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.

SUMMARY Twenty-three infants and children aged 21 months to 13 years with chronic diarrhoea and 6 patients without diarrhoea were investigated for lactose malabsorption with the hydrogen breath test (HBT) adapted for use in young infants and children. A further 8 children with proven or suspected coeliac disease were also investigated. The HBT was compared with the histology of the jejunal mucosa, mucosal lactase estimations, a lactose tolerance test, symptoms during the test, and follow-up after starting a lactose free diet.The 6 patients without diarrhoea showed no evidence of hypolactasia and the hydrogen (H2)* concentration on the HBT was below 7 parts per million (ppm), a level considered to be clinically nonsignificant. 12 of the 23 patients with diarrhoea had a breath H2 concentration greater than 24 ppm and this correlated well with their clinical symptoms during or after the test and with the remission of the diarrhoea after lactose withdrawal. Of the remaining 11 patients with diarrhoea whose breath H2 concentration was lower than 25 ppm, symptoms did not improve when a lactosefree diet was started in 3, while a further 4 improved on a full diet.There was poor correlation between the HBT and the findings on the jejunal mucosal specimens. All but one of the coeliac patients had an HBT less than 20 ppm and none of these required lactose withdrawal for remission of symptoms. The HBT is a noninvasive test particularly suitable for outpatients and it gives a useful prognostic guide to the efficacy of lactose-free diet in the treatment of chronic diarrhoea in children.

No abstract

No abstract

No abstract