Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine

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Tagbo, Beckie N
Bancroft, Rowan E
Fajolu, Iretiola
Abdulkadir, Mohammed B
Bashir, Muhammad F
Okunola, Olusola P
Isiaka, Ayodeji H
Lawal, Namadi M
Edelu, Benedict O
Onyejiaka, Ngozi
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Oxford University Press
Background Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). Methods From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. Results A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. Conclusions Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the country.
pediatric, meningitis, Nigeria, neumococcus, meningococcus
Beckie N Tagbo, Rowan E Bancroft, Iretiola Fajolu, Mohammed B Abdulkadir, Muhammad F Bashir, Olusola P Okunola, Ayodeji H Isiaka, Namadi M Lawal, Benedict O Edelu, Ngozi Onyejiaka, Chinonyerem J Ihuoma, Florence Ndu, Uchenna C Ozumba, Frances Udeinya, Folasade Ogunsola, Aishat O Saka, Abayomi Fadeyi, Sunday A Aderibigbe, Jimoh Abdulraheem, Adamu G Yusuf, Peter Sylvanus Ndow, Philomena Ogbogu, Chinomnso Kanu, Velly Emina, Olajumoke J Makinwa, Florian Gehre, Kabir Yusuf, Fiona Braka, Jason M Mwenda, Johnson M Ticha, Dorothy Nwodo, Archibald Worwui, Joseph N Biey, Brenda A Kwambana-Adams, Martin Antonio for the African Paediatric Bacterial Meningitis Surveillance Network. Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine, Clinical Infectious Diseases, Volume 69, Issue Supplement_3, 1 October 2019, Pages S81–S88,