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Zhang K, Xue L, Li X, He D, Peng Z. Exploring the seasonality and optimal control strategy of HIV/AIDS epidemic in China: The impact of seasonal testing. CHAOS (WOODBURY, N.Y.) 2024; 34:073117. [PMID: 38980384 DOI: 10.1063/5.0202918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/16/2024] [Indexed: 07/10/2024]
Abstract
In this work, we investigate how the seasonal variation in the number of individuals who are tested for an HIV antibody in outpatient clinics affects the HIV transmission patterns in China, which has not been well studied. Based on the characteristics of outpatient testing data and reported cases, we establish a periodic infectious disease model to study the impact of seasonal testing on HIV transmission. The results indicate that the seasonal testing is a driving factor for the seasonality of new cases. We demonstrate the feasibility of ending the HIV/AIDS epidemic. We find that the diagnostic rates related to testing play a crucial role in controlling the size of the epidemic. Specifically, when considering minimizing both infected individuals and diagnostic rates, the level of attention paid to undiagnosed infected individuals is always positively correlated with the optimal diagnostic rates, while the optimal diagnostic rates are negatively correlated with the size of the epidemic at the terminal time.
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Affiliation(s)
- Kai Zhang
- College of Mathematical Sciences, Harbin Engineering University, Harbin, Heilongjiang 150001, China
| | - Ling Xue
- College of Mathematical Sciences, Harbin Engineering University, Harbin, Heilongjiang 150001, China
| | - Xuezhi Li
- School of Mathematics and Information Science, Henan Normal University, Xinxiang 453007, China
| | - Daihai He
- Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zhihang Peng
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
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Kekeisen-Chen JF, Tarbangdo FT, Sharma S, Marasini D, Marjuki H, Kibler JL, Reese HE, Ouattara S, Ake FH, Yameogo I, Ouedraogo I, Seini E, Zoma RL, Tonde I, Sanou M, Novak RT, McNamara LA. Expansion of Neisseria meningitidis Serogroup C Clonal Complex 10217 during Meningitis Outbreak, Burkina Faso, 2019. Emerg Infect Dis 2024; 30:460-468. [PMID: 38407254 PMCID: PMC10902552 DOI: 10.3201/eid3003.221760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
During January 28-May 5, 2019, a meningitis outbreak caused by Neisseria meningitidis serogroup C (NmC) occurred in Burkina Faso. Demographic and laboratory data for meningitis cases were collected through national case-based surveillance. Cerebrospinal fluid was collected and tested by culture and real-time PCR. Among 301 suspected cases reported in 6 districts, N. meningitidis was the primary pathogen detected; 103 cases were serogroup C and 13 were serogroup X. Whole-genome sequencing revealed that 18 cerebrospinal fluid specimens tested positive for NmC sequence type (ST) 10217 within clonal complex 10217, an ST responsible for large epidemics in Niger and Nigeria. Expansion of NmC ST10217 into Burkina Faso, continued NmC outbreaks in the meningitis belt of Africa since 2019, and ongoing circulation of N. meningitidis serogroup X in the region underscore the urgent need to use multivalent conjugate vaccines in regional mass vaccination campaigns to reduce further spread of those serogroups.
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Oduoye MO, Akanbi-Hakeem HB, Muzammil MA, Arama UO, Abbasi HQ, Farhan K, Fariha FNU, Modupeoluwa OO, Paul HW, Badarou ADE, Akilimali A. Meningitis in Niger Republic amidst COVID-19: current issues and novel recommendations. Ann Med Surg (Lond) 2024; 86:345-352. [PMID: 38222679 PMCID: PMC10783331 DOI: 10.1097/ms9.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/05/2023] [Indexed: 01/16/2024] Open
Abstract
Amidst coronavirus disease 2019 (COVID-19), there has been a misplaced priority on meningitis in the Niger Republic, thus refocusing resources and attention away from the continuing meningitis campaign in the Niger Republic. The over-strained state of public health resources and staff has also led to decreased surveillance, postponed diagnoses, and constrained immunization efforts in Niger Republic. This review aims to bridge the gaps regarding meningitis amid COVID-19 in Niger Republic and offer recommendations to government to mitigate meningitis in the country, with the hope of finding a permanent solution to this debilitating disease. The authors reviewed 45 past and present pieces of literature on meningitis and COVID-19 from 2013 to 2023 in well-renowned scientific databases such as PubMed, ResearchGate, Google Scholar, African Journals Online, Medline, and Embase. Since 2015, Niger Republic has experienced multiple meningitis epidemics that have resulted in 20, 789 cases and 1, 369 deaths [a case fatality rate (CFR) of 6.6%]. A total of 231 cases of meningitis were reported from 1 November 2021 to 31 January 2022. And recently, 559 cases of meningitis (of which 111 are laboratory confirmed), including 18 deaths (overall CFR 3.2%), occurred in the Zinder region, southeast of Niger Republic, from 1 November 2022 to 27 January 2023. Meningitis remains a public health concern in the world, especially in Niger Republic, which could lead to serious long-term complications. Therefore, adequate and novel measures and therapeutic actions should be implemented by the Niger Government to lessen the burden of the disease in the country.
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Affiliation(s)
- Malik Olatunde Oduoye
- Ahmadu Bello University, Zaria, Kaduna State
- Department of Research, Medical Research Circle, Bukavu
| | | | | | | | | | - Kanza Farhan
- Medical College, Jinnah Sindh Medical University, Karachi
| | | | | | - Houessou W. Paul
- Faculty of Health Sciences of Andre Salifou Zinder University, Niger Republic
| | - Achiraf-deen E. Badarou
- Department of General Medicine, FSS-Cotonou, Association of Medical Students of Cotonou, Cotonou, Littoral, Benin
| | - Aymar Akilimali
- Department of Research, Medical Research Circle, Bukavu
- Faculty of Medicine, University of Goma, Goma, Democratic Republic of Congo
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Pinilla-Monsalve GD, Llanos-Leyton N, González MC, Manrique-Hernández EF, Rey-Serrano JJ, Quiñones-Bautista JA. Socioepidemiological macro-determinants associated with the cumulative incidence of bacterial meningitis: A focus on the African Meningitis Belt. Front Neurol 2023; 14:1088182. [PMID: 36864915 PMCID: PMC9971970 DOI: 10.3389/fneur.2023.1088182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023] Open
Abstract
Background Bacterial meningitis (BM) is a public health challenge as it is associated with high lethality and neurological sequelae. Worldwide, most cases are registered in the African Meningitis Belt (AMB). The role of particular socioepidemiological features is essential for understanding disease dynamics and optimizing policy-making. Objective To identify socioepidemiological macro-determinants that contribute to explaining the differences in BM incidence between AMB and the rest of Africa. Methods Country-level ecologic study based on the cumulative incidence estimates of the Global Burden of Disease study and reports of the MenAfriNet Consortium. Data about relevant socioepidemiological features were extracted from international sources. Multivariate regression models were implemented to define variables associated with the classification of African countries within the AMB and the incidence of BM worldwide. Results Cumulative incidences at the AMB sub-regions were 111.93 (west), 87.23 (central), 65.10 (east), and 42.47 (north) per 100,000 population. A pattern of common origin with continuous exposition and seasonality of cases was observed. Socio-epidemiological determinants contributing to differentiating the AMB from the rest of Africa were household occupancy (OR 3.17 CI 95% 1.09-9.22, p = 0.034) and malaria incidence (OR 1.01 CI 95% 1.00-1.02, p = 0.016). BM cumulative incidence worldwide was additionally associated with temperature and gross national income per capita. Conclusion Socioeconomic and climate conditions are macro-determinants associated with BM cumulative incidence. Multilevel designs are required to confirm these findings.
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Affiliation(s)
- Gabriel D. Pinilla-Monsalve
- Departamento de Neurología, Fundación Valle del Lili, Cali, Colombia,Departamento de Ciencias Clínicas, Universidad Icesi, Cali, Colombia,Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada,*Correspondence: Gabriel D. Pinilla-Monsalve ✉
| | - Natalia Llanos-Leyton
- Departamento de Ciencias Clínicas, Universidad Icesi, Cali, Colombia,Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Juan José Rey-Serrano
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Jairo Alonso Quiñones-Bautista
- Departamento de Neurología, Fundación Valle del Lili, Cali, Colombia,Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
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Yarber AY, Jenkins GS, Singh A, Diokhane A. Temporal Relationships Between Saharan Dust Proxies, Climate, and Meningitis in Senegal. GEOHEALTH 2023; 7:e2021GH000574. [PMID: 36776988 PMCID: PMC9905059 DOI: 10.1029/2021gh000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/08/2022] [Accepted: 12/05/2022] [Indexed: 06/18/2023]
Abstract
The Harmattan, a dry, northeasterly trade wind, transports large quantities of Saharan dust over the Sahelian region during the dry season (December-March). Studies have shown that bacterial meningitis outbreaks in Sahelian regions show hyper-endemic to endemic levels during high-dust months. We examine the (a) seasonality and intraseasonal variability of dust, climate, and meningitis and the (b) quantitative relationships between various dust proxies with meningitis lags of 0-10 weeks in Senegal from 2012 to 2017. The results show that the onset of the meningitis season occurs in February, roughly 2 months after the dusty season has begun. The meningitis season peaks at the beginning of April, when northeasterly wind speeds and particulate matter (PM) are relatively high, and the meningitis season ends near the end of June, when temperature and humidity rise and northeasterly wind speeds decline. Furthermore, we find that Senegal's relatively high humidity year-round may help slow the transmission of the infection, contributing to a lower disease incidence than landlocked countries in the meningitis belt. Lastly, our results suggest the desert dust may have a significant impact on the onset to the peak of the meningitis season in Senegal, particularly at the 0-2 and 10-week lag, whether that be directly through biological processes or indirectly through changes in human behavior. PM and visibility, however, are not in phase with aerosol optical depth throughout the year and consequently show different relationships with meningitis. This study further exemplifies the critical need for more PM, meteorological, and meningitis measurements in West Africa to further resolve these relationships.
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Affiliation(s)
- Aara’L. Y. Yarber
- Department of Meteorology and Atmospheric SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Gregory S. Jenkins
- Department of Meteorology and Atmospheric SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
- Alliance for Education, Science, Engineering, and Development in AfricaThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Ajit Singh
- School of Geography, Earth and Environmental SciencesUniversity of BirminghamBirminghamUK
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Aminata Diokhane
- Centre de Gestion de la Qualite de l’Air (CGQA)Direction de l’Environnement et des Etablissements Classes (DEEC)DakarSenegal
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High-spatial resolution epidemic surveillance of bacterial meningitis in the African meningitis belt in Burkina Faso. Sci Rep 2022; 12:19451. [PMID: 36376459 PMCID: PMC9663584 DOI: 10.1038/s41598-022-23279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Despite improved surveillance capacities and WHO recommendations for subdistrict analysis, routine epidemic surveillance of acute bacterial meningitis in the African meningitis belt remains largely limited to the district level. We evaluated the appropriateness and performance of analyses at higher spatial resolution. We used suspected meningitis surveillance data at health centre (HC) resolution from Burkina Faso from 14 health districts spanning years 2004-2014 and analysed them using spatio-temporal statistics and generative models. An operational analysis compared epidemic signals at district and HC-level using weekly incidence thresholds. Eighty-four percent (N = 98/116) of epidemic clusters spanned only one HC-week. Spatial propagation of epidemic clusters was mostly limited to 10-30 km. During the 2004-2009 (with serogroup A meningitis) and 2010-2014 (after serogroup A elimination) period, using weekly HC-level incidence thresholds of 100 and 50 per 100,000 respectively, we found a gain in epidemic detection and timeliness in 9 (41% of total) and 10 (67%), respectively, district years with at least one HC signal. Individual meningitis epidemics expanded little in space, suggesting that a health centre level analysis is most appropriate for epidemic surveillance. Epidemic surveillance could gain in precision and timeliness by higher spatial resolution. The optimal threshold should be defined depending on the current background incidence of bacterial meningitis.
