An outbreak of pneumococcal meningitis among older children (≥5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana

Kwambana-Adams, Brenda; Asiedu-Bekoe, Franklin; Sarkodie, Badu; Afreh, Osei Kuffour; Kuma, George Khumalo; Owusu-Okyere, Godfred; Foster-Nyarko, Ebenezer; Ohene, Sally-Ann; Okot, Charles; Worwui, Archibald; Okoi, Catherine; Senghore, Madikay; Otu, Jacob; Ebruke, Chinelo; Bannerman, Richard; Amponsa-Achiano, Kwame; Opare, David; Kay, Gemma L.; Letsa, Timothy; Kaluwa, Owen; Appiah-Denkyira, Ebenezer; Bampoe, V.; Zaman, Syed M A; Pallen, Mark J.; D’Alessandro, Umberto; Mwenda, Jason M.; Antonio, Martín

doi:10.1186/s12879-016-1914-3

Cited by 78 publications

(89 citation statements)

References 40 publications

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“…The incidence of serotype 1 Sp fluctuated over time, with a decline in Sp1 coinciding with an increase in other pathogens. Similar waves of serotype 1 meningitis have been described in Ghana [14,37]. As observed previously, over one-third of Sp meningitis cases died in hospital despite receiving appropriate treatment with ceftriaxone; this highlights the importance of disease prevention to reduce morbidity and mortality.…”

Section: Discussionsupporting

confidence: 77%

Burden of Pneumococcal Disease in Northern Togo before the Introduction of Pneumococcal Conjugate Vaccine

Moïsi

Makawa

Tall³

et al. 2017

PLoS ONE

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BackgroundS. pneumoniae is a leading cause of meningitis morbidity and mortality in the African meningitis belt, but little is known of its contribution to the burden of pneumonia in the region. We aimed to estimate the incidence of pneumococcal disease in children and adults in northern Togo, before the introduction of pneumococcal conjugate vaccine (PCV).Methods and findingsFrom May 1st 2010 to April 30th 2013, we systematically enrolled all hospitalized patients meeting a case definition of suspected meningitis or clinical pneumonia, residing in Tone or Cinkasse districts, northern Togo and providing informed consent. We collected clinical data and tested biological specimens according to standardized procedures, including bacteriology and PCR testing of cerebro-spinal fluid for meningitis patients and blood cultures and whole blood lytA PCR for pneumonia patients. Chest X-rays (CXR) were interpreted using the WHO methodology. We included 404 patients with meningitis (104 <5 years of age) and 1550 with pneumonia (251 <5 years) over the study period. Of these, 78 (19%) had pneumococcal meningitis (13 <5 years), 574 (37%) had radiologically-confirmed pneumonia (83 <5 years) and 73 (5%) had culture-confirmed pneumococcal pneumonia (2 <5 years). PCV13 serotypes caused 79% (54/68) of laboratory-confirmed pneumococcal meningitis and 83% (29/35) of culture-confirmed pneumococcal pneumonia. Serotype 1 predominated in meningitis (n = 33) but not in pneumonia patients (n = 1). The incidence of pneumococcal disease was 7.5 per 100,000 among children <5 years of age and 14.8 in persons 5 years of age and above in the study area. When considering CXR-confirmed and blood PCR-positive pneumonia cases as likely pneumococcal, incidence estimates increased to 43.7 and 66.0 per 100,000 in each of these age groups, respectively. Incidence was at least 3-fold higher when we restricted the analysis to the urban area immediately around the study hospitals.ConclusionsOur findings highlight the important role of S. pneumoniae as a meningitis and pneumonia-causing pathogen in the African meningitis belt. Pneumococcal disease incidence in our population was substantially lower than expected from global models; we hypothesize that poor access to hospital care led us to substantially underestimate the burden of disease. Surveillance is ongoing and will enable an evaluation of PCV impact, providing novel, high quality data from the region.

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Section: Discussionsupporting

confidence: 77%

Burden of Pneumococcal Disease in Northern Togo before the Introduction of Pneumococcal Conjugate Vaccine

Moïsi

Makawa

Tall³

et al. 2017

PLoS ONE

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“…Serotype 12F in particular is emerging as an important cause of invasive pneumococcal disease with the propensity to cause outbreaks. 10 The global resistance profile showed resistance to penicillin G, erythromycin, tetracyclin and trimethoprim-sulfamethoxazole, with PNSSP at 42.85%. These are the antibiotics commonly used in auto-medication as they can be obtained without prescription at non-conventional pharmacies.…”

