1
|
Adjorlolo S, Egbenya DL. A twin disaster: Addressing the COVID-19 pandemic and a cerebrospinal meningitis outbreak simultaneously in a low-resource country. Glob Health Action 2020; 13:1795963. [PMID: 32762300 PMCID: PMC7480482 DOI: 10.1080/16549716.2020.1795963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Managing a deadly pandemic in low- and middle-income countries (LMIC) is challenging. The task becomes tougher when there is an outbreak of an equally deadly disease. This is the present situation of Ghana, a low-resource country, that is confronted with the coronavirus disease 2019 (COVID-19) pandemic and cerebrospinal meningitis (CSM) outbreak. Apart from the resource constraint at both governmental and individual levels, such a situation affects the overall wellbeing of ordinary citizens as well as healthcare professionals, particularly those in high-risk areas. Perhaps, more than ever, we have to ensure equitable distribution of scarce healthcare resources in our effort to manage this ‘twin disaster’ of COVID-19 and CSM. We evaluated Ghana’s situation (outbreak response) and recommended measures to help us navigate this conundrum of a public health crisis.
Collapse
Affiliation(s)
- Samuel Adjorlolo
- Department of Mental Health Nursing, School of Nursing and Midwifery, University of Ghana , Legon, Ghana.,Research and Grant Institute of Ghana , Accra, Ghana
| | - Daniel Lawer Egbenya
- Research and Grant Institute of Ghana , Accra, Ghana.,Department of Anatomy and Cell Biology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast , Cape Coast, Ghana
| |
Collapse
|
2
|
Ousmane S, Kobayashi M, Seidou I, Issaka B, Sharpley S, Farrar JL, Whitney CG, Ouattara M. Characterization of pneumococcal meningitis before and after introduction of 13-valent pneumococcal conjugate vaccine in Niger, 2010-2018. Vaccine 2020; 38:3922-3929. [PMID: 32327220 DOI: 10.1016/j.vaccine.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
Pneumococcal meningitis in the African meningitis belt is primarily caused by Streptococcus pneumoniae serotype 1, a serotype contained in the 13-valent pneumococcal conjugate vaccine (PCV13). In 2014, Niger introduced PCV13 with doses given at 6, 10, and 14 weeks of age. We leveraged existing meningitis surveillance data to describe pneumococcal meningitis trends in Niger. As a national reference laboratory for meningitis, Centre de Recherche Médicale et Sanitaire (CERMES) receives cerebrospinal fluid specimens from suspected bacterial meningitis cases and performs confirmatory testing for an etiology by culture or polymerase chain reaction (PCR). Specimens with S. pneumoniae detection during 2010-2018 were sent to the Centers for Disease Control and Prevention for serotyping by sequential triplex real-time PCR. Specimens that were non-typeable by real-time PCR underwent serotyping by conventional multiplex PCR. We tested differences in the distribution of pneumococcal serotypes before (2010-2012) and after (2016-2018) PCV13 introduction. During January 2010 to December 2018, CERMES received 16,155 specimens; 5,651 (35%) had bacterial etiology confirmed. S. pneumoniae accounted for 13.2% (744/5,651); 53.1% (395/744) were serotyped. During 2010-12, PCV13-associated serotypes (VT) constituted three-fourths of serotyped pneumococcus-positive specimens; this proportion declined in all age groups in 2016-18, most substantially in children aged < 5 years (74.0% to 28.1%; P < 0.05). Among persons aged ≥ 5 years, VT constituted > 50% of pneumococcal meningitis after PCV13 introduction; serotype 1 remained the most common VT among persons aged ≥ 5 years, but not among those < 5 years. VT as a group caused a smaller proportion of reported pneumococcal meningitis cases after PCV13 introduction in Niger. Serotype 1, however, remains the major cause of pneumococcal meningitis in older children and adults. Different vaccination strategies, such as changing the infant vaccination schedule or extending vaccine coverage to older children and adults, are needed, in addition to stronger surveillance.