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Ojo OS, Ogunjo ST. Machine learning models for prediction of rainfall over Nigeria. SCIENTIFIC AFRICAN 2022. [DOI: 10.1016/j.sciaf.2022.e01246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Prunas O, Weinberger DM, Medini D, Tizzoni M, Argante L. Evaluating the Impact of Meningococcal Vaccines With Synthetic Controls. Am J Epidemiol 2022; 191:724-734. [PMID: 34753175 PMCID: PMC8971084 DOI: 10.1093/aje/kwab266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
Invasive meningococcal disease (IMD) has a low and unpredictable incidence, presenting challenges for real-world evaluations of meningococcal vaccines. Traditionally, meningococcal vaccine impact is evaluated by predicting counterfactuals from pre-immunization IMD incidences, possibly controlling for IMD in unvaccinated age groups, but the selection of controls can influence results. We retrospectively applied a synthetic control (SC) method, previously used for pneumococcal disease, to data from 2 programs for immunization of infants against serogroups B and C IMD in England and Brazil. Time series of infectious/noninfectious diseases in infants and IMD cases in older unvaccinated age groups were used as candidate controls, automatically combined in a SC through Bayesian variable selection. SC closely predicted IMD in absence of vaccination, adjusting for nontrivial changes in IMD incidence. Vaccine impact estimates were in line with previous assessments. IMD cases in unvaccinated age groups were the most frequent SC-selected controls. Similar results were obtained when excluding IMD from control sets and using other diseases only, particularly respiratory diseases and measles. Using non-IMD controls may be important where there are herd immunity effects. SC is a robust and flexible method that addresses uncertainty introduced when equally plausible controls exhibit different post-immunization behaviors, allowing objective comparisons of IMD programs between countries.
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Affiliation(s)
| | | | - Duccio Medini
- Correspondence to Dr. Duccio Medini, Via Fiorentina 1, Siena, 53100, Italy (e-mail: )
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Mazamay S, Guégan JF, Diallo N, Bompangue D, Bokabo E, Muyembe JJ, Taty N, Vita TP, Broutin H. An overview of bacterial meningitis epidemics in Africa from 1928 to 2018 with a focus on epidemics "outside-the-belt". BMC Infect Dis 2021; 21:1027. [PMID: 34592937 PMCID: PMC8485505 DOI: 10.1186/s12879-021-06724-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bacterial meningitis occurs worldwide but Africa remains the most affected continent, especially in the "Meningitis belt" that extends from Senegal to Ethiopia. Three main bacteria are responsible for causing bacterial meningitis, i.e., N. meningitidis (Nm), S. pneumoniae and H. influenzae type b. Among Nm, serogroup A used to be responsible for up to 80 to 85% of meningococcal meningitis cases in Africa. Since 2000, other Nm serogroups including W, X and C have also been responsible for causing epidemics. This overview aims to describe the main patterns of meningitis disease cases and pathogens from 1928 to 2018 in Africa with a special focus on disease conditions “out-of-the-belt” area that is still usually unexplored. Based on basic spatio-temporal methods, and a 90-years database of reported suspected meningitis cases and death from the World Health Organization, we used both geographic information system and spatio-temporal statistics to identify the major localizations of meningitis epidemics over this period in Africa. Results Bacterial meningitis extends today outside its historical limits of the meningitis belt. Since the introduction of MenAfrivac vaccine in 2010, there has been a dramatic decrease in NmA cases while other pathogen species and Nm variants including NmW, NmC and Streptococcus pneumoniae have become more prevalent reflecting a greater diversity of bacterial strains causing meningitis epidemics in Africa today. Conclusion Bacterial meningitis remains a major public health problem in Africa today. Formerly concentrated in the region of the meningitis belt with Sub-Saharan and Sudanian environmental conditions, the disease extends now outside these historical limits to reach more forested regions in the central parts of the continent. With global environmental changes and massive vaccination targeting a unique serogroup, an epidemiological transition of bacterial meningitis is ongoing, requiring both a better consideration of the etiological nature of the responsible agents and of their proximal and distal determinants. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06724-1.
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Affiliation(s)
- Serge Mazamay
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo. .,MIVEGEC, Université de Montpellier, IRD, CNRS, 911 avenue Agropolis, BP 64501, 34394, Montpellier Cedex 5, France.
| | - Jean-François Guégan
- MIVEGEC, Université de Montpellier, IRD, CNRS, 911 avenue Agropolis, BP 64501, 34394, Montpellier Cedex 5, France.,ASTRE, INRAE, Cirad, Université de Montpellier, Campus international de Baillarguet, 34398, Montpellier Cedex 5, France
| | - Neby Diallo
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Didier Bompangue
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo.,Chrono-Environnement, UMR CNRS 6249 Université de Franche-Comté, Besançon, France
| | - Eric Bokabo
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Jacques Muyembe
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nadège Taty
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Tonton Paul Vita
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Hélène Broutin
- MIVEGEC, Université de Montpellier, IRD, CNRS, 911 avenue Agropolis, BP 64501, 34394, Montpellier Cedex 5, France.,Département de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Sénégal.,Centre de Recherche en Ecologie et Evolution de la Santé (CREES), Montpellier, France
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Knowledge, beliefs and practices regarding prevention of bacterial meningitis in Burkina Faso, 5 years after MenAfriVac mass campaigns. PLoS One 2021; 16:e0253263. [PMID: 34260604 PMCID: PMC8279338 DOI: 10.1371/journal.pone.0253263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background To adapt communications concerning vaccine prevention, we studied knowledge, beliefs and practices around meningitis risk and prevention in a young adult population in Burkina Faso in 2016, 5 years after the MenAfriVac® mass campaign and one year before the vaccine’s inclusion in the infant immunization schedule. Methods In a representative sample of the population aged 15 to 33 years (N = 220) in Bobo-Dioulasso, Burkina Faso, study nurses administered a standardized paper questionnaire consisting of predominantly open questions, collecting information on meningitis risk factors and prevention, and on exposure to dry air and kitchen fire smoke. We identified themes and analyzed their frequency. We created a meningitis knowledge score (range 0 to 4) based on pre-defined best responses and analyzed the determinants of knowledge score levels ≥2 (basic score) and ≥3 (high score) using multivariate logistic regression. Results Biomedically supported facts and good practices were known by the majority of participants (eg vaccine prevention, 84.5%). Younger women aged 15–20 years had a higher frequency of low scores <2 (17.0%) compared to older women aged 21–33 years (6.3%) and men of both age groups (3.8%). Junior secondary School attendance explained the differences between the two groups of women, the gender gap for the older, but not the young women, and explained score differences among young women. Local understandings and practices for risk and prevention were commonly reported and used (risk from unripe mango consumption and prevention through nasal application of shea nut butter). Discussion This study shows a gender gap in knowledge of meningitis risk and prevention, largely due to education-level inequalities. Women below 21 years had particularly low levels of knowledge and may need interventions outside schools and perinatal care. Our study suggests a strong adherence to local understandings of and practices around meningitis risk and prevention, which should be taken into account by vaccination promotion.
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Moore JE, Millar BC. Does Nasopharyngeal and Oropharyngeal Swabbing for COVID-19 Increase the Risk of Acquisition of Invasive Meningococcal Disease? J Patient Saf 2021; 17:271-272. [PMID: 33782254 DOI: 10.1097/pts.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- John E Moore
- Laboratory for Disinfection and Pathogen, Elimination Studies, Northern Ireland, Public Health Laboratory, Nightingale (Belfast City) Hospital, Belfast, Northern Ireland, United Kingdom
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Aku FY, Akweongo P, Nyarko KM, Mensah LG, Amegan-Aho K, Kumi L, Afari EA, Ameme DK, Kenu E. Factors associated with culture proven neonatal sepsis in the Ho municipality 2016. Pan Afr Med J 2020; 36:281. [PMID: 33088410 PMCID: PMC7545969 DOI: 10.11604/pamj.2020.36.281.20408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/03/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Neonatal Sepsis (NNS) is a public health problem which causes death or disability unless appropriate antibiotic treatment is given promptly. Globally, sepsis is an important cause of morbidity and mortality in neonates despite recent progress in health care delivery. We assessed the factors associated with culture proven sepsis among neonates in the Ho Municipality, Ghana. Methods a cross-sectional study was conducted in two public hospitals in the Ho Municipality between January and May, 2016. All neonates who were clinically suspected with sepsis in the Neonatal Intensive Care Unit (NICU) and their mothers were recruited. A 2ml blood sample was taken aseptically and dispensed into a mixture of thioglycollate and tryptone soy broth in a 1: 10 dilution and microbiological procedures performed. Case notes of both neonates and their mothers were reviewed and interviews conducted to collect both clinical and socio-demographic data. We determined the factors associated with culture proven neonatal sepsis using logistic regression model and statistical significance was determined at 95% confidence intervals. Results out of 150 neonates, 26 (17%) had laboratory confirmed sepsis. The most common pathogen isolated was Staphylococcus epidermidis 14, (54%). Neonates whose mothers were primigravida (OR=2.74; 95% CI: 1.12-6.68), and those who attended antenatal clinics (ANC) fewer than three schedules (OR=2.90; 95% CI: 1.06-7.96) had higher odds of developing culture proven sepsis. Conclusion neonates who were the first babies of their mothers were more likely to develop laboratory confirmed sepsis. Also, neonates of mothers who attended ANC less than 3 times were more likely to develop laboratory confirmed sepsis. High index of suspicion is required to diagnose neonatal sepsis among neonates of primigravida mothers and mothers who attend fewer than three ANC schedules.
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Affiliation(s)
- Fortress Yayra Aku
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.,School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Patricia Akweongo
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Kofi Mensah Nyarko
- Namibia Field Epidemiology Training Programme, Ministry of Health and Social Services, Wndhoek, Namibia
| | | | - Kokou Amegan-Aho
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Lawrence Kumi
- Regional Health Directorate, Ghana Health Service, Volta Region, Ho, Ghana
| | - Edwin Andrew Afari
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Donne Kofi Ameme
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
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Mazamay S, Bompangue D, Guégan JF, Muyembe JJ, Raoul F, Broutin H. Understanding the spatio-temporal dynamics of meningitis epidemics outside the belt: the case of the Democratic Republic of Congo (DRC). BMC Infect Dis 2020; 20:291. [PMID: 32312246 PMCID: PMC7168871 DOI: 10.1186/s12879-020-04996-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004 and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However, for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures. METHODS Based on weekly suspected cases of meningitis (2000-2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to identify spatial clusters of cases. Both using conventional statistics and the Cleveland's algorithm for decomposition into general trend, seasonal and residuals, we searched for the existence of seasonality. RESULTS We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC. CONCLUSION Despite challenges related to completeness of data reporting, meningitis dynamics shows weak seasonality in DRC. This tends to suggest that climatic, environmental factors might be less preponderant in shaping seasonal patterns in central Africa. The characterization of 8 distinct clusters of meningitis could be used for a better sentinel meningitis surveillance and optimization of vaccine strategy in DRC. Improving biological monitoring of suspected cases should be a priority for future eco-epidemiological studies to better understand the emergence and spread of meningitis pathogens, and the potential ecological, environmental drivers of this disease.
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Affiliation(s)
- Serge Mazamay
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- MIVEGEC, UMR IRD CNRS UM, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - Didier Bompangue
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Jean-François Guégan
- MIVEGEC, UMR IRD CNRS UM, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- ASTRE UMR INRAE Cirad UM, Campus International de Baillarguet, 34398 Montpellier 722 Cedex 5, France
| | - Jean-Jacques Muyembe
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Francis Raoul
- UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Hélène Broutin
- MIVEGEC, UMR IRD CNRS UM, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- Département de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
- CREES (Centre de Recherche en Ecologie et Evolution de la Santé), Montpellier, France
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14
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Musa SS, Zhao S, Hussaini N, Habib AG, He D. Mathematical modeling and analysis of meningococcal meningitis transmission dynamics. INT J BIOMATH 2020. [DOI: 10.1142/s1793524520500060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Meningococcal meningitis (MCM) is one of the serious public health threats in the tropical and sub-tropical regions. In this paper, we propose an epidemic model to study the transmission dynamics of MCM with high- and low-risk susceptible populations. The model considers two different groups of susceptible individuals depending on the availability of medical resources (MR, including hospitals, health workers, etc.), which varies the infection risk. We find that the model exhibits the phenomenon of backward bifurcation (BB), which increases the difficulty of MCM control since the dynamics are not merely relying on the basic reproduction number, [Formula: see text]. This study explores the effects of MR on the MCM epidemics by mathematical analysis and shows the existence of BB on MCM disease. Our findings suggest that providing adequate MR in a community is crucial in mitigating MCM incidences and deaths, especially, in the MCM endemic regions.
