Incidence and etiological agents of bacterial meningitis among children <5 years of age in two districts of Romania

Abstract

To expand upon the limited comprehensive population-based data for childhood bacterial meningitis in Eastern Europe, the present study was conducted in the Iasi and Constanta districts of Romania. From March 2000 through March 2002, children <5 years of age hospitalized for bacterial meningitis were enrolled in a prospective surveillance study. A total of 56 cases of bacterial meningitis were identified, including 37 due to Neisseria meningitidis (22 per 100,000 per year), 13 due to Haemophilus influenzae type b (7.6 per 100,000 per year), and six due to Streptococcus pneumoniae (3.5 per 100,000 per year). Of the 31 meningococcal isolates that were serotyped, 12 were serogroup A, eight were serogroup B, and 11 were serogroup C. Among all cases of bacterial meningitis, 25 occurred in children <1 year of age, including those due to meningococci (n=14), H. influenzae type b (n=7), pneumococci (n=3), and Klebsiella pneumoniae (n=1). In Romania the incidence of H. influenzae type b meningitis is similar to that found in other areas of Southern and Eastern Europe during the pre-vaccination era, and the incidence of meningococcal meningitis is one of the highest yet found in Europe. An unexpectedly high proportion of these meningococcal meningitis cases is due to serogroup A. Disease burden could be substantially reduced through the introduction of H. influenzae type b conjugate vaccine and, when available, meningococcal conjugate vaccine protective against serogroups A, B and C.

An expanded age range for meningococcal meningitis: molecular diagnostic evidence from population-based surveillance in Asia

“…There is still no licensed vaccine available to protect against serogroup B disease and Active Bacterial Core surveillance (ABCs) data in the United States estimated that infants aged < 1 year had the highest rates of meningococcal disease at 5.38 cases per 100,000 population in 1998–2007 [29]. In Romania, children aged < 5 years old were found to have a meningococcal meningitis incidence rate of 22 per 100,000 annually based on prospective population-based surveillance in 2000–2002 [30]. …”

Changing epidemiology of meningococcal disease in Europe from the mid-20th to the early 21st Century

“…Serogroup A disease was reported at high levels in Romania after 2000, being the most important cause of disease in two districts among young children [82], and was also noted in Greece [83]. The Czech Republic has experienced continuing serogroup Y disease, particularly with the highly virulent ST-23 complex [69], and the ST-23 complex associated with serogroup Y was also found at a much higher prevalence in Sweden (11%) and Finland (8%) during 2000-2002 compared with other European countries [84].…”

Bacterial meningitis and living conditions

“…Despite the decline, the incidence levels of these infections remain high in Salvador, principally in children aged <5 years, with an incidence of almost 22 cases/100,000 inhabitants in this age group, a lower rate than that registered in Romania (33 cases/100,000 inhabitants) 34 , but higher than that recorded in Santo Domingo, Dominican Republic (16 cases/100,000 inhabitants) 9 . As reported in previous studies 2,13,22,35 , males have a higher risk of being infected by bacterial meningitis in Salvador.…”