Collapse
Affiliation(s)
- Sani Ousmane
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Miwako Kobayashi
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Issaka Seidou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Sable Sharpley
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jennifer L Farrar
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Cynthia G Whitney
- Rollins School of Public Health, Department of Global Health, Emory University, Atlanta, USA
| | - Mahamoudou Ouattara
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| |
Collapse
|
3
|
Sidikou F, Potts CC, Zaneidou M, Mbaeyi S, Kadadé G, Paye MF, Ousmane S, Issaka B, Chen A, Chang HY, Issifou D, Lingani C, Sakande S, Bienvenu B, Mahamane AE, Diallo AO, Moussa A, Seidou I, Abdou M, Sidiki A, Garba O, Haladou S, Testa J, Obama Nse R, Mainassara HB, Wang X. Epidemiology of Bacterial Meningitis in the Nine Years Since Meningococcal Serogroup A Conjugate Vaccine Introduction, Niger, 2010-2018. J Infect Dis 2019; 220:S206-S215. [PMID: 31671439 DOI: 10.1093/infdis/jiz296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2010, Niger and other meningitis belt countries introduced a meningococcal serogroup A conjugate vaccine (MACV). We describe the epidemiology of bacterial meningitis in Niger from 2010 to 2018. METHODS Suspected and confirmed meningitis cases from January 1, 2010 to July 15, 2018 were obtained from national aggregate and laboratory surveillance. Cerebrospinal fluid specimens were analyzed by culture and/or polymerase chain reaction. Annual incidence was calculated as cases per 100 000 population. Selected isolates obtained during 2016-2017 were characterized by whole-genome sequencing. RESULTS Of the 21 142 suspected cases of meningitis, 5590 were confirmed: Neisseria meningitidis ([Nm] 85%), Streptococcus pneumoniae ([Sp] 13%), and Haemophilus influenzae ([Hi] 2%). No NmA cases occurred after 2011. Annual incidence per 100 000 population was more dynamic for Nm (0.06-7.71) than for Sp (0.18-0.70) and Hi (0.01-0.23). The predominant Nm serogroups varied over time (NmW in 2010-2011, NmC in 2015-2018, and both NmC and NmX in 2017-2018). Meningococcal meningitis incidence was highest in the regions of Niamey, Tillabery, Dosso, Tahoua, and Maradi. The NmW isolates were clonal complex (CC)11, NmX were CC181, and NmC were CC10217. CONCLUSIONS After MACV introduction, we observed an absence of NmA, the emergence and continuing burden of NmC, and an increase in NmX. Niger's dynamic Nm serogroup distribution highlights the need for strong surveillance programs to inform vaccine policy.
Collapse
Affiliation(s)
- Fati Sidikou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Caelin C Potts
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maman Zaneidou
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Sarah Mbaeyi
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Goumbi Kadadé
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Marietou F Paye
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Alexander Chen
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - How-Yi Chang
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djibo Issifou
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Clement Lingani
- World Health Organization-Intercountry Support Team, Ouagadougou, Burkina Faso
| | | | | | - Ali Elhadji Mahamane
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Alpha Oumar Diallo
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amadou Moussa
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Issaka Seidou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Moussa Abdou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Ali Sidiki
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Omar Garba
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Sani Haladou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Jean Testa
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | | | - Halima Boubacar Mainassara
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
4
|
Mbaeyi SA, Lingani C, Diallo AO, Bicaba B, Ouédraogo-Traoré R, Acyl M, Gamougame K, Coulibaly O, Coulibaly S, Zaneidou M, Sidikou F, Nikiema C, Sadji AY, Aké F, Tarbangdo F, Sakande S, Tall H, Njanpop-Lafourcade BM, Moïsi J, N’diaye A, Bwaka A, Bita A, Fernandez K, Poy A, Soeters HM, Vuong J, Novak R, Ronveaux O. Improving Case-Based Meningitis Surveillance in 5 Countries in the Meningitis Belt of Sub-Saharan Africa, 2015–2017. J Infect Dis 2019; 220:S155-S164. [DOI: 10.1093/infdis/jiz303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The MenAfriNet consortium was established in 2014 to support implementation of case-based meningitis surveillance in 5 countries in the meningitis belt of sub-Saharan Africa: Burkina Faso, Chad, Mali, Niger, and Togo. Assessing surveillance performance is critical for interpretation of the collected data and implementation of future surveillance-strengthening initiatives.