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Affiliation(s)
- Salihu Sabiu Musa
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hung Hom Hong Kong, P. R. China
- Department of Mathematics, Kano University of Science and Technology, Wudil, Nigeria
| | - Shi Zhao
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hung Hom Hong Kong, P. R. China
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong, P. R. China
- Division of Biostatistics, JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, P. R. China
| | - Nafiu Hussaini
- Department of Mathematical Sciences, Bayero University, Kano, Nigeria
| | | | - Daihai He
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hung Hom Hong Kong, P. R. China
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Oumar Bah A, Lam M, Bah A, Bowong S. Theoretical assessment of the impact of desert aerosols on the dynamical transmission of meningitidis serogroup A. INT J BIOMATH 2019. [DOI: 10.1142/s1793524519500608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper has been motivated by the following biological question: how influential are desert aerosols in the transmission of meningitidis serogroup A (MenA)? A mathematical model for the dynamical transmission of MenA is considered, with the aim of investigating the impact of desert aerosols. Sensitivity analysis of the model has been performed in order to determine the impact of related parameters on meningitis outbreak. We derive the basic reproduction number [Formula: see text]. We prove that there exists a threshold parameter [Formula: see text] such that when [Formula: see text], the disease-free equilibrium is globally asymptotically stable (GAS). However, when [Formula: see text], the model exhibits the phenomenon of backward bifurcation. At the endemic level, we show that the number of infectious individuals in the presence of desert aerosols is larger than the corresponding number without the presence of desert aerosols. In conjunction with the inequality [Formula: see text] where [Formula: see text] is the basic reproduction number without desert aerosols, we found that the ingestion of aerosols by carriers will increase the endemic level, and the severity of the outbreak. This suggests that the control of MenA passes through a combination of a large coverage vaccination of young susceptible individuals and the production of a vaccine with a high level of efficacy as well as respecting the hygienic rules to avoid the inhalation of desert aerosols. Theoretical results are supported by numerical simulations.
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Affiliation(s)
- A. Oumar Bah
- Department of Mathematics, Faculty of Science and Technic, Université Cheikh Anta Diopde Dakar, Dakar-Fann, Senegal
| | - M. Lam
- Department of Mathematics, Faculty of Science and Technic, Université Cheikh Anta Diopde Dakar, Dakar-Fann, Senegal
| | - A. Bah
- Department of Computer Engineering, National Advanced School of Engineering, Université Cheikh Anta Diopde Dakar, Dakar-Fann, Senegal
| | - S. Bowong
- Laboratory of Mathematics, Department of Mathematics, and Computer Science, Faculty of Science, University of Douala, P. O. Box 24157, Douala, Cameroon
- UMI 209 IRD and UPMC UMMISCO, 32 Avenue Henri Varagnat, 93143 Bondy Cedex, France
- Project Team GRIMCAPE, University of Yaoundé, Yaoundé, Cameroon
- The African Center of Excellence in Information, and Communication Technologies (CETIC), National Advanced School of Engineering, University of Yaoundé 1, Yaoundé, Cameroon
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Arifin SMN, Zimmer C, Trotter C, Colombini A, Sidikou F, LaForce FM, Cohen T, Yaesoubi R. Cost-Effectiveness of Alternative Uses of Polyvalent Meningococcal Vaccines in Niger: An Agent-Based Transmission Modeling Study. Med Decis Making 2019; 39:553-567. [PMID: 31268405 PMCID: PMC6786941 DOI: 10.1177/0272989x19859899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. Despite the introduction of an effective serogroup A conjugate vaccine (MenAfriVac™), sporadic epidemics of other Neisseria meningitidis serogroups remain a concern in Africa. Polyvalent meningococcal conjugate (PMC) vaccines may offer alternatives to current strategies that rely on routine infant vaccination with MenAfriVac plus, in the event of an epidemic, district-specific reactive campaigns using polyvalent meningococcal polysaccharide (PMP) vaccines. Methods. We developed an agent-based transmission model of N. meningitidis in Niger to compare the health effects and costs of current vaccination practice and 3 alternatives. Each alternative replaces MenAfriVac in the infant vaccination series with PMC and either replaces PMP with PMC for reactive campaigns or implements a one-time catch up campaign with PMC for children and young adults. Results. Over a 28-year period, replacement of MenAfriVac with PMC in the infant immunization series and of PMP in reactive campaigns would avert 63% of expected cases (95% prediction interval 49%-75%) if elimination of serogroup A is not followed by serogroup replacement. At a PMC price of $4/dose, this would cost $1412 ($81-$3510) per disability-adjusted life-year (DALY) averted. If serogroup replacement occurs, the cost-effectiveness of this strategy improves to $662 (cost-saving, $2473) per DALY averted. Sensitivity analyses accounting for incomplete laboratory confirmation suggest that a catch-up PMC campaign would also meet standard cost-effectiveness thresholds. Limitations. The assumption that polyvalent vaccines offer similar protection against all serogroups is simplifying. Conclusions. The use of PMC vaccines to replace MenAfriVac in routine infant immunization and in district-specific reactive campaigns would have important health benefits and is likely to be cost-effective in Niger. An additional PMC catch-up campaign would also be cost-effective if we account for incomplete laboratory reporting.
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Affiliation(s)
- S M Niaz Arifin
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Christoph Zimmer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Fati Sidikou
- Centre de Recherche Medicale et Sanitaire (CERMES), Niamey, NE, Niger
| | | | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Mueller JE. Meningococcal strain evolution, dusty dry air and respiratory tract infections: An explosive relationship. EBioMedicine 2019; 42:34-35. [PMID: 30935890 PMCID: PMC6491798 DOI: 10.1016/j.ebiom.2019.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 11/26/2022] Open
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Hitchings MDT, Coldiron ME, Grais RF, Lipsitch M. Analysis of a meningococcal meningitis outbreak in Niger - potential effectiveness of reactive prophylaxis. PLoS Negl Trop Dis 2019; 13:e0007077. [PMID: 30856166 PMCID: PMC6428357 DOI: 10.1371/journal.pntd.0007077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/21/2019] [Accepted: 02/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Seasonal epidemics of bacterial meningitis in the African Meningitis Belt carry a high burden of disease and mortality. Reactive mass vaccination is used as a control measure during epidemics, but the time taken to gain immunity from the vaccine reduces the flexibility and effectiveness of these campaigns. Targeted reactive antibiotic prophylaxis could be used to supplement reactive mass vaccination and further reduce the incidence of meningitis, and the potential effectiveness and efficiency of these strategies should be explored. METHODS AND FINDINGS Data from an outbreak of meningococcal meningitis in Niger, caused primarily by Neisseria meningitidis serogroup C, is used to estimate clustering of meningitis cases at the household and village level. In addition, reactive antibiotic prophylaxis and reactive vaccination strategies are simulated to estimate their potential effectiveness and efficiency, with a focus on the threshold and spatial unit used to declare an epidemic and initiate the intervention. There is village-level clustering of suspected meningitis cases after an epidemic has been declared in a health area. Risk of suspected meningitis among household contacts of a suspected meningitis case is no higher than among members of the same village. Village-wide antibiotic prophylaxis can target subsequent cases in villages: across of range of parameters pertaining to how the intervention is performed, up to 220/672 suspected cases during the season are potentially preventable. On the other hand, household prophylaxis targets very few cases. In general, the village-wide strategy is not very sensitive to the method used to declare an epidemic. Finally, village-wide antibiotic prophylaxis is potentially more efficient than mass vaccination of all individuals at the beginning of the season, and than the equivalent reactive vaccination strategy. CONCLUSIONS Village-wide antibiotic prophylaxis should be considered and tested further as a response against outbreaks of meningococcal meningitis in the Meningitis Belt, as a supplement to reactive mass vaccination.
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Affiliation(s)
- Matt D. T. Hitchings
- Center for Communicable Disease Dynamics and Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | | | | | - Marc Lipsitch
- Center for Communicable Disease Dynamics and Departments of Epidemiology and Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
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Manzo LM, Ousmane S, Ibrahim DD, Zaneidou M, Testa J, Maïnassara HB. Bacterial meningitis in Niger: an analysis of national surveillance data, 2003-2015. Pan Afr Med J 2018; 30:235. [PMID: 30574254 PMCID: PMC6295294 DOI: 10.11604/pamj.2018.30.235.15937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/12/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Bacterial meningitis (BM) is one of the most severe infectious disease in Niger republic. To best describe the trends of BM disease, meningitis surveillance data from the Centre de Recherche Medicale et Sanitaire (CERMES) and the Direction of Surveillance and Response to Epidemics (DSRE) were reviewed and analyzed. Methods Data on number of notified cases of BM and on pathogens were analyzed during 2003-2015. Excel 2013 was used for trend analysis on the etiology of BM prevalence and incidence. Results A total of 10051 cerebrospinal fluid (CSF) samples collected were confirmed by laboratory methods. The main etiologies of meningitis detected were N. meningitidis (82.1%), S. pneumonia (12.1%) and H. influenza (3.4%). N. meningitidis mostly affected children in the age groups of 5-9 years (32.9%) and 10-14 years (24.9%) with respective mean incidence of 14.9 and 11.3. The percentage estimate of N. meningitidis serogroup A (NmA) meningitis fell to 0% in 2015 while during the same year that of N. meningitidis serogroup C (NmC) and N. meningitidis serogroup W (NmW) reached 82.9% and 17% respectively. Conclusion Overall, the epidemiological trends of the BM in Niger were dynamic. The emergence of NmC strains suggests that there may be an urgent need for serogroup C containing vaccines in Niger in the coming years.
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Affiliation(s)
- Lawaly Maman Manzo
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
| | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
| | - Dan Dano Ibrahim
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
| | - Maman Zaneidou
- Direction de la Surveillance et Riposte aux Epidémies (DSRE), Ministère de la Santé Publique, Niamey, Niger
| | - Jean Testa
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
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Koutangni T, Crépey P, Woringer M, Porgho S, Bicaba BW, Tall H, Mueller JE. Compartmental models for seasonal hyperendemic bacterial meningitis in the African meningitis belt. Epidemiol Infect 2018; 147:e14. [PMID: 30264686 PMCID: PMC6520558 DOI: 10.1017/s0950268818002625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 07/03/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022] Open
Abstract
The pathophysiological mechanisms underlying the seasonal dynamic and epidemic occurrence of bacterial meningitis in the African meningitis belt remain unknown. Regular seasonality (seasonal hyperendemicity) is observed for both meningococcal and pneumococcal meningitis and understanding this is critical for better prevention and modelling. The two principal hypotheses for hyperendemicity during the dry season imply (1) an increased risk of invasive disease given asymptomatic carriage of meningococci and pneumococci; or (2) an increased transmission of these bacteria from carriers and ill individuals. In this study, we formulated three compartmental deterministic models of seasonal hyperendemicity, featuring one (model1-'inv' or model2-'transm'), or a combination (model3-'inv-transm') of the two hypotheses. We parameterised the models based on current knowledge on meningococcal and pneumococcal biology and pathophysiology. We compared the three models' performance in reproducing weekly incidences of suspected cases of acute bacterial meningitis reported by health centres in Burkina Faso during 2004-2010, through the meningitis surveillance system. The three models performed well (coefficient of determination R2, 0.72, 0.86 and 0.87, respectively). Model2-'transm' and model3-'inv-transm' better captured the amplitude of the seasonal incidence. However, model2-'transm' required a higher constant invasion rate for a similar average baseline transmission rate. The results suggest that a combination of seasonal changes of the risk of invasive disease and carriage transmission is involved in the hyperendemic seasonality of bacterial meningitis in the African meningitis belt. Consequently, both interventions reducing the risk of nasopharyngeal invasion and the bacteria transmission, especially during the dry season are believed to be needed to limit the recurrent seasonality of bacterial meningitis in the meningitis belt.
