Review of meningitis surveillance data, upper West Region, Ghana 2009-2013

Abstract

IntroductionThe Upper West region of Ghana is within the meningitis belt. Analysis of long term surveillance data is necessary for understanding changes in the disease occurrence. We analyzed five years of surveillance data to describe by person, place and time and to determine trends in meningitis.MethodsMeningitis surveillance data from Ghana Health Service in the Upper West Region, from 2009 to 2013 were reviewed. Data was obtained from District-Health Information Management System and line list from the Disease Control Unit. Population figures (denominators) and rainfall data were also analyzed.ResultsWithin the period 980 cases of meningitis were reported in the region, 507(52%) females and 473(48%) males. The mean age of cases was 20.1years and standard deviation 18.8 years with, 77.6 %( 761/980) cases occurring in persons aged under 30 years. Children under five years were 19.3% (190/980). Attack rates ranged from 6.1/100,000 population in the Daffiama-bussei-Issa-district to 47.5/100,000 in Jirapa. Overall case fatality rate of meningitis was 12.2% with 14deaths/100,000 population. Bacterial agents were isolated from 35% (245/702) of CSF. Majority were Streptococcus pneumonia 48.2 % ( 122/258), and N. meningitides Y/W 135 40.3% (102/258). Meningitis was found to be seasonal with peaks in the dry season.ConclusionMeningitis in the region is seasonal, and showed a decreasing trend. Jirapa, Lawra, Nadowli and Wa West districts had the highest burden. Control effort of the disease should focus on vaccination against streptococcus pneumonia and N. meningitis W135 especially within crowded settlements such as boarding schools.

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“…The second and third most frequent serogroups were W/Y (18.9%) and C (8.5%), suggesting that these serogroups have the potential to cause outbreaks. Indeed, there was a drop in the burden of serogroup A related meningitis in the “meningitis belt” after the introduction of mass vaccination using MenA conjugated vaccine formulation, serogroups W and C emerged as common etiologies of meningococcal meningitis and serogroups W subsequently become a leading cause of most recent meningococcal meningitis outbreaks [ 8 , 10 , 18 , 33 – 36 ]. Serogroup X was reported in 7.5% of the samples, showing its public health importance and indeed, this serogroup is emerging in sub Saharan Africa as an important cause of meningococcal meningitis [ 37 ].…”

Invasive Streptococcus pneumoniae infection among hospitalized patients in Jingzhou city, China, 2010-2012

“…Although 72% of patients with Sp detected in our study were diagnosed with pneumonia, only 7% of patients diagnosed with pneumonia had Sp detected. Sp is also a common cause of meningitis globally[ 15 ], and was the most common cause of bacterial meningitis in one previous population-based study in China[ 16 ]. Nevertheless, Sp was only identified in 6% of patients who met our case definition of meningitis.…”

Etiology of acute meningitis and encephalitis from hospital-based surveillance in South Kazakhstan oblast, February 2017—January 2018

“…In the UK, the annual IR of viral and bacterial meningitis in adults are 2.73 and 1.24 per 100,000 persons respectively, with enteroviruses (EV) and herpes simplex viruses (HSV) being the predominant viral agents and Streptococcus pneumoniae the main bacterium [6]. In Ghana, located in West Africa's "meningitis belt", the incidence of meningitis ranges by district from 6.1 to 47.5 per 100,000, mainly caused by S. pneumoniae and Neisseria meningitidis, with a case fatality rate (CFR) of 12.2% [7]. Globally, EV are the leading cause of aseptic viral EM are commonly associated with meningitis outbreaks [8][9][10][11][12][13].…”