Methods
Detailed epidemiologic and laboratory data were collected on suspected meningitis cases through case-based meningitis surveillance in participating districts in 5 countries. Performance of case-based surveillance was evaluated through sensitivity of case ascertainment in case-based versus aggregate meningitis surveillance and an analysis of surveillance indicators.
Results
From 2015 to 2017, 18 262 suspected meningitis cases were identified through case-based surveillance and 16 262 were identified through aggregate surveillance, for a case ascertainment sensitivity of 112.3%. Among suspected cases, 16 885 (92.5%) had a cerebrospinal fluid (CSF) specimen collected, 13 625 (80.7%) of which were received at a national reference laboratory. Among these, 13 439 (98.6%) underwent confirmatory testing, and, of those tested, 4371 (32.5%) were confirmed for a bacterial pathogen.
Conclusions
Overall strong performance for case ascertainment, CSF collection, and laboratory confirmation provide evidence for the quality of MenAfriNet case-based surveillance in evaluating epidemiologic trends and informing future vaccination strategies.
Collapse
Affiliation(s)
- Sarah A Mbaeyi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clement Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brice Bicaba
- Ministère de la Santé du Burkina Faso, Ouagadougou
| | | | - Mahamat Acyl
- Ministère de la Santé Publique du Tchad, N’Djamena
| | | | - Oumou Coulibaly
- Ministère de la Santé et de l’Hygiène Publique du Mali, Bamako, Mali
| | | | | | | | | | - Adodo Yao Sadji
- Ministère de la Santé et de la Protection Sociale du Togo, Lomé
| | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | | | | | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | | | | | - Aboubacar N’diaye
- World Health Organization, Intercountry Support Team for Central Africa, Libreville, Gabon
| | - Ado Bwaka
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Andre Bita
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | | | - Alain Poy
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Heidi M Soeters
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeni Vuong
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | |
Collapse
|
5
|
Amidu N, Antuamwine BB, Addai-Mensah O, Abdul-Karim A, Stebleson A, Abubakari BB, Abenyeri J, Opoku AS, Nkukah JE, Najibullah AS. Diagnosis of bacterial meningitis in Ghana: Polymerase chain reaction versus latex agglutination methods. PLoS One 2019; 14:e0210812. [PMID: 30653582 PMCID: PMC6336253 DOI: 10.1371/journal.pone.0210812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/02/2019] [Indexed: 01/01/2023] Open
Abstract
Bacterial meningitis is a public health crisis in the northern part of Ghana, where it contributes to very high mortality and morbidity rates. Early detection of the causative organism will lead to better management and effective treatment. Our aim was to evaluate the diagnostic accuracy of Pastorex and Wellcogen latex agglutination tests for the detection of bacterial meningitis in a resource-limited setting. CSF samples from 330 suspected meningitis patients within the northern zone of Ghana were analysed for bacterial agents at the zonal Public Health Reference Laboratory in Tamale using polymerase chain reaction (PCR) and two latex agglutination test kits; Pastorex and Wellcogen. The overall positivity rate of samples tested for bacterial meningitis was 46.4%. Streptococcus pneumoniae was the most common cause of bacterial meningitis within the sub-region, with positivity rate of 25.2%, 28.2% and 28.8% when diagnosed using Wellcogen, Pastorex and PCR respectively. The Pastorex method was 97.4% sensitive while the Wellcogen technique was 87.6% sensitive. Both techniques however produced the same specificity of 99.4%. Our study revealed that the Pastorex method has a better diagnostic value for bacterial meningitis than the Wellcogen method and should be the method of choice in the absence of PCR.