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Affiliation(s)
- T. Koutangni
- Université Pierre et Marie Curie, 4 Place Jussieu, 75005 Paris, France
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, 20 avenue George Sand, 93210 La Plaine St Denis, France
| | - P. Crépey
- UMR Emergence des Pathologies Virales, Université Aix-Marseille – IRD 190 – Inserm 1207 – EHESP, 27 Boulevard Jean-Moulin 13385 Marseille Cedex 5, France
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) – EA 7449, F-35000 Rennes, France
| | - M. Woringer
- Institut de Biologie de l'Ecole Normale Supérieure (IBENS), PSL Research University, 45 Rue dʼUlm, 75005 Paris, France
| | - S. Porgho
- Direction de la Lutte contre la Maladie, Ministère de la Santé, 03 BP 7035 Ouagadougou 03, Burkina Faso
| | - B. W. Bicaba
- Direction de la Lutte contre la Maladie, Ministère de la Santé, 03 BP 7035 Ouagadougou 03, Burkina Faso
| | - H. Tall
- Agence de Médecine Préventive, 10 BP 638. Ouagadougou, Burkina Faso
| | - J. E. Mueller
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, 20 avenue George Sand, 93210 La Plaine St Denis, France
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Woringer M, Martiny N, Porgho S, Bicaba BW, Bar-Hen A, Mueller JE. Atmospheric Dust, Early Cases, and Localized Meningitis Epidemics in the African Meningitis Belt: An Analysis Using High Spatial Resolution Data. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:97002. [PMID: 30192160 PMCID: PMC6375477 DOI: 10.1289/ehp2752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Bacterial meningitis causes a high burden of disease in the African meningitis belt, with regular seasonal hyperendemicity and sporadic short, but intense, localized epidemics during the late dry season occurring at a small spatial scale [i.e., below the district level, in individual health centers (HCs)]. In addition, epidemic waves with larger geographic extent occur every 7-10 y. Although atmospheric dust load is thought to be an essential factor for hyperendemicity, its role for localized epidemics remains hypothetic. OBJECTIVES Our goal was to evaluate the association of localized meningitis epidemics in HC catchment areas with the dust load and the occurrence of cases in the same population early in the dry season. METHODS We compiled weekly reported cases of suspected bacterial meningitis at the HC resolution for 14 districts of Burkina Faso for the period 2004-2014. Using logistic regression, we evaluated the association of epidemic HC-weeks with atmospheric dust [approximated by the aerosol optical thickness (AOT) satellite product] and with the observation of early meningitis cases during October-December. RESULTS Although AOT was strongly associated with epidemic HC-weeks in crude analyses across all HC-weeks during the meningitis season [odds ratio (OR) [Formula: see text]; 95% CI: 4.90, 9.50], the association was no longer apparent when controlling for calendar week (OR [Formula: see text]; 95% CI: 0.60, 1.50). The number of early meningitis cases reported during October-December was associated with epidemic HC-weeks in the same HC catchment area during January-May of the following year (OR for each additional early case [Formula: see text]; 95% CI: 1.06, 1.21). CONCLUSIONS Spatial variations of atmospheric dust load do not seem to be a factor in the occurrence of localized meningitis epidemics, and the factor triggering them remains to be identified. The pathophysiological mechanism linking early cases to localized epidemics is not understood, but their occurrence and number of early cases could be an indicator for epidemic risk. https://doi.org/10.1289/EHP2752.
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Affiliation(s)
| | - Nadège Martiny
- 2 UMR6282 BIOGEOSCIENCES, University of Burgundy , Dijon, France
| | - Souleymane Porgho
- 3 Direction de la lutte contre la maladie, Ministry of Health , Ouagadougou, Burkina Faso
| | - Brice W Bicaba
- 3 Direction de la lutte contre la maladie, Ministry of Health , Ouagadougou, Burkina Faso
| | - Avner Bar-Hen
- 4 Conservatoire national d'arts et métiers (CNAM) , Paris, France
| | - Judith E Mueller
- 5 French School of Public Health (EHESP), Sorbonne Paris Cité , Paris, France
- 6 Institut Pasteur, Paris, France
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Jenkins GS, Gueye M. WRF 1960-2014 Winter Season Simulations of Particulate Matter in the Sahel: Implications for Air Quality and Respiratory Health. GEOHEALTH 2018; 2:248-260. [PMID: 32159017 PMCID: PMC7007090 DOI: 10.1002/2018gh000132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 05/24/2023]
Abstract
We use the Weather Research and Forecast model using the Goddard Global Ozone Chemistry Aerosol Radiation and Transport (GOCART) dust module (WRF-CHEM) to simulate the particulate matter (PM) variations in the Sahel during the winter seasons (January-March) of 1960-2014. Two simulations are undertaken where the direct aerosol feedback is turned off, and only transport is considered and where the direct aerosol feedback is turned on. We find that simulated Sahelian PM10 and PM2.5 concentrations were lower in the 1960s and after 2003 and higher during the period between 1988 and 2002. Higher Sahelian PM10 concentrations are due to stronger winds between the surface and 925 hPa over the Sahara, which transport dust into the Sahel. Negative PM10 concentration anomalies are found over the Bodele Depression and associated with weaker 925 wind anomalies after 1997 through 2014. Further west, positive PM10 concentration anomalies are found across the Adrar Plateau in the Sahara and responsible for dust transport to the Western Sahel. The North Atlantic Oscillation (NAO) is positively correlated to Sahelian dust concentrations especially during the periods of 1960-1970 and 1988-2002. The temporal/spatial patterns of PM10 concentrations have significant respiratory health implications for inhabitants of the Sahel.
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Affiliation(s)
- Gregory S. Jenkins
- Department of Meteorology and Atmospheric SciencesPenn State UniversityUniversity ParkPAUSA
- Alliance for Education, Science, Engineering, and Development in AfricaPenn State UniversityUniversity ParkPAUSA
| | - Moussa Gueye
- Department of Meteorology and Atmospheric SciencesPenn State UniversityUniversity ParkPAUSA
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Serra LC, York LJ, Gamil A, Balmer P, Webber C. A Review of Meningococcal Disease and Vaccination Recommendations for Travelers. Infect Dis Ther 2018; 7:219-234. [PMID: 29550909 PMCID: PMC5986680 DOI: 10.1007/s40121-018-0196-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 11/14/2022] Open
Abstract
International travel has been steadily increasing since the middle of the twentieth century, including travel to regions with high levels of endemic meningococcal disease and areas with sporadic or sustained meningococcal outbreaks. Although invasive meningococcal disease (IMD) is relatively rare in travelers since the advent of quadrivalent meningococcal vaccines, it remains a serious concern because of its rapid progression, poor prognosis and outcomes, associated treatment delays, and the potential to precipitate outbreaks. Moreover, fatality occurs in up to 22% of those infected. This review will focus on IMD in travelers, with an emphasis on IMD epidemiology and the geographic regions of potential concern for international travelers. As vaccination is the best approach for preventing IMD among travelers, currently available meningococcal vaccines and corresponding country-specific national meningococcal vaccination recommendations, where available, will be summarized by age and type of vaccine recommended. The use of the quadrivalent meningococcal vaccines, specifically the tetanus toxoid conjugate vaccine (including MenACWY-TT; Nimenrix®), as a protective measure against IMD in travelers will be emphasized. FUNDING Pfizer Inc.
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Affiliation(s)
- Lidia C Serra
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA.
| | - Laura J York
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Amgad Gamil
- Pfizer Vaccines, Global Medical Development, Scientific and Clinical Affairs, Dubai, United Arab Emirates
| | - Paul Balmer
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Chris Webber
- Pfizer Vaccines, Clinical Research and Development, Pearl River, NY, USA
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Coldiron ME, Assao B, Page AL, Hitchings MDT, Alcoba G, Ciglenecki I, Langendorf C, Mambula C, Adehossi E, Sidikou F, Tassiou EI, De Lastours V, Grais RF. Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial. PLoS Med 2018; 15:e1002593. [PMID: 29944651 PMCID: PMC6019097 DOI: 10.1371/journal.pmed.1002593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antibiotic prophylaxis for contacts of meningitis cases is not recommended during outbreaks in the African meningitis belt. We assessed the effectiveness of single-dose oral ciprofloxacin administered to household contacts and in village-wide distributions on the overall attack rate (AR) in an outbreak of meningococcal meningitis. METHODS AND FINDINGS In this 3-arm, open-label, cluster-randomized trial during a meningococcal meningitis outbreak in Madarounfa District, Niger, villages notifying a suspected case were randomly assigned (1:1:1) to standard care (the control arm), single-dose oral ciprofloxacin for household contacts within 24 hours of case notification, or village-wide distribution of ciprofloxacin within 72 hours of first case notification. The primary outcome was the overall AR of suspected meningitis after inclusion. A random sample of 20 participating villages was enrolled to document any changes in fecal carriage prevalence of ciprofloxacin-resistant and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae before and after the intervention. Between April 22 and May 18, 2017, 49 villages were included: 17 to the control arm, 17 to household prophylaxis, and 15 to village-wide prophylaxis. A total of 248 cases were notified in the study after the index cases. The AR was 451 per 100,000 persons in the control arm, 386 per 100,000 persons in the household prophylaxis arm (t test versus control p = 0.68), and 190 per 100,000 persons in the village-wide prophylaxis arm (t test versus control p = 0.032). The adjusted AR ratio between the household prophylaxis arm and the control arm was 0.94 (95% CI 0.52-1.73, p = 0.85), and the adjusted AR ratio between the village-wide prophylaxis arm and the control arm was 0.40 (95% CI 0.19‒0.87, p = 0.022). No adverse events were notified. Baseline carriage prevalence of ciprofloxacin-resistant Enterobacteriaceae was 95% and of ESBL-producing Enterobacteriaceae was >90%, and did not change post-intervention. One limitation of the study was the small number of cerebrospinal fluid samples sent for confirmatory testing. CONCLUSIONS Village-wide distribution of single-dose oral ciprofloxacin within 72 hours of case notification reduced overall meningitis AR. Distributions of ciprofloxacin could be an effective tool in future meningitis outbreak responses, but further studies investigating length of protection, effectiveness in urban settings, and potential impact on antimicrobial resistance patterns should be carried out. TRIAL REGISTRATION ClinicalTrials.gov NCT02724046.
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Affiliation(s)
| | | | | | - Matt D. T. Hitchings
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | | | | | | | | | - Fati Sidikou
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | - Victoire De Lastours
- Department of Internal Medicine, Hôpital Beaujon, Assistance Publique–Hôpitaux de Paris, Paris, France
- IAME Research Group UMC1137, Université Paris Diderot, Paris, France
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Vuocolo S, Balmer P, Gruber WC, Jansen KU, Anderson AS, Perez JL, York LJ. Vaccination strategies for the prevention of meningococcal disease. Hum Vaccin Immunother 2018; 14:1203-1215. [PMID: 29543535 PMCID: PMC5989901 DOI: 10.1080/21645515.2018.1451287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/08/2018] [Indexed: 01/05/2023] Open
Abstract
Routine prophylactic vaccination and mass vaccination strategies have been used to control both endemic and epidemic disease caused by Neisseria meningitidis globally. This review discusses real-world examples of these vaccination strategies, their implementation, and outcomes of these efforts, with the overall goal of providing insights on how to achieve optimal control of meningococcal disease through vaccination in varied settings. Tailoring immunization programs to fit the needs of the target population has the potential to optimally reduce disease incidence.
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Affiliation(s)
- Scott Vuocolo
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Paul Balmer
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | | | | | - John L. Perez
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Laura J. York
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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26
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Mustapha MM, Harrison LH. Vaccine prevention of meningococcal disease in Africa: Major advances, remaining challenges. Hum Vaccin Immunother 2018; 14:1107-1115. [PMID: 29211624 DOI: 10.1080/21645515.2017.1412020] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Africa historically has had the highest incidence of meningococcal disease with high endemic rates and periodic epidemics. The meningitis belt, a region of sub-Saharan Africa extending from Senegal to Ethiopia, has experienced large, devastating epidemics. However, dramatic shifts in the epidemiology of meningococcal disease have occurred recently. For instance, meningococcal capsular group A (NmA) epidemics in the meningitis belt have essentially been eliminated by use of conjugate vaccine. However, NmW epidemics have emerged and spread across the continent since 2000; NmX epidemics have occurred sporadically, and NmC recently emerged in Nigeria and Niger. Outside the meningitis belt, NmB predominates in North Africa, while NmW followed by NmB predominate in South Africa. Improved surveillance is necessary to address the challenges of this changing epidemiologic picture. A low-cost, multivalent conjugate vaccine covering NmA and the emergent and prevalent meningococcal capsular groups C, W, and X in the meningitis belt is a pressing need.
