources toward priority areas. One effective, but resourceintensive, approach to disease control is Mass Drug Administration (MDA). An MDA is where preventive chemotherapy is used as a strategic approach to treat populations at risk of infection, with medicines being distributed across communities [2]. These form a core component of the 2021-2030 WHO Neglected Tropical Diseases (NTDs) Roadmap [3]. The WHO targets for MDAs typically require greater than 80% uptake to be considered effective with disease control [4]. With a community-wide intervention such as an MDA, local acceptance is vital to ensuring high engagement.Ghana is a lower-middle income country in West Africa with approximately 30 million people. Like many countries in sub-Saharan Africa, Ghana has used MDAs successfully to control diseases such as onchocerciasis and lymphatic filariasis [4]. During the COVID-19 pandemic, and following WHO guidance, MDAs mostly did not take place in Ghana.There are ongoing research partnerships between the Ghana Health Service, the University for Health and Allied Sciences (Ghana), and the University of Southampton (UK). These include the Oti Regional Health Directorate and Nkwanta South Municipality (a rural area close to the Togo border) (Figure 1).In January 2022, a research survey took place around community viewpoints on the pandemic response and COVID-19 vaccination [5]. Alongside this, a small number of supplementary questions were asked around knowledge, acceptance and value of MDAs to manage NTDs. The previous MDA in these communities took place in the last quarter of 2019, distributing ivermectin as a means to control (in particular) onchocerciasis. Onchocerciasis is a mosquito-driven NTD prevalent in parts of Ghana.Survey data was collected on electronic devices, using Kobo Toolbox platform, by 47 residents, known as Community-Based Surveillance Volunteers (CBSVs). This is similar to the methods used to distribute medicines during an MDA, albeit data collection that is usually paper-based. The survey was carried out in three hard-to-reach sub-municipalities within Nkwanta South, specifically Alokpatsa (population of 11,028), Brewaniase (14,483), and Tutukpene (15,453). A total of 1,370 responses were received.

Background: Descriptive analysis of meningitis outbreak in Jaman North districts of Brong Ahafo Region.Design: Descriptive secondary data analysisData Source: records of meningitis cases were extracted from case-based forms and line list.Main outcome measure: The source and pattern of outbreakResults: A total of 367 suspected cases with 44 confirmed were recorded from Jaman North during the period of January to March 2016. The mean age of those affected was 58 ± 13years. The case fatality rate was 0.82% and the proportion of males to females was 1:1.3 (160/207). The age group most affected was 15-29 years (54.7%) and the least was 45-49 years (3.0%). Streptococcus pneumoniae formed 77.3% of confirmed cases whilst Neisseria meningitides was 20.5%. Cases with Neisseria meningitides came from a border town in La Côte d’Ivoire.Conclusion: A protracted propagated meningitis outbreak occurred; and the predominant bacteria strain among confirmed cases was Streptococcus pneumoniae. Cases were mainly females and the most vulnerable group were people aged 15-29 years.Keywords: Streptococcus pneumoniae, Neisseria meningitides, meningitis outbreak, Jaman North District, GhanaFunding: This work was funded by the authors. Author BKD was sponsored under CDC (Frontline FETP)-CDC CoAg 6NU2GGH001876.

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