Collapse
MESH Headings
- Adolescent
- Adult
- Bacterial Typing Techniques
- Child
- Child, Preschool
- Female
- Ghana
- Humans
- Latex Fixation Tests/methods
- Male
- Meningitis, Bacterial/cerebrospinal fluid
- Meningitis, Bacterial/diagnosis
- Meningitis, Bacterial/microbiology
- Meningitis, Haemophilus/cerebrospinal fluid
- Meningitis, Haemophilus/diagnosis
- Meningitis, Haemophilus/microbiology
- Meningitis, Meningococcal/cerebrospinal fluid
- Meningitis, Meningococcal/diagnosis
- Meningitis, Meningococcal/microbiology
- Meningitis, Pneumococcal/cerebrospinal fluid
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/microbiology
- Predictive Value of Tests
- ROC Curve
- Real-Time Polymerase Chain Reaction
- Reproducibility of Results
- Serotyping
- Streptococcal Infections/cerebrospinal fluid
- Streptococcal Infections/diagnosis
- Streptococcal Infections/microbiology
- Streptococcus agalactiae/genetics
- Streptococcus agalactiae/isolation & purification
- Young Adult
Collapse
Affiliation(s)
- Nafiu Amidu
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- * E-mail:
| | - Benedict Boateng Antuamwine
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Otchere Addai-Mensah
- Department of Medical Laboratory Technology, School of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Azure Stebleson
- Public Health Reference Laboratory, Northern Region, Tamale, Ghana
| | | | - John Abenyeri
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Afia Serwaa Opoku
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - John Eyulaku Nkukah
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Ali Sidi Najibullah
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| |
Collapse
|
6
|
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.
Collapse
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
| | | |
Collapse
|
7
|
Soysal A, Toprak DG, Türkoğlu S, Bakir M. Evaluation of the line probe assay for the rapid detection of bacterial meningitis pathogens in cerebrospinal fluid samples from children. BMC Microbiol 2017; 17:14. [PMID: 28077083 PMCID: PMC5228108 DOI: 10.1186/s12866-016-0834-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/10/2016] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study is to compare the diagnostic performance of the line probe assay (LPA) with conventional multiplex polymerase chain reaction (PCR) for Streptococcus pneumoniae as well as real-time PCR for Neisseria meningitidis and Haemophilus influenzae type b (Hib) in cerebrospinal fluid (CSF) samples from children during the multicenter national surveillance of bacterial meningitis between the years 2006 and 2009 in Turkey. Results During the study period 1460 subjects were enrolled and among them 841 (57%) met the criteria for probable bacterial meningitis. The mean age of subjects was 51 ± 47 months (range, 1–212 months). We performed the line probe assay in 751 (89%) CSF samples of 841 probable bacterial meningitis cases, of whom 431 (57%) were negative, 127 (17%) were positive for S. pneumoniae, 53 (7%) were positive for H. influenzae type b, and 41 (5%) were positive for N. meningitidis. The LPA was positive in 19 of 23 (82%) S. pneumoniae samples, 4 of 6 (67%) N. meningitidis samples and 2 of 2 (100%) Hib samples in CSF culture-positive cases. The specificity of the LPA for all of S. pneumoniae, H. influenzae type b, and N. meningitidis was 88% (95% CI: 85–91%), when using the standard PCR as a reference. The specificity of LPA for each of S. pneumoniae, H. influenzae type b, and N. meningitidis was 93% (95% CI: 89–95%), 96% (95% CI: 94–98%), and 99% (95% CI: 97–99%), respectively. For all of S. pneumoniae, H. influenzae type b and N. meningitidis the sensitivity of the LPA was 76% (95% CI: 70–82%) and for each of S. pneumoniae, H. influenzae type b and N. meningitidis was 72% (95% CI:63–79%), 88% (95% CI: 73–95%), and 81% (95% CI:67–92%), respectively. Conclusions The LPA assay can be used to detect common bacterial meningitis pathogens in CSF samples, but the assay requires further improvement.