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Affiliation(s)
- Mustapha M Mustapha
- a Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh , Pittsburgh , Pennsylvania , USA
| | - Lee H Harrison
- a Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh , Pittsburgh , Pennsylvania , USA
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27
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Al-Darabsah I, Yuan Y. A periodic disease transmission model with asymptomatic carriage and latency periods. J Math Biol 2017; 77:343-376. [PMID: 29274002 DOI: 10.1007/s00285-017-1199-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 12/13/2017] [Indexed: 11/28/2022]
Abstract
In this paper, the global dynamics of a periodic disease transmission model with two delays in incubation and asymptomatic carriage periods is investigated. We first derive the model system with a general nonlinear incidence rate function by stage-structure. Then, we identify the basic reproduction ratio [Formula: see text] for the model and present numerical algorithm to calculate it. We obtain the global attractivity of the disease-free state when [Formula: see text] and discuss the disease persistence when [Formula: see text]. We also explore the coexistence of endemic state in the nonautonomous system and prove the uniqueness with constants coefficients. Numerical simulations are provided to present a case study regarding the meningococcal meningitis disease transmission and discuss the influence of carriers on [Formula: see text].
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Affiliation(s)
- Isam Al-Darabsah
- Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Yuan Yuan
- Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
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28
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Paireau J, Chen A, Broutin H, Grenfell B, Basta NE. Seasonal dynamics of bacterial meningitis: a time-series analysis. LANCET GLOBAL HEALTH 2017; 4:e370-7. [PMID: 27198841 PMCID: PMC5516123 DOI: 10.1016/s2214-109x(16)30064-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/13/2016] [Indexed: 12/19/2022]
Abstract
Background Bacterial meningitis, which is caused mainly by Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae, inflicts a substantial burden of disease worldwide. Yet, the temporal dynamics of this disease are poorly characterised and many questions remain about the ecology of the disease. We aimed to comprehensively assess seasonal trends in bacterial meningitis on a global scale. Methods We developed the first bacterial meningitis global database by compiling monthly incidence data as reported by country-level surveillance systems. Using country-level wavelet analysis, we identified whether a 12 month periodic component (annual seasonality) was detected in time-series that had at least 5 years of data with at least 40 cases reported per year. We estimated the mean timing of disease activity by computing the centre of gravity of the distribution of cases and investigated whether synchrony exists between the three pathogens responsible for most cases of bacterial meningitis. Findings We used country-level data from 66 countries, including from 47 countries outside the meningitis belt in sub-Saharan Africa. A persistent seasonality was detected in 49 (96%) of the 51 time-series from 38 countries eligible for inclusion in the wavelet analyses. The mean timing of disease activity had a latitudinal trend, with bacterial meningitis seasons peaking during the winter months in countries in both the northern and southern hemispheres. The three pathogens shared similar seasonality, but time-shifts differed slightly by country. Interpretation Our findings provide key insight into the seasonal dynamics of bacterial meningitis and add to knowledge about the global epidemiology of meningitis and the host, environment, and pathogen characteristics driving these patterns. Comprehensive understanding of global seasonal trends in meningitis could be used to design more effective prevention and control strategies. Funding Princeton University Health Grand Challenge, US National Institutes of Health (NIH), NIH Fogarty International Center Research and Policy for Infectious Disease Dynamics programme (RAPIDD), Bill & Melinda Gates Foundation.
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Affiliation(s)
- Juliette Paireau
- Princeton Environmental Institute, Princeton University, Princeton, NJ, USA; Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.
| | - Angelica Chen
- Department of Computer Science, Princeton University, Princeton, NJ, USA
| | - Helene Broutin
- MIVEGEC (Mixed Research Group CNRS 5290/IRD 224/University of Montpellier), Montpellier, France; Service de Parasitologie-Mycologie, Faculté de Médecine, Pharmacie et Odontologie, University Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Bryan Grenfell
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Nicole E Basta
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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29
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Gituro CN, Nyerere A, Ngayo MO, Maina E, Githuku J, Boru W. Etiology of bacterial meningitis: a cross-sectional study among patients admitted in a semi-urban hospital in Nairobi, Kenya. Pan Afr Med J 2017; 28:10. [PMID: 30167035 PMCID: PMC6113691 DOI: 10.11604/pamj.supp.2017.28.1.9383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 10/24/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction bacterial meningitis, responsible for childhood morbidity and mortality, can also lead to permanent neurological disability among survivors. This study conducted from January to December, 2015 used standard bacteriological and molecular methods to investigate the etiology of three common causes of bacterial meningitis among hospitalized patients admitted at a semi-urban hospital in Nairobi, Kenya. Methods a total of 196 patients admitted at Mama Lucy Kibaki with clinically diagnosed meningitis were recruited into this cross-sectional study. Participants’ information was collected through patient interviews and abstraction of health records. Bacterial culture, gram stains and multiplex polymerase chain reaction (PCR) were used to investigate causes of bacterial meningitis from cerebrospinal fluid (CSF) samples. Characteristics such as age, gender, occupation, underlying conditions of patients with laboratory confirmed bacterial meningitis infection are described. Results among the 196 patients diagnosed with bacterial meningitis, the median age was 1 year (range 1 to 36 years) with 87.2% aged 1 to 4 years; 54.6% were males. Using PCR, 22 out of 196 (11.2%) samples had evidence suggesting a bacterial infection. These included 12/22 (54.5%) S. pneumonia, 7/22 (31.8%) N. meningitides and 3/22 (13.6%) H. influenza. From bacterial culture, four of 196 (2.1%) samples grew S. pneumonia. All three samples found positive for H. influenza were from male patients aged between 1 to 4 years. Conclusion of the three common causes evaluated, S. pneumonia was the most common cause of bacterial meningitis among patients from this region, particularly among infants. One older patient was diabetic, thereby highlighting the importance of pre-existing conditions. Although serotyping of bacteria was not done, under-vaccination might have played a role in the cases identified and ensuring complete and timely vaccination may prevent further cases of bacterial meningitis.
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Affiliation(s)
- Charles Njonjo Gituro
- National Public Health Laboratory Services (NPHLS), Ministry of Health, Nairobi Kenya.,Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Ministry of Health, Kenya
| | - Andrew Nyerere
- Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Musa Otieno Ngayo
- Centre of Microbiology and Research Kenya Medical Research Institute, Nairobi, Kenya
| | - Edward Maina
- Centre of Microbiology and Research Kenya Medical Research Institute, Nairobi, Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training Program, Nairobi, Ministry of Health, Kenya
| | - Waqo Boru
- Field Epidemiology and Laboratory Training Program, Nairobi, Ministry of Health, Kenya
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30
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Piotrowski C, Lede V, Butthof A, Kaiser N, Hirrlinger PG, Tschöp MH, Schöneberg T, Bechmann I. Open housing drives the expression of immune response genes in the nasal mucosa, but not the olfactory bulb. PLoS One 2017; 12:e0187192. [PMID: 29077773 PMCID: PMC5659768 DOI: 10.1371/journal.pone.0187192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/16/2017] [Indexed: 11/25/2022] Open
Abstract
Nasal mucosa and olfactory bulb are separated by the cribriform plate which is perforated by olfactory nerves. We have previously demonstrated that the cribriform plate is permissive for T cells and monocytes and that viruses can enter the bulb upon intranasal injection by axonal transportation. Therefore, we hypothesized that nasal mucosa and olfactory bulb are equipped to deal with constant infectious threats. To detect genes involved in this process, we compared gene expression in nasal mucosa and bulb of mice kept under specific pathogen free (SPF) conditions to gene expression of mice kept on non-SPF conditions using RNA deep sequencing. We found massive alterations in the expression of immune-related genes of the nasal mucosa, while the bulb did not respond immunologically. The absence of induction of immune-related genes in the olfactory bulb suggests effective defence mechanisms hindering entrance of environmental pathogens beyond the outer arachnoid layer. The genes detected in this study may include candidates conferring susceptibility to meningitis.
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Affiliation(s)
- Carolin Piotrowski
- Institute of Anatomy, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Vera Lede
- Rudolf Schönheimer Institute of Biochemistry, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Anne Butthof
- Rudolf Schönheimer Institute of Biochemistry, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Nicole Kaiser
- Institute of Anatomy, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Petra G. Hirrlinger
- Medical Experimental Center, Faculty of Medicine, University of Leipzig, Leipzig,Germany
| | | | - Torsten Schöneberg
- Rudolf Schönheimer Institute of Biochemistry, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Ingo Bechmann
- Institute of Anatomy, Faculty of Medicine, University of Leipzig, Leipzig, Germany
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31
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Mueller JE, Woringer M, Porgho S, Madec Y, Tall H, Martiny N, Bicaba BW. The association between respiratory tract infection incidence and localised meningitis epidemics: an analysis of high-resolution surveillance data from Burkina Faso. Sci Rep 2017; 7:11570. [PMID: 28912442 PMCID: PMC5599514 DOI: 10.1038/s41598-017-11889-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/30/2017] [Indexed: 12/03/2022] Open
Abstract
Meningococcal meningitis epidemics in the African meningitis belt consist of localised meningitis epidemics (LME) that reach attack proportions of 1% within a few weeks. A meningococcal serogroup A conjugate vaccine was introduced in meningitis belt countries from 2010 on, but LME due to other serogroups continue to occur. The mechanisms underlying LME are poorly understood, but an association with respiratory pathogens has been hypothesised. We analysed national routine surveillance data in high spatial resolution (health centre level) from 13 districts in Burkina Faso, 2004–2014. We defined LME as a weekly incidence rate of suspected meningitis ≥75 per 100,000 during ≥2 weeks; and high incidence episodes of respiratory tract infections (RTI) as the 5th quintile of monthly incidences. We included 10,334 health centre month observations during the meningitis season (January-May), including 85 with LME, and 1891 (1820) high-incidence episodes of upper (lower) RTI. In mixed effects logistic regression accounting for spatial structure, and controlling for dust conditions, relative air humidity and month, the occurrence of LME was strongly associated with high incidence episodes of upper (odds ratio 23.9, 95%-confidence interval 3.1–185.3), but not lower RTI. In the African meningitis belt, meningitis epidemics may be triggered by outbreaks of upper RTI.
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Affiliation(s)
- Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, Paris, France. .,Institut Pasteur, Paris, France.
| | | | - Souleymane Porgho
- Direction de la lutte contre la maladie, Ministry of Health, Ouagadougou, Burkina Faso
| | | | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | - Nadège Martiny
- UMR6282 BIOGEOSCIENCES, University of Burgundy, Dijon, France
| | - Brice W Bicaba
- Direction de la lutte contre la maladie, Ministry of Health, Ouagadougou, Burkina Faso
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Bårnes GK, Brynildsrud OB, Børud B, Workalemahu B, Kristiansen PA, Beyene D, Aseffa A, Caugant DA. Whole genome sequencing reveals within-host genetic changes in paired meningococcal carriage isolates from Ethiopia. BMC Genomics 2017; 18:407. [PMID: 28545446 PMCID: PMC5445459 DOI: 10.1186/s12864-017-3806-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/17/2017] [Indexed: 11/17/2022] Open
Abstract
Background Meningococcal colonization is a prerequisite for transmission and disease, but the bacterium only very infrequently causes disease while asymptomatic carriage is common. Carriage is highly dynamic, showing a great variety across time and space within and across populations, but also within individuals. The understanding of genetic changes in the meningococcus during carriage, when the bacteria resides in its natural niche, is important for understanding not only the carriage state, but the dynamics of the entire meningococcal population. Results Paired meningococcal isolates, obtained from 50 asymptomatic carriers about 2 months apart were analyzed with whole genome sequencing (WGS). Phylogenetic analysis revealed that most paired isolates from the same individual were closely related, and the average and median number of allelic differences between paired isolates defined as the same strain was 35. About twice as many differences were seen between isolates from different individuals within the same sequence type (ST). In 8%, different strains were detected at different time points. A difference in ST was observed in 6%, including an individual who was found to carry three different STs over the course of 9 weeks. One individual carried different strains from the same ST. In total, 566 of 1605 cgMLST genes had undergone within-host genetic changes in one or more pairs. The most frequently changed cgMLST gene was relA that was changed in 47% of pairs. Across the whole genome, pilE, differed mostly, in 85% of the pairs. The most frequent mechanisms of genetic difference between paired isolates were phase variation and recombination, including gene conversion. Different STs showed variation with regard to which genes that were most frequently changed, mostly due to absence/presence of phase variation. Conclusions This study revealed within-host genetic differences in meningococcal isolates during short-term asymptomatic carriage. The most frequently changed genes were genes belonging to the pilin family, the restriction/modification system, opacity proteins and genes involved in glycosylation. Higher resolution genome-wide sequence typing is necessary to resolve the diversity of isolates and reveals genetic differences not discovered by traditional typing schemes, and would be the preferred choice of technology. Electronic supplementary material The online version of this article (doi:10.1186/s12864-017-3806-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guro K Bårnes
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ola Brønstad Brynildsrud
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Bente Børud
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Paul A Kristiansen
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | - Demissew Beyene
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Hamlin Fistula Ethiopia, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway. .,WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
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Janowski A, Newland J. Of the Phrensy: an update on the epidemiology and pathogenesis of bacterial meningitis in the pediatric population. F1000Res 2017; 6. [PMID: 28184287 PMCID: PMC5288681 DOI: 10.12688/f1000research.8533.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 01/23/2023] Open
Abstract
In the past century, advances in antibiotics and vaccination have dramatically altered the incidence and clinical outcomes of bacterial meningitis. We review the shifting epidemiology of meningitis in children, including after the implementation of vaccines that target common meningitic pathogens and the introduction of intrapartum antibiotic prophylaxis offered to mothers colonized with
Streptococcus agalactiae. We also discuss what is currently known about the pathogenesis of meningitis. Recent studies of the human microbiome have illustrated dynamic relationships of bacterial and viral populations with the host, which may potentiate the risk of bacterial meningitis.
