Hospital-based Surveillance for Pediatric Bacterial Meningitis in the Era of the 13-Valent Pneumococcal Conjugate Vaccine in Ghana

Abstract

Background Global surveillance for vaccine preventable invasive bacterial diseases has been set up by the World Health Organization to provide disease burden data to support decisions on introducing pneumococcal conjugate vaccine (PCV). We present data from 2010 to 2016 collected at the 2 sentinel sites in Ghana. Methods Data were collected from children <5 years of age presenting at the 2 major teaching hospitals with clinical signs of meningitis. Cerebrospinal fluid specimens were collected and tested first at the sentinel site laboratory with conventional microbiology methods and subsequently with molecular analysis, at the World Health Organization Regional Reference Laboratory housed at the Medical Research Council Unit The Gambia, for identification of Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, the 3 most common bacteria causing meningitis. Results There were 4008 suspected cases of meningitis during the surveillance period, of which 31 (0.8%) were laboratory confirmed. Suspected meningitis cases decreased from 923 in 2010 to 219 in 2016. Of 3817 patients with available outcome data, 226 (5.9%) died. S. pneumoniae was the most common bacterial pathogen, accounting for 68.5% of confirmed cases (50 of 73). H. influenzae and N. meningitidis accounted for 6.8% (5 of 73) and 21.9% (16 of 73), respectively. The proportion of pneumococcal vaccine serotypes causing meningitis decreased from 81.3% (13 of 16) before the introduction of 13-valent PCV (2010–2012) to 40.0% (8 of 20) after its introduction (2013–2016). Conclusions Cases of suspected meningitis decreased among children <5 years of age between 2010 and 2016, with declines in the proportion of vaccine-type pneumococcal meningitis after the introduction of 13-valent PCV in Ghana.

Post-Vaccination Streptococcus pneumoniae Carriage and Virulence Gene Distribution among Children Less Than Five Years of Age, Cape Coast, Ghana

“…The success of PCV vaccination was described by the drastic annual decline of 8% in pneumococci-related deaths recorded between 2010 and 2015 (Wahl et al, 2018). As a result, PCV vaccination is expected to further reduce pneumococcal carriage and disease among Ghanaian children as shown in other studies [ 6 , 7 ]. Other benefits of PCV vaccination are embedded in its ability to reduce antibiotic-resistant strains as well as confer herd protection [ 7 , 8 ].…”

“…As a result, PCV vaccination is expected to further reduce pneumococcal carriage and disease among Ghanaian children as shown in other studies [ 6 , 7 ]. Other benefits of PCV vaccination are embedded in its ability to reduce antibiotic-resistant strains as well as confer herd protection [ 7 , 8 ]. In May 2012, Ghana introduced PCV13 vaccination into its childhood immunization program based on a vaccine schedule of 3 + 0 [ 9 ].…”

“…Six years after the implementation of PCV13 in Ghana, limited data are available to describe the impact of PCV13 vaccination among Ghanaian children [ 7 , 20 ]. One study that investigated the impact of PCV13 among healthy children was conducted among children mainly residing in Accra, which is the capital city of Ghana.…”

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] .…”

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.…”