Collapse
Affiliation(s)
- Ahmet Soysal
- Division of Pediatric Infectious Diseases, Marmara University Medical Faculty Department of Pediatrics, Istanbul, Turkey. .,Division of Pediatric Infectious Diseases, Marmara University Pendik Training and Research Hospital Department of Pediatrics, Mimar Sinan Street, No:41, Fevzi Cakmak Mah. Ust Kaynarca, Pendik, Istanbul, Turkey.
| | | | | | - Mustafa Bakir
- Division of Pediatric Infectious Diseases, Marmara University Medical Faculty Department of Pediatrics, Istanbul, Turkey
| |
Collapse
|
8
|
Maïnassara HB, Oumarou GI, Issaka B, Sidiki A, Idi I, Pelat JPM, Fontanet A, Mueller JE. Evaluation of response strategies against epidemics due to Neisseria meningitidis C in Niger. Trop Med Int Health 2016; 22:196-204. [PMID: 27860062 DOI: 10.1111/tmi.12815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To inform public health recommendations, we evaluated the effectiveness and efficiency of current and hypothetical surveillance and vaccine response strategies against Neisseria meningitidis C meningitis epidemics in 2015 in Niger. METHODS We analysed reports of suspected and confirmed cases of meningitis from the region of Dosso during 2014 and 2015. Based on a definition of epidemic signals, the effectiveness and efficiency of surveillance and vaccine response strategies were evaluated by calculating the number of potentially vaccine-preventable cases and number of vaccine doses needed per epidemic signal. RESULTS A total of 4763 weekly health area reports, collected in 90 health areas with 1282 suspected meningitis cases, were included. At a threshold of 10 per 100 000, the total number of estimated vaccine-preventable cases was 29 with district-level surveillance and vaccine response, 141 with health area-level surveillance and vaccination and 339 with health area-level surveillance and district-level vaccination. While being most effective, the latter strategy required the largest number of vaccine doses (1.8 million), similar to the strategy of surveillance and vaccination at district level (1.3 million), whereas the strategy of surveillance and vaccination at health area level would have required only 0.8 million doses. Thus, efficiency was lowest for district-level surveillance and highest for health area-level surveillance with district-level vaccination. CONCLUSION In this analysis, we found that effectiveness and efficiency were higher at health area-level surveillance and district-level vaccination than for other strategies. Use of N. meningitidis C vaccines in a preventive strategy thus should be considered, in particular as most reactive vaccine response strategies in our analysis had little impact on disease burden.
Collapse
Affiliation(s)
- Halima Boubacar Maïnassara
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger.,Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
| | | | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Ali Sidiki
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Issa Idi
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
| | - Judith E Mueller
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
| |
Collapse
|
9
|
Mihret W, Lema T, Merid Y, Kassu A, Abebe W, Moges B, Tenna A, Woldegebriel F, Yidnekachew M, Mekonnen W, Ahmed A, Yamuah L, Silamsaw M, Petros B, Oksnes J, Rosenqvist E, Ayele S, Aseffa A, Caugant DA, Norheim G. Surveillance of Bacterial Meningitis, Ethiopia, 2012-2013. Emerg Infect Dis 2016; 22:75-8. [PMID: 26689450 PMCID: PMC4696686 DOI: 10.3201/eid2201.150432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Among 139 patients with suspected bacterial meningitis in Ethiopia, 2012–2013, meningococci (19.4%) and pneumococci (12.9%) were the major disease-causing organisms. Meningococcal serogroups detected were A (n = 11), W (n = 7), C (n = 1), and X (n = 1). Affordable, multivalent meningitis vaccines for the African meningitis belt are urgently needed.