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Affiliation(s)
- Andrew Janowski
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
| | - Jason Newland
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
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Moïsi JC, Makawa MS, Tall H, Agbenoko K, Njanpop-Lafourcade BM, Tamekloe S, Amidou M, Mueller JE, Gessner BD. Burden of Pneumococcal Disease in Northern Togo before the Introduction of Pneumococcal Conjugate Vaccine. PLoS One 2017; 12:e0170412. [PMID: 28114427 PMCID: PMC5256990 DOI: 10.1371/journal.pone.0170412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/04/2017] [Indexed: 11/18/2022] Open
Abstract
Background S. pneumoniae is a leading cause of meningitis morbidity and mortality in the African meningitis belt, but little is known of its contribution to the burden of pneumonia in the region. We aimed to estimate the incidence of pneumococcal disease in children and adults in northern Togo, before the introduction of pneumococcal conjugate vaccine (PCV). Methods and findings From May 1st 2010 to April 30th 2013, we systematically enrolled all hospitalized patients meeting a case definition of suspected meningitis or clinical pneumonia, residing in Tone or Cinkasse districts, northern Togo and providing informed consent. We collected clinical data and tested biological specimens according to standardized procedures, including bacteriology and PCR testing of cerebro-spinal fluid for meningitis patients and blood cultures and whole blood lytA PCR for pneumonia patients. Chest X-rays (CXR) were interpreted using the WHO methodology. We included 404 patients with meningitis (104 <5 years of age) and 1550 with pneumonia (251 <5 years) over the study period. Of these, 78 (19%) had pneumococcal meningitis (13 <5 years), 574 (37%) had radiologically-confirmed pneumonia (83 <5 years) and 73 (5%) had culture-confirmed pneumococcal pneumonia (2 <5 years). PCV13 serotypes caused 79% (54/68) of laboratory-confirmed pneumococcal meningitis and 83% (29/35) of culture-confirmed pneumococcal pneumonia. Serotype 1 predominated in meningitis (n = 33) but not in pneumonia patients (n = 1). The incidence of pneumococcal disease was 7.5 per 100,000 among children <5 years of age and 14.8 in persons 5 years of age and above in the study area. When considering CXR-confirmed and blood PCR-positive pneumonia cases as likely pneumococcal, incidence estimates increased to 43.7 and 66.0 per 100,000 in each of these age groups, respectively. Incidence was at least 3-fold higher when we restricted the analysis to the urban area immediately around the study hospitals. Conclusions Our findings highlight the important role of S. pneumoniae as a meningitis and pneumonia-causing pathogen in the African meningitis belt. Pneumococcal disease incidence in our population was substantially lower than expected from global models; we hypothesize that poor access to hospital care led us to substantially underestimate the burden of disease. Surveillance is ongoing and will enable an evaluation of PCV impact, providing novel, high quality data from the region.
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Affiliation(s)
| | | | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | | | | | | | | | - Judith E. Mueller
- Agence de Médecine Préventive, Paris, France
- Ecole des Hautes Etudes en Santé Publique (Sorbonne Paris Cité), Paris, France
- Unité Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
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35
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Bowong S, Mountaga L, Bah A, Tewa JJ, Kurths J. Parameter and state estimation in a Neisseria meningitidis model: A study case of Niger. CHAOS (WOODBURY, N.Y.) 2016; 26:123115. [PMID: 28039983 DOI: 10.1063/1.4971783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Neisseria meningitidis (Nm) is a major cause of bacterial meningitidis outbreaks in Africa and the Middle East. The availability of yearly reported meningitis cases in the African meningitis belt offers the opportunity to analyze the transmission dynamics and the impact of control strategies. In this paper, we propose a method for the estimation of state variables that are not accessible to measurements and an unknown parameter in a Nm model. We suppose that the yearly number of Nm induced mortality and the total population are known inputs, which can be obtained from data, and the yearly number of new Nm cases is the model output. We also suppose that the Nm transmission rate is an unknown parameter. We first show how the recruitment rate into the population can be estimated using real data of the total population and Nm induced mortality. Then, we use an auxiliary system called observer whose solutions converge exponentially to those of the original model. This observer does not use the unknown infection transmission rate but only uses the known inputs and the model output. This allows us to estimate unmeasured state variables such as the number of carriers that play an important role in the transmission of the infection and the total number of infected individuals within a human community. Finally, we also provide a simple method to estimate the unknown Nm transmission rate. In order to validate the estimation results, numerical simulations are conducted using real data of Niger.
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Affiliation(s)
- S Bowong
- Laboratory of Mathematics, Department of Mathematics and Computer Science, Faculty of Science, University of Douala, P.O. Box 24157 Douala, Cameroon
| | - L Mountaga
- Department of Mathematics, Faculty of Science and Technic, University Cheikh Anta Diop, Dakar, Senegal
| | - A Bah
- UMI 209 IRD and UPMC UMMISCO, Bondy, France
| | - J J Tewa
- UMI 209 IRD and UPMC UMMISCO, Bondy, France
| | - J Kurths
- Postdam Institute for Climate Impact Research (PIK), Telegraphenberg A 31, 14412 Potsdam, Germany
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Reta MA, Zeleke TA. Neonatal bacterial meningitis in Tikur Anbessa Specialized Hospital, Ethiopia: a 10-year retrospective review. SPRINGERPLUS 2016; 5:1971. [PMID: 27917346 PMCID: PMC5108733 DOI: 10.1186/s40064-016-3668-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/08/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bacterial meningitis is still a major public health threat in developing countries. It is an overwhelming infection with a high morbidity and mortality rate, especially in neonates. The aim of this study was to determine the prevalence and etiological agents that cause bacterial neonatal meningitis at Tikur Anbessa Specialized Hospital (TASH). METHODS This is a retrospective analysis of 1189 cerebrospinal fluid (CSF) specimens submitted to the bacteriology laboratory of TASH for culture from 2001 to 2010. All newborns younger than 29 days old that were suspected for bacterial meningitis cases were included in the study. RESULTS Based on CSF culture, 56 newborns were identified as having bacterial meningitis from a total of 1189 suspected cases. The overall prevalence of neonatal bacterial meningitis from the total suspected cases was 4.7%. The organisms identified and their prevalence rates were Streptococcus pneumoniae 13 (23%), Escherichia coli 9 (16%), Acinetobacter 7 (13%), Neisseria meningitides 5 (9%), Klebsiella spp. 5 (9%), Staphylococcus aureus 3 (5%) and Streptococcus pyogen 3 (5%). There were two (4%) cases each that was caused by Coagulase-Negative-Staphylococcus and Non-Group-A-Streptococcus, while 1 (2%) caused by Haemophilus influenzae. S. pneumoniae was the main etiological agent identified from CSF culture. The male to female ratio was 1:0.88 (53% were male). The birth weights of 34 (61%) patients were under 2500 g, and 22 (39%) patients had normal birth weights. Twenty-seven (48%) were early onset cases, and 29 (52%) were late-onset. CONCLUSION Streptococcus pneumoniae and Escherichia coli were the two main etiological agents for neonatal bacterial meningitis infection in the study area.
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Affiliation(s)
- Melese Abate Reta
- Department of Medical Laboratory Science, Faculty of Health Science, Woldia University, P.O. Box 400, Woldia, Ethiopia
| | - Tamrat Abebe Zeleke
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Agier L, Martiny N, Thiongane O, Mueller JE, Paireau J, Watkins ER, Irving TJ, Koutangni T, Broutin H. Towards understanding the epidemiology of Neisseria meningitidis in the African meningitis belt: a multi-disciplinary overview. Int J Infect Dis 2016; 54:103-112. [PMID: 27826113 DOI: 10.1016/j.ijid.2016.10.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/21/2016] [Accepted: 10/29/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Neisseria meningitidis is the major cause of seasonal meningitis epidemics in the African meningitis belt. In the changing context of a reduction in incidence of serogroup A and an increase in incidence of serogroups W and C and of Streptococcus pneumoniae, a better understanding of the determinants driving the disease transmission dynamics remains crucial to improving bacterial meningitis control. METHODS The literature was searched to provide a multi-disciplinary overview of the determinants of meningitis transmission dynamics in the African meningitis belt. RESULTS Seasonal hyperendemicity is likely predominantly caused by increased invasion rates, sporadic localized epidemics by increased transmission rates, and larger pluri-annual epidemic waves by changing population immunity. Carriage likely involves competition for colonization and cross-immunity. The duration of immunity likely depends on the acquisition type. Major risk factors include dust and low humidity, and presumably human contact rates and co-infections; social studies highlighted environmental and dietary factors, with supernatural explanations. CONCLUSIONS Efforts should focus on implementing multi-country, longitudinal seroprevalence and epidemiological studies, validating immune markers of protection, and improving surveillance, including more systematic molecular characterizations of the bacteria. Integrating climate and social factors into disease control strategies represents a high priority for optimizing the public health response and anticipating the geographic evolution of the African meningitis belt.
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Affiliation(s)
- Lydiane Agier
- Combining Health Information, Computation and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK.
| | - Nadège Martiny
- Centre de Recherches de Climatologie (CRC), UMR 6282 CNRS Biogeosciences, Université de Bourgogne, Dijon, France
| | - Oumy Thiongane
- Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Antenne IRD Bobo Dioulasso, Bobo, Burkina Faso
| | - Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France; Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Juliette Paireau
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France; Department of Ecology and Evolutionary Biology, Princeton Environmental Institute, Princeton University, Princeton, New Jersey, USA
| | | | - Tom J Irving
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Thibaut Koutangni
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France; Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Hélène Broutin
- MIVEGEC, UMR 590CNRS/224IRD/UM, Montpellier, France; Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop, Fann, Dakar, Senegal
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Bårnes GK, Kristiansen PA, Beyene D, Workalemahu B, Fissiha P, Merdekios B, Bohlin J, Préziosi MP, Aseffa A, Caugant DA. Prevalence and epidemiology of meningococcal carriage in Southern Ethiopia prior to implementation of MenAfriVac, a conjugate vaccine. BMC Infect Dis 2016; 16:639. [PMID: 27814682 PMCID: PMC5097444 DOI: 10.1186/s12879-016-1975-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/26/2016] [Indexed: 01/07/2023] Open
Abstract
Background Neisseria meningitidis colonizes humans and transmits mainly by asymptomatic carriage. We sought to determine the prevalence and epidemiology of meningococcal carriage in Ethiopia prior to the introduction of MenAfriVac, a serogroup A meningococcal conjugate vaccine. Methods A cross-sectional meningococcal carriage study was conducted in Arba Minch, southern Ethiopia. A total of 7479 oropharyngeal samples were collected from 1 to 29 year old volunteers, between March and October, 2014. The swabs were cultured for N. meningitidis and Neisseria lactamica in Ethiopia. N. meningitidis isolates were confirmed and characterized by their serogroup, sequence type (ST) and PorA:FetA profile in Norway. Results Overall carriage prevalence was 6.6 %. There was no significant difference in overall carriage between male (6.7 %) and female (6.4 %) participants. Highest carriage prevalence (10.9 %) for females was found in the 15–19 years of age, while prevalence among males was highest (11.3 %) in the 20–24 age group. Non-groupable isolates dominated (76.4 %), followed by serogroups X (14.0 %) and W (5.9 %) isolates. No serogroup A was found. Most non-groupable isolates were ST-192. Serogroup W isolates were assigned to the ST-11 clonal complex, and serogroup X isolates to the ST-181 and ST-41/44 clonal complexes. Overall carriage prevalence of N. lactamica was 28.1 %. Carriage of N. meningitidis and N. lactamica varied depending on age and geographic area, but there was no association between carriage of the two species. Conclusions Epidemic strains of serogroups W and X were circulating in this area of Ethiopia. As no serogroup A was found among the carriage isolates the immediate impact of mass-vaccination with MenAfriVac on transmission of N. meningitidis in this population is expected to be marginal.
