Pediatric Bacterial Meningitis Surveillance in Niger: Increased Importance of Neisseria meningitidis Serogroup C, and a Decrease in Streptococcus pneumoniae Following 13-Valent Pneumococcal Conjugate Vaccine Introduction

Mamadou Kourna Hama; Dam Khan; Boubou Laouali; Catherine Okoi; Abdoulaye Yam; Moussa Haladou; Archibald Worwui; Peter Sylvanus Ndow; Ricardo Nse Obama; Jason M Mwenda; Joseph Biey; Bernard Ntsama; Brenda A Kwambana-Adams; Martin Antonio

doi:10.1093/cid/ciz598

Pediatric Bacterial Meningitis Surveillance in Niger: Increased Importance of Neisseria meningitidis Serogroup C, and a Decrease in Streptococcus pneumoniae Following 13-Valent Pneumococcal Conjugate Vaccine Introduction

Clin Infect Dis. 2019 Sep 5;69(Suppl 2):S133-S139. doi: 10.1093/cid/ciz598.

Authors

Affiliations

¹ Laboratoire Hopital National de Niamey, Niger.
² World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, United Kingdom.
³ WHO Country Office, Niamey, Niger.
⁴ WHO Regional Office for Africa, Brazzaville, Republic of Congo.
⁵ WHO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso.
⁶ Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.

Abstract

Background: Meningitis is endemic in Niger. Haemophilus influenzae type b (Hib) vaccine and the 13-valent pneumococcal conjugate vaccine (PCV13) were introduced in 2008 and 2014, respectively. Vaccination campaign against Neisseria meningitidis serogroup A was carried out in 2010-2011. We evaluated changes in pathogen distribution using data from hospital-based surveillance in Niger from 2010 through 2016.

Methods: Cerebrospinal fluid (CSF) specimens from children <5 years old with suspected meningitis were tested to detect vaccine-preventable bacterial pathogens. Confirmatory identification and serotyping/grouping of Streptococcus pneumoniae, N. meningitidis, and H. influenzae were done. Antimicrobial susceptibility testing and whole genome sequencing were performed on S. pneumoniae isolates.

Results: The surveillance included 2580 patients with suspected meningitis, of whom 80.8% (2085/2580) had CSF collected. Bacterial meningitis was confirmed in 273 patients: 48% (131/273) was N. meningitidis, 45% (123/273) S. pneumoniae, and 7% (19/273) H. influenzae. Streptococcus pneumoniae meningitis decreased from 34 in 2014, to 16 in 2016. PCV13 serotypes made up 88% (7/8) of S. pneumoniae meningitis prevaccination and 20% (5/20) postvaccination. Neisseria meningitidis serogroup C (NmC) was responsible for 59% (10/17) of serogrouped N. meningitidis meningitis. Hib caused 67% (2/3) of the H. influenzae meningitis isolates serotyped. Penicillin resistance was found in 16% (4/25) of S. pneumoniae isolates. Sequence type 217 was the most common lineage among S. pneumoniae isolates.

Conclusions: Neisseria meningitidis and S. pneumoniae remain important causes of meningitis in children in Niger. The decline in the numbers of S. pneumoniae meningitis post-PCV13 is encouraging and should continue to be monitored. NmC is the predominant serogroup causing N. meningitidis meningitis.

Keywords: N. meningitidis; S. pneumoniae; Niger; cerebrospinal fluid; meningitis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child, Preschool
Female
Haemophilus influenzae / classification
Hospitals / statistics & numerical data*
Humans
Immunization Programs
Infant
Infant, Newborn
Male
Meningitis, Bacterial / cerebrospinal fluid
Meningitis, Bacterial / epidemiology*
Meningitis, Bacterial / prevention & control
Neisseria meningitidis, Serogroup C / classification*
Niger / epidemiology
Pneumococcal Vaccines / administration & dosage*
Population Surveillance
Serogroup
Serotyping
Streptococcus pneumoniae / classification*
Whole Genome Sequencing

Substances

13-valent pneumococcal vaccine
Pneumococcal Vaccines