Collapse
|
10
|
Maïnassara HB, Paireau J, Idi I, Pelat JPM, Oukem-Boyer OOM, Fontanet A, Mueller JE. Response Strategies against Meningitis Epidemics after Elimination of Serogroup A Meningococci, Niger. Emerg Infect Dis 2016. [PMID: 26196461 PMCID: PMC4517723 DOI: 10.3201/eid2108.141361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Surveillance and epidemic vaccine response would be most effective at the health area level. To inform epidemic response strategies for the African meningitis belt after a meningococcal serogroup A conjugate vaccine was introduced in 2010, we compared the effectiveness and efficiency of meningitis surveillance and vaccine response strategies at district and health area levels using various thresholds of weekly incidence rates. We analyzed reports of suspected cases from 3 regions in Niger during 2002–2012 (154,392 health area weeks), simulating elimination of serogroup A meningitis by excluding health area years with identification of such cases. Effectiveness was highest for health area surveillance and district vaccination (58–366 cases; thresholds 7–20 cases/100,000 doses), whereas efficiency was optimized with health area vaccination (5.6–7.7 cases/100,000 doses). District-level intervention prevented <6 cases (0.2 cases/100,000 doses). Reducing the delay between epidemic signal and vaccine protection by 2 weeks doubled efficiency. Subdistrict surveillance and response might be most appropriate for meningitis epidemic response after elimination of serogroup A meningitis.
Collapse
|
11
|
Agnememel A, Traincard F, Dartevelle S, Mulard L, Mahamane AE, Oukem-Boyer OOM, Denizon M, Kacou-N Douba A, Dosso M, Gake B, Lombart JP, Taha MK. Development and evaluation of a dipstick diagnostic test for Neisseria meningitidis serogroup X. J Clin Microbiol 2015; 53:449-54. [PMID: 25411183 PMCID: PMC4298516 DOI: 10.1128/jcm.02444-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/13/2014] [Indexed: 11/20/2022] Open
Abstract
The emergence of Neisseria meningitidis serogroup X (NmX) in the African meningitis belt has urged the development of diagnostic tools and vaccines for this serogroup, especially following the introduction of a conjugate vaccine against N. meningitidis serogroup A (NmA). We have developed and evaluated a new rapid diagnostic test (RDT) for detecting the capsular polysaccharide (cps) antigen of this emerging serogroup. Whole inactivated NmX bacteria were used to immunize rabbits. Following purification by affinity chromatography, the cpsX-specific IgG antibodies were utilized to develop an NmX-specific immunochromatography dipstick RDT. The test was validated against purified cpsX and meningococcal strains of different serogroups. Its performance was evaluated against that of PCR on a collection of 369 cerebrospinal fluid (CSF) samples obtained from patients living in countries within the meningitis belt (Cameroon, Côte d'Ivoire, and Niger) or in France. The RDT was highly specific for NmX strains. Cutoffs of 10(5) CFU/ml and 1 ng/ml were observed for the reference NmX strain and purified cpsX, respectively. Sensitivity and specificity were 100% and 94%, respectively. A high agreement between PCR and RDT (Kappa coefficient, 0.98) was observed. The RDT gave a high positive likelihood ratio and a low negative likelihood (0.07), indicating almost 100% probability of declaring disease or not when the test is positive or negative, respectively. This unique NmX-specific test could be added to the available set of RDT for the detection of meningococcal meningitis in Africa as a major tool to reinforce epidemiological surveillance after the introduction of the NmA conjugate vaccine.