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Affiliation(s)
- Guro K Bårnes
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Paul A Kristiansen
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | - Behailu Merdekios
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Jon Bohlin
- Department of Methodology Research and Analysis, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Dominique A Caugant
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
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Maïnassara HB, Paireau J, Idi I, Jusot JF, Moulia Pelat JP, Ouwe Missi Oukem-Boyer O, Fontanet A, Mueller JE. Serogroup-Specific Characteristics of Localized Meningococcal Meningitis Epidemics in Niger 2002-2012 and 2015: Analysis of Health Center Level Surveillance Data. PLoS One 2016; 11:e0163110. [PMID: 27657530 PMCID: PMC5033479 DOI: 10.1371/journal.pone.0163110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/04/2016] [Indexed: 11/18/2022] Open
Abstract
To compare dynamics of localized meningitis epidemics (LE) by meningococcal (Nm) serogroup, we analyzed a surveillance database of suspected and laboratory-confirmed Nm cases from 373 health areas (HA) of three regions in Niger during 2002-2012 and one region concerned by NmC epidemics during 2015. We defined LE as HA weekly incidence rates of ≥20 suspected cases per 100,000 during ≥2 weeks and assigned the predominant serogroup based on polymerase chain reaction testing of cerebrospinal fluid. Among the 175 LE, median peak weekly incidence rate in LE due to NmA, W, X and C were 54, 39, 109 and 46 per 100,000, respectively. These differences impacted ability of the epidemic to be detected at the district level. While this analysis is limited by the small number of LE due to NmX (N = 4) and NmW (N = 5), further research should explore whether strategies for prevention and response to meningitis epidemics need to be adapted according to predominant meningococcal serogroups.
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Affiliation(s)
- Halima Boubacar Maïnassara
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
- * E-mail:
| | - Juliette Paireau
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, United States of America
| | - Issa Idi
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | | | | | - Arnaud Fontanet
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
| | - Judith E. Mueller
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
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Colombini A, Trotter C, Madrid Y, Karachaliou A, Preziosi MP. Costs of Neisseria meningitidis Group A Disease and Economic Impact of Vaccination in Burkina Faso. Clin Infect Dis 2016; 61 Suppl 5:S473-82. [PMID: 26553677 PMCID: PMC4639502 DOI: 10.1093/cid/civ600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background. Five years since the successful introduction of MenAfriVac in a mass vaccination campaign targeting 1- to 29-year-olds in Burkina Faso, consideration must be given to the optimal strategies for sustaining population protection. This study aims to estimate the economic impact of a range of vaccination strategies in Burkina Faso. Methods. We performed a cost-of-illness study, comparing different vaccination scenarios in terms of costs to both households and health systems over a 26-year time horizon. These scenarios are (1) reactive vaccination campaign (baseline comparator); (2) preventive vaccination campaign; (3) routine immunization at 9 months; and (4) a combination of routine and an initial catchup campaign of children under 5. Costs were estimated from a literature review, which included unpublished programmatic documents and peer-reviewed publications. The future disease burden for each vaccination strategy was predicted using a dynamic transmission model of group A Neisseria meningitidis. Results. From 2010 to 2014, the total costs associated with the preventive campaign targeting 1- to 29-year-olds with MenAfriVac were similar to the estimated costs of the reactive vaccination strategy (approximately 10 million US dollars [USD]). Between 2015 and 2035, routine immunization with or without a catch-up campaign of 1- to 4-year-olds is cost saving compared with the reactive strategy, both with and without discounting costs and cases. Most of the savings are accrued from lower costs of case management and household costs resulting from a lower burden of disease. After the initial investment in the preventive strategy, 1 USD invested in the routine strategy saves an additional 1.3 USD compared to the reactive strategy. Conclusions. Prevention strategies using MenAfriVac will be significantly cost saving in Burkina Faso, both for the health system and for households, compared with the reactive strategy. This will protect households from catastrophic expenditures and increase the development capacity of the population.
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Affiliation(s)
- Anaïs Colombini
- Independent Consultant, World Health Organization Initiative for Vaccine Research, Geneva, Switzerland
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
| | | | - Andromachi Karachaliou
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
| | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
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Diokhane AM, Jenkins GS, Manga N, Drame MS, Mbodji B. Linkages between observed, modeled Saharan dust loading and meningitis in Senegal during 2012 and 2013. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2016; 60:557-75. [PMID: 26296434 DOI: 10.1007/s00484-015-1051-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 08/08/2015] [Accepted: 08/09/2015] [Indexed: 05/24/2023]
Abstract
The Sahara desert transports large quantities of dust over the Sahelian region during the Northern Hemisphere winter and spring seasons (December-April). In episodic events, high dust concentrations are found at the surface, negatively impacting respiratory health. Bacterial meningitis in particular is known to affect populations that live in the Sahelian zones, which is otherwise known as the meningitis belt. During the winter and spring of 2012, suspected meningitis cases (SMCs) were with three times higher than in 2013. We show higher surface particular matter concentrations at Dakar, Senegal and elevated atmospheric dust loading in Senegal for the period of 1 January-31 May during 2012 relative to 2013. We analyze simulated particulate matter over Senegal from the Weather Research and Forecasting (WRF) model during 2012 and 2013. The results show higher simulated dust concentrations during the winter season of 2012 for Senegal. The WRF model correctly captures the large dust events from 1 January-31 March but has shown less skill during April and May for simulated dust concentrations. The results also show that the boundary conditions are the key feature for correctly simulating large dust events and initial conditions are less important.
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Affiliation(s)
- Aminata Mbow Diokhane
- Centre de Gestion de la Qualité de l'Air (CGQA), from the Direction de l'Environnement et des Etablissements Classés (DEEC), Dakar, Senegal
| | - Gregory S Jenkins
- Department of Physics and Astronomy, Howard University, Washington, DC, USA.
| | - Noel Manga
- Unité de formation et de recherche en Sciences de la santé (UFR-2S), Université Assane Seck Ziguinchor (UASZ), Ziguinchor, Senegal
| | - Mamadou S Drame
- Laboratory for Atmospheric-Oceanic Physics-Simeon Fongang (LPAO-SF), Cheikh Anta Diop University, Dakar, Senegal
| | - Boubacar Mbodji
- Centre de Gestion de la Qualité de l'Air (CGQA), from the Direction de l'Environnement et des Etablissements Classés (DEEC), Dakar, Senegal
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Ouatara S, Faye A, Leye MMM, Niang K, Tal-Dia A. [Study of the immunization coverage determinants of vaccination campaign against meningococcal A meningitis in Burkina Faso]. Rev Epidemiol Sante Publique 2015; 63:347-53. [PMID: 26547670 DOI: 10.1016/j.respe.2015.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 08/31/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa countries suffer from repeated and explosive epidemics of meningitis mainly due to Neisseria meningitidis A. In December 2010, Burkina Faso organized a vaccination campaign with MenAfriVac® for people aged 1-29 years old. The objective of this study was to analyze the determinants of immunization coverage. METHODS We used a cross-sectional survey by cluster sampling in two stages, descriptive and analytical, conducted in the region of "Boucle du Mouhoun". Data were collected during a home interview. The dependent variable was vaccination status and the independent variables included individual and household characteristics but also the means of communication used during the campaign. A logistic regression model was used to estimate the risk of being vaccinated using the 'Survey' Package (SVYGLM) of R. RESULTS Two thousand and twenty-five people were included with a 93.5 % estimated coverage. Factors associated with high vaccination coverage are rural areas (ORa=2.53 [1.53-4.17]) and smaller households (ORa=3.06 [1.36-6.91]). The risk of being vaccinated was lower for persons from salaried heads of household (ORa=0.14 [0.02-0.87]) versus farmers, persons informed by religious and traditional leaders (ORa=0.25 [0.11-0.57]) or family and friends (ORa=0.51 [0.29-0.9]) versus community mobilizers. CONCLUSION The coverage recorded is sufficient to provide community immunity. However, a part of the target population could not benefit from vaccination due to lack of information. Particular emphasis should be placed on large urban families using community mobilizers.
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Affiliation(s)
- S Ouatara
- Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Sénégal; Ministère de la Santé, Ouagadougou, Burkina Faso
| | - A Faye
- Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Sénégal; Université de Montréal, Montréal, QC, Canada.
| | - M M M Leye
- Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Sénégal
| | - K Niang
- Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Sénégal
| | - A Tal-Dia
- Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Sénégal
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Abstract
Neisseria meningitidis may cause invasive disease (meningitis and sepsis), leading to considerable disease burden and mortality. However, effective vaccines are available against most pathogenic serogroups. Large-scale vaccination campaigns with the MCC vaccine conducted in UK and with MenAfriVac in the Sahel have clearly demonstrated the direct and indirect effect of immunization programmes on disease and carriage. Moreover, the introduction of novel subcapsular vaccines against serogroup B, which may cross-protect against other serogroups, is likely to have a further effect on trends. Accurate data collection is key to elaborate vaccination strategies able to reduce meningococcal disease burden through direct protection and herd immunity.
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Affiliation(s)
- Paola Stefanelli
- a Department of Infectious, Parasitic & Immuno-mediated Diseases , Istituto Superiore di Sanità , Rome , Italy
| | - Giovanni Rezza
- a Department of Infectious, Parasitic & Immuno-mediated Diseases , Istituto Superiore di Sanità , Rome , Italy
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Trotter CL, Cibrelus L, Fernandez K, Lingani C, Ronveaux O, Stuart JM. Response thresholds for epidemic meningitis in sub-Saharan Africa following the introduction of MenAfriVac®. Vaccine 2015; 33:6212-7. [PMID: 26463444 DOI: 10.1016/j.vaccine.2015.09.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Since 2010, countries in the African meningitis belt have been introducing a new serogroup A meningococcal conjugate vaccine (MenAfriVac(®)) through mass campaigns. With the subsequent decline in meningitis due to Neisseria meningitidis serogroup A (NmA) and relative increase in meningitis due to other serogroups, mainly N. meningitidis serogroup W (NmW), the World Health Organisation (WHO) initiated a review of the incidence thresholds that guide response to meningitis epidemics in the African meningitis belt. METHODS Meningitis surveillance data from African meningitis belt countries from 2002 to 2013 were used to construct a single NmW dataset. The performance of different weekly attack rates, used as thresholds to initiate vaccination response, on preventing further cases was estimated. The cumulative seasonal attack rate used to define an epidemic was also varied. RESULTS Considerable variation in effect at different thresholds was observed. In predicting epidemics defined as a seasonal cumulative incidence of 100/10(5) population, an epidemic threshold of 10 cases/10(5) population/week performed well. Based on this same epidemic threshold, with a 6 week interval between crossing the epidemic threshold and population protection from a meningococcal vaccination campaign, an estimated 17 cases per event would be prevented by vaccination. Lowering the threshold increased the number of cases per event potentially prevented, as did shortening the response interval. If the interval was shortened to 4 weeks at the threshold of 10/10(5), the number of cases prevented would increase to 54 per event. CONCLUSIONS Accelerating time to vaccination could prevent more cases per event than lowering the threshold. Once the meningitis epidemic threshold is crossed, it is of critical importance that vaccination campaigns, where appropriate, are initiated rapidly.