Section: Discussionmentioning

confidence: 99%

“…9 Kwambana found that Pneumococci expressing the serotype 1 capsule dominated the West African pneumococcal meningitis outbreaks. 10 Some studies reported that strains isolated from the upper respiratory tract of subjects in the Center Region of Cameroon were relatively sensitive to β-lactamines. 11 The increasing resistance of S. pneumoniae to penicillin and other beta-lactamines raises enormous challenges in treatment regimens.…”

Section: Introductionmentioning

confidence: 99%

Susceptibility of Streptococcus pneumoniae causing bacterial meningitis in children in Yaoundé (Cameroon): results of a surveillance site

Tiabou

Boula

Taguebue

et al. 2019

PPIJ

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Background: Streptococcus pneumoniae (S. pneumoniae) is the main cause of febrile conditions especially among children below two years and the elderly above 65 years old worldwide. In Cameroon, the frequency of S. pneumoniae as the cause of meningitis varied from 57.2% to 56.2% from 2001 to 2012. The aim of this study was to determine the susceptibility to antibiotics of S. pneumoniae involved in meningitis. Methods: A cross-sectional study was carried out during a four-year period from April 2012 to March 2016. Cerebrospinal fluid (CSF) was collected by clinicians from children less than 5 years with clinically suspected bacterial meningitis at the Mother and Child Center, Chantal Biya Foundation (MCC-CBF), in Yaounde. A probable case is a suspected clinical case with the CSF showing at least one of the following elements: turbid appearance; leukocytes ≥ 10/mm 3 , elevated protein (> 100mg/dl) or decreased glucose (<40mg/dl). Cases are confirmed when isolates are identified. The identification of S. pneumoniae was done by soluble antigens, the Binax Now® test, Gram stain, catalase test, optochin test, bile solubility and molecular serotyping.The antimicrobial susceptibility testing was carried out using the disc diffusion method on Mueller-Hinton medium with 10% sheep blood and the minimal inhibitory concentration was found using the Etest®. Results: Out of 6449 clinically suspected cases of bacterial meningitis, 384 were probable and 91 cases were confirmed. Most were isolated in children less than one year old: 54/91 (59.34%) and in boys 51/91 (56.04%). These incidences occurred mainly during the dry season. In the confirmed cases, 60 (65.93%) were due to S. pneumoniae, 9 (9.89%) due to Haemophilus influenzae B, 2 (2.19%) due to Neisseria meningitis and 20 (21.97%) due to other germs. Among the serotyped pneumococci 10/51 (19.60 %) belonged to serotype 6A/6B. Of 35 viable isolates of S. pneumoniae, 15 (42.85%) were resistant to penicillin G and 3 (8.57 %) to ceftriaxone. Conclusion: S. pneumoniae is the main etiology of childhood meningitis in Yaounde. The frequency of resistance to penicillin G was high, while moderate to ceftriaxone.

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“…Optimal population-specific vaccination strategies targeting outbreak control are needed. Additionally, preparation for future outbreaks in Africa as well as the Asia-Pacific region requires strengthened surveillance [50].…”

Section: Epidemics Outbreaks and Emergency Settingsmentioning

confidence: 99%

State-of-the-art in the pneumococcal field: Proceedings of the 11th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD-11)

2020

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The International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) is the premier global scientific symposium dedicated to the exchange, advancement and dissemination of the latest research on the pneumococcus, one of the world's deadliest bacterial pathogens. Since the first ISPPD was held in 1998, substantial progress has been made to control pneumococcal disease, for instance, more than half of surviving infants (78.6 million) from 143 countries now have access to the life-saving pneumococcal conjugate vaccine (PCV). The 11th ISPPD (ISPPD-11) was held in Melbourne, Australia in April 2018 and the proceedings of the symposium are captured in this report. Twenty years on from the first ISPPD, there remain many challenges and unanswered questions such as the continued disparity in disease incidence in Indigenous populations, the slow roll-out of PCV in some regions such as Asia, the persisting burden of disease in adults, serotype replacement and diagnosis of pneumococcal pneumonia. ISPPD-11 also put the spotlight on cutting-edge science including metagenomic, transcriptomic, microscopy, medical imaging and mathematical modelling approaches. ISPPD-11 was highly diverse, bringing together 1184 delegates from 86 countries, representing various fields including academia, primary healthcare, pharmaceuticals, biotechnology, policymakers and public health.

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An outbreak of pneumococcal meningitis among older children (≥5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana

Cited by 78 publications

References 40 publications

Burden of Pneumococcal Disease in Northern Togo before the Introduction of Pneumococcal Conjugate Vaccine

Burden of Pneumococcal Disease in Northern Togo before the Introduction of Pneumococcal Conjugate Vaccine

Susceptibility of Streptococcus pneumoniae causing bacterial meningitis in children in Yaoundé (Cameroon): results of a surveillance site

State-of-the-art in the pneumococcal field: Proceedings of the 11th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD-11)

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