Collapse
Affiliation(s)
- Alain Agnememel
- Institut Pasteur, Invasive Bacterial Infection Unit, National Reference Centre for Meningococci, Paris, France WHO Collaborating Centre for Meningococci, Institut Pasteur, Paris, France Université Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - François Traincard
- Institut Pasteur, Plateforme d'Ingénierie des Anticorps (PFIA), Paris, France
| | - Sylvie Dartevelle
- Institut Pasteur, Plateforme d'Ingénierie des Anticorps (PFIA), Paris, France
| | - Laurence Mulard
- Institut Pasteur, Unité de Chimie des Biomolécules, Paris, France CNRS UMR 3523, Institut Pasteur, Paris, France
| | | | | | - Mélanie Denizon
- Institut Pasteur, Invasive Bacterial Infection Unit, National Reference Centre for Meningococci, Paris, France WHO Collaborating Centre for Meningococci, Institut Pasteur, Paris, France
| | | | | | - Bouba Gake
- Centre Pasteur Annexe de Garoua, Garoua, Cameroon
| | | | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infection Unit, National Reference Centre for Meningococci, Paris, France WHO Collaborating Centre for Meningococci, Institut Pasteur, Paris, France
| |
Collapse
|
12
|
Comparative study of bacteriological culture and real-time fluorescence quantitative PCR (RT-PCR) and multiplex PCR-based reverse line blot (mPCR/RLB) hybridization assay in the diagnosis of bacterial neonatal meningitis. BMC Pediatr 2014; 14:224. [PMID: 25200110 PMCID: PMC4165992 DOI: 10.1186/1471-2431-14-224] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/26/2014] [Indexed: 11/23/2022] Open
Abstract
Background Bacterial meningitis is more common in the neonatal period than any other time in life; however, it is still a challenge for the evidence based diagnosis. Strategy for identification of neonatal bacterial meningitis pathogens is presented by evaluating three different available methods to establish evidence-based diagnosis for neonatal bacterial meningitis. Methods The cerebrospinal fluid samples from 56 neonates diagnosed as bacterial meningitis in 2009 in Beijing Children’s Hospital were analyzed in the study. Two PCR based molecular assays, real-time fluorescence quantitative PCR (RT-PCR) and multiplex PCR based-reverse line blot hybridization (mPCR/RLB), were used to assess 7 common neonatal meningitis bacterial pathongens, including Escherichia coli, Staphylococcus aureus, Listerisa monocytogenes, Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, and Streptococcus agalactiae. The findings in examinations of two assays were compared with the results obtained bacterial culture tests. Results Bacterial meningitis was identified in five cases (9%) by CSF cultures, 25 (45%) by RT-PCR and 16 (29%) by mPCR/RLB. One strain of S. epidermidis and one of E. faecalis were identified using mPCR/RLB but not by RT-PCR. In contrast, cultures identified one strain of S. pneumoniae which was missed by both PCR assays. Overall, the bacterial pathogens in 28 cases were identified with these three methods. Both RT-PCR and mPCR/RLB assays were more sensitive than bacterial culture, (p < 0.05). Conclusion Our study confirmed that both RT-PCR and mPCR/RLB assays have better sensitivity than bacterial culture. They are capable of detecting the pathogens in CSF samples with negative culture results.