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Affiliation(s)
| | - Laurence Cibrelus
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Katya Fernandez
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Clément Lingani
- World Health Organization, AFRO Inter-Country Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Olivier Ronveaux
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - James M Stuart
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Koutangni T, Boubacar Maïnassara H, Mueller JE. Incidence, carriage and case-carrier ratios for meningococcal meningitis in the African meningitis belt: a systematic review and meta-analysis. PLoS One 2015; 10:e0116725. [PMID: 25658307 PMCID: PMC4319942 DOI: 10.1371/journal.pone.0116725] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 12/12/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To facilitate the interpretation of meningococcal meningitis epidemiology in the "African meningitis belt", we aimed at obtaining serogroup-specific pooled estimates of incidence, carriage and case-carrier ratios for meningococcal meningitis in the African meningitis belt and describe their variations across the endemic, hyperendemic and epidemic context. METHODS We conducted a systematic review and meta-analysis of studies reporting serogroup-specific meningococcal meningitis monthly incidence and carriage in the same population and time period. Epidemiological contexts were defined as endemic (wet season, no epidemic), hyperendemic (dry season, no epidemic), and epidemic (dry season, epidemic). FINDINGS Eight studies reporting a total of eighty pairs of serogroup-specific meningococcal meningitis incidence and carriage estimates were included in this review. For serogroup A, changes associated with the transition from endemic to hyperendemic incidence and from hyperendemic to epidemic incidence were 15-fold and 120-fold respectively. Changes in carriage prevalence associated with both transitions were 1-fold and 30-fold respectively.
For serogroup W and X, the transition from endemic to hyperendemic incidence involved a 4-fold and 1•1-fold increase respectively. Increases in carriage prevalence for the later transition were 7-fold and 1•7-fold respectively. No data were available for the hyperendemic-epidemic transition for these serogroups. Our findings suggested that the regular seasonal variation in serogroup A meningococcal meningitis incidence between the rainy and the dry season could be mainly driven by seasonal change in the ratio of clinical cases to subclinical infections. In contrast appearance of epidemic incidences is related to a substantial increase in transmission and colonisation and to lesser extent with changes in the case-carrier ratio. CONCLUSION Seasonal change in the rate of progression to disease given carriage together with variations in frequency of carriage transmission should be considered in models attempting to capture the epidemiology of meningococcal meningitis and mainly to predict meningitis epidemics in the African meningitis belt.
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Affiliation(s)
- Thibaut Koutangni
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | | | - Judith E. Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
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Streptococcus pneumoniae serotype 1 burden in the African meningitis belt: exploration of functionality in specific antibodies. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:404-12. [PMID: 25651921 DOI: 10.1128/cvi.00758-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Streptococcus pneumoniae serotype 1 (Sp1) constitutes an important cause of seasonal endemic meningitis in all age groups in the African meningitis belt. Despite a higher meningitis incidence, the Burkinabé population has an Sp1-specific antibody seroprevalence similar to that reported in the United Kingdom (UK). We aimed to establish whether the opsonophagocytic activity (OPA) of pneumococcal IgG naturally present in Burkina Faso differs from that seen in individuals in the UK and to compare the OPAs generated by natural and vaccine-induced immunity. Samples collected from pneumococcal vaccine-naive Burkinabé and UK subjects were matched for age (1 to 39 years) and anti-Sp1 IgG level, analyzed for OPA to 3 S. pneumoniae serotypes (1, 5, and 19A), and compared to postvaccine samples. Furthermore, the Burkinabé samples were assessed for IgG avidity and serotype-specific IgM concentrations. One hundred sixty-nine matched serum samples from both populations were selected. A greater proportion of Burkinabé subjects aged 1 to 19 years had functional Sp1 activity (OPA ≥ 8) compared to UK subjects (12% versus 2%, P < 0.001); however, the proportions were similar among adults (9%). The correlation between Sp1 IgG concentration and OPA was good (P < 0.001), but many individuals had nonfunctional IgG, which was not related to avidity. While the Sp1 IgM concentrations correlated with OPA, not all of the function in serum samples with low IgG could be attributed to IgM. Finally, vaccine-induced Sp1-specific IgG was more functional than equivalent amounts of naturally occurring IgG. In conclusion, despite a substantially higher pneumococcal meningitis incidence, no decreased functional immunity to Sp1 could be evidenced in the Burkinabé population compared to that in the population from the UK. Furthermore, the naturally induced antibodies were less functional than vaccine-induced antibodies.
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Climate, demographic factors and geographical variations in the incidence of invasive meningococcal disease in Italy. Epidemiol Infect 2014; 143:1742-50. [PMID: 25308801 DOI: 10.1017/s0950268814002659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We investigated the effect of climatic, demographic factors and intra-country geographical variations on the incidence of invasive meningococcal disease (IMD) in Italy. For this purpose, incidence rates of IMD cases reported in Italy between 1994 and 2012 were calculated, and a cluster analysis was performed. A geographical gradient was determined, with lower incidence rates in central and southern Italy, compared to the northern parts, where most clusters were observed. IMD rates were higher in medium-sized towns than in villages. Adults were at lower risk of IMD than children aged ⩽4 years. IMD incidence tended to decrease with increasing monthly mean temperatures (incidence rate ratio 0·94, 95% confidence interval 0·90-0·99). In conclusion, geographical variations in IMD incidence were found, where age and temperature were associated with disease occurrence. Whether geographical variations should be considered in national intervention plans is still a matter for discussion.
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Ferrari MJ, Fermon F, Nackers F, Llosa A, Magone C, Grais RF. Time is (still) of the essence: quantifying the impact of emergency meningitis vaccination response in Katsina State, Nigeria. Int Health 2014; 6:282-90. [PMID: 25193978 DOI: 10.1093/inthealth/ihu062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In 2009, a large meningitis A epidemic affected a broad region of northern Nigeria and southern Niger, resulting in more than 75 000 cases and 4000 deaths. In collaboration with state and federal agencies, Médecins Sans Frontières (MSF) intervened with a large-scale vaccination campaign using polysaccharide vaccine. Here the authors analyze the impact (cases averted) of the vaccination response as a function of the timing and coverage achieved. METHODS Phenomenological epidemic models were fitted to replicate meningitis surveillance data from the Nigerian Ministry of Health/WHO surveillance system and from reinforced surveillance conducted by MSF in both vaccinated and unvaccinated areas using a dynamic, state-space framework to account for under-reporting of cases. RESULTS The overall impact of the vaccination campaigns (reduction in meningitis cases) in Katsina State, northern Nigeria, ranged from 4% to 12%. At the local level, vaccination reduced cases by as much as 50% when campaigns were conducted early in the epidemic. CONCLUSIONS Reactive vaccination with polysaccharide vaccine during meningitis outbreaks can significantly reduce the case burden when conducted early and comprehensively. Introduction of the conjugate MenAfriVac vaccine has reduced rates of disease caused by serogroup A Neisseria meningitidis in the region. Despite this, reactive campaigns with polysaccharide vaccine remain a necessary and important tool for meningitis outbreak response.
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Affiliation(s)
- Matthew J Ferrari
- Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA 16802 USA
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Pérez García-Pando C, Stanton MC, Diggle PJ, Trzaska S, Miller RL, Perlwitz JP, Baldasano JM, Cuevas E, Ceccato P, Yaka P, Thomson MC. Soil dust aerosols and wind as predictors of seasonal meningitis incidence in Niger. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:679-86. [PMID: 24633049 PMCID: PMC4080544 DOI: 10.1289/ehp.1306640] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/12/2014] [Indexed: 05/02/2023]
Abstract
BACKGROUND Epidemics of meningococcal meningitis are concentrated in sub-Saharan Africa during the dry season, a period when the region is affected by the Harmattan, a dry and dusty northeasterly trade wind blowing from the Sahara into the Gulf of Guinea. OBJECTIVES We examined the potential of climate-based statistical forecasting models to predict seasonal incidence of meningitis in Niger at both the national and district levels. DATA AND METHODS We used time series of meningitis incidence from 1986 through 2006 for 38 districts in Niger. We tested models based on data that would be readily available in an operational framework, such as climate and dust, population, and the incidence of early cases before the onset of the meningitis season in January-May. Incidence was used as a proxy for immunological state, susceptibility, and carriage in the population. We compared a range of negative binomial generalized linear models fitted to the meningitis data. RESULTS At the national level, a model using early incidence in December and averaged November-December zonal wind provided the best fit (pseudo-R2 = 0.57), with zonal wind having the greatest impact. A model with surface dust concentration as a predictive variable performed indistinguishably well. At the district level, the best spatiotemporal model included zonal wind, dust concentration, early incidence in December, and population density (pseudo-R2 = 0.41). CONCLUSIONS We showed that wind and dust information and incidence in the early dry season predict part of the year-to-year variability of the seasonal incidence of meningitis at both national and district levels in Niger. Models of this form could provide an early-season alert that wind, dust, and other conditions are potentially conducive to an epidemic.
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Paireau J, Maïnassara HB, Jusot JF, Collard JM, Idi I, Moulia-Pelat JP, Mueller JE, Fontanet A. Spatio-temporal factors associated with meningococcal meningitis annual incidence at the health centre level in Niger, 2004-2010. PLoS Negl Trop Dis 2014; 8:e2899. [PMID: 24852960 PMCID: PMC4031065 DOI: 10.1371/journal.pntd.0002899] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/13/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Epidemics of meningococcal meningitis (MM) recurrently strike the African Meningitis Belt. This study aimed at investigating factors, still poorly understood, that influence annual incidence of MM serogroup A, the main etiologic agent over 2004-2010, at a fine spatial scale in Niger. METHODOLOGY/PRINCIPAL FINDINGS To take into account data dependencies over space and time and control for unobserved confounding factors, we developed an explanatory Bayesian hierarchical model over 2004-2010 at the health centre catchment area (HCCA) level. The multivariate model revealed that both climatic and non-climatic factors were important for explaining spatio-temporal variations in incidence: mean relative humidity during November-June over the study region (posterior mean Incidence Rate Ratio (IRR) = 0.656, 95% Credible Interval (CI) 0.405-0.949) and occurrence of early rains in March in a HCCA (IRR = 0.353, 95% CI 0.239-0.502) were protective factors; a higher risk was associated with the percentage of neighbouring HCCAs having at least one MM A case during the same year (IRR = 2.365, 95% CI 2.078-2.695), the presence of a road crossing the HCCA (IRR = 1.743, 95% CI 1.173-2.474) and the occurrence of cases before 31 December in a HCCA (IRR = 6.801, 95% CI 4.004-10.910). At the study region level, higher annual incidence correlated with greater geographic spread and, to a lesser extent, with higher intensity of localized outbreaks. CONCLUSIONS Based on these findings, we hypothesize that spatio-temporal variability of MM A incidence between years and HCCAs result from variations in the intensity or duration of the dry season climatic effects on disease risk, and is further impacted by factors of spatial contacts, representing facilitated pathogen transmission. Additional unexplained factors may contribute to the observed incidence patterns and should be further investigated.
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Affiliation(s)
- Juliette Paireau
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
- Univ. Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
| | - Halima B. Maïnassara
- Unité d'Epidémiologie/Santé-Environnement-Climat, Centre de Recherche Médicale et Sanitaire (CERMES)/Réseau International des Instituts Pasteur, Niamey, Niger
| | - Jean-François Jusot
- Unité d'Epidémiologie/Santé-Environnement-Climat, Centre de Recherche Médicale et Sanitaire (CERMES)/Réseau International des Instituts Pasteur, Niamey, Niger
| | - Jean-Marc Collard
- Unité de Biologie, Centre de Recherche Médicale et Sanitaire (CERMES)/Réseau International des Instituts Pasteur, Niamey, Niger
| | - Issa Idi
- Unité d'Epidémiologie/Santé-Environnement-Climat, Centre de Recherche Médicale et Sanitaire (CERMES)/Réseau International des Instituts Pasteur, Niamey, Niger
| | - Jean-Paul Moulia-Pelat
- Unité d'Epidémiologie/Santé-Environnement-Climat, Centre de Recherche Médicale et Sanitaire (CERMES)/Réseau International des Instituts Pasteur, Niamey, Niger
| | - Judith E. Mueller
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
| | - Arnaud Fontanet
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
- Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
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