Population-based surveillance for bacterial meningitis in the Dominican Republic: implications for control by vaccination

Abstract

Quantifying the local burden of disease is an important step towards the introduction of new vaccines, such as Haemophilus influenzae type b (Hib) conjugate vaccine. We adapted a generic protocol developed by the World Health Organization for population-based surveillance of bacterial meningitis. All hospitals that admit paediatric patients with meningitis in the National District, Dominican Republic were included in the system and standard laboratory methods were used. The system identified 111 cases of confirmed bacterial meningitis. Hib was the leading cause of bacterial meningitis, followed by group B streptococcus, S. pneumoniae, and N. meningitidis. Unlike hospital-based case series, this population-based system was able to calculate incidence rates. The incidence of Hib meningitis was 13 cases per 100,000 children < 5 years old. The data from this study were used by the Ministry of Health to support the introduction of routine Hib vaccination and will be used to monitor its effectiveness.

Impact of Haemophilus influenzae type b conjugate vaccine on bacterial meningitis in the Dominican Republic

“…The National District-including the capital, Santo Domingo, and the surrounding periurban area-accounts for approximately 40% of the country's population, with 300 000 children less than 5 years of age. In 1998 and 1999, active, population-based surveillance for bacterial meningitis in eight hospitals (four public and four private) in the National District documented an incidence of 13 cases of Hib meningitis per 100 000 children less than 5 years of age (11). During this 2-year period, surveillance officers regularly reviewed laboratory records and admission logs to identify case patients and completed standardized case report forms.…”

“…The objective of this study was to evaluate the impact of routine childhood immunization against Hib on both confirmed and probable cases of bacterial meningitis in the Dominican Republic, where bacterial meningitis has been a reportable disease since 1998 (10). Before the introduction of Hib conjugate vaccines into the routine infant immunization schedule in 2001, Hib was the leading cause of bacterial meningitis in children after the first month of life (11). This report summarizes trends in confirmed and probable cases of bacterial meningitis among children admitted to the main pediatric referral hospital in Santo Do-mingo from 1998 through 2004 and presents the results of a case-control study of the effectiveness of Hib vaccine against culture-confirmed disease.…”

Epidemiology of Pediatric Pneumococcal Meningitis and Bacteremia in Latin America and the Caribbean

“…Eight studies of meningitis 23,31,35,37,47,52,54,57 (Fig. 2) and 5 of bacteremia 28,54,55,57,61 (Fig.…”

“…The pooled CFR in the age group between 0 and 59 months was 33.2 (CI 95% 21.3-46.2) for meningitis [37][38][39]43,46,55,61 . The CFRs ranged from 12% in Trotman 2009 38 to 60% in Reis et al 35 The sensitivity analysis excluding Reis et al 35 showed a pooled CFR of 29.3% (95% CI: 19.9-39.7).…”

Standardizing Surveillance of Pneumococcal Disease

“…Before 2003, when support from PneumoADIP commenced, few GAVI-eligible countries (countries with gross national income per capita !US$1000) conducted pneumococcal disease surveillance. In addition, data collected in different countries could not be compared or aggregated, because of heterogeneity in case ascertainment, evaluation, and enrollment methods [4,[9][10][11][12][13]. Consequently, it was difficult to attribute observed inter-or intracountry differences in pneumococcal disease epidemiology to true epidemiological differences, rather than methodological differences [14].…”