Collapse
|
13
|
Chanteau S. A country-wide field evaluation of rapid diagnostic test for meningococcal meningitis. Trans R Soc Trop Med Hyg 2014; 108:183-4. [DOI: 10.1093/trstmh/tru022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
14
|
Nørskov-Lauritsen N. Classification, identification, and clinical significance of Haemophilus and Aggregatibacter species with host specificity for humans. Clin Microbiol Rev 2014; 27:214-40. [PMID: 24696434 PMCID: PMC3993099 DOI: 10.1128/cmr.00103-13] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The aim of this review is to provide a comprehensive update on the current classification and identification of Haemophilus and Aggregatibacter species with exclusive or predominant host specificity for humans. Haemophilus influenzae and some of the other Haemophilus species are commonly encountered in the clinical microbiology laboratory and demonstrate a wide range of pathogenicity, from life-threatening invasive disease to respiratory infections to a nonpathogenic, commensal lifestyle. New species of Haemophilus have been described (Haemophilus pittmaniae and Haemophilus sputorum), and the new genus Aggregatibacter was created to accommodate some former Haemophilus and Actinobacillus species (Aggregatibacter aphrophilus, Aggregatibacter segnis, and Aggregatibacter actinomycetemcomitans). Aggregatibacter species are now a dominant etiology of infective endocarditis caused by fastidious organisms (HACEK endocarditis), and A. aphrophilus has emerged as an important cause of brain abscesses. Correct identification of Haemophilus and Aggregatibacter species based on phenotypic characterization can be challenging. It has become clear that 15 to 20% of presumptive H. influenzae isolates from the respiratory tracts of healthy individuals do not belong to this species but represent nonhemolytic variants of Haemophilus haemolyticus. Due to the limited pathogenicity of H. haemolyticus, the proportion of misidentified strains may be lower in clinical samples, but even among invasive strains, a misidentification rate of 0.5 to 2% can be found. Several methods have been investigated for differentiation of H. influenzae from its less pathogenic relatives, but a simple method for reliable discrimination is not available. With the implementation of identification by matrix-assisted laser desorption ionization-time of flight mass spectrometry, the more rarely encountered species of Haemophilus and Aggregatibacter will increasingly be identified in clinical microbiology practice. However, identification of some strains will still be problematic, necessitating DNA sequencing of multiple housekeeping gene fragments or full-length 16S rRNA genes.
Collapse
|
15
|
Collard JM, Issaka B, Zaneidou M, Hugonnet S, Nicolas P, Taha MK, Greenwood B, Jusot JF. Epidemiological changes in meningococcal meningitis in Niger from 2008 to 2011 and the impact of vaccination. BMC Infect Dis 2013; 13:576. [PMID: 24313998 PMCID: PMC4029580 DOI: 10.1186/1471-2334-13-576] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 12/04/2013] [Indexed: 01/11/2023] Open
Abstract
Background The epidemiology of bacterial meningitis in the African ‘meningitis belt’ changes periodically. In order to design an effective vaccination strategy, we have examined the epidemiological and microbiological patterns of bacterial meningitis, and especially that of meningococcal meningitis, in Niger during the period 2008–2011. During this period a mass vaccination campaign with the newly developed meningococcal A conjugate vaccine (MenAfriVac®) was undertaken. Method Cerebrospinal fluid samples were collected from health facilities throughout Niger and analysed by culture, seroagglutination and/or speciation polymerase chain reaction, followed by genogrouping PCR for Neisseria meningitidis infections. A sample of strains were analysed by multi-locus sequence typing. Results N. meningitidis serogroup A cases were prevalent in 2008 and 2009 [98.6% and 97.5% of all N. meningitidis cases respectively]. The prevalence of serogroup A declined in 2010 [26.4%], with the emergence of serogroup W Sequence Type (ST) 11 [72.2% of cases], and the serogroup A meningococcus finally disappeared in 2011. The geographical distribution of cases N. meningitidis serogroups A and W within Niger is described. Conclusion The substantial decline of serogroup A cases that has been observed from 2010 onwards in Niger seems to be due to several factors including a major polysaccharide A/C vaccination campaign in 2009, the introduction of MenAfriVac® in 10 districts at risk in December 2010, the natural dynamics of meningococcal infection and the persistence of serogroup A sequence-type 7 for about 10 years. The emergence of serogroup W strains suggests that there may be a need for serogroup W containing vaccines in Niger in the coming years.
Collapse
|
16
|
Collard JM, Wang X, Mahamane AE, Idi I, Issaka B, Ousseni M, Mayer LW, Nato F, Moulia-Pelat JP. A five-year field assessment of rapid diagnostic tests for meningococcal meningitis in Niger by using the combination of conventional and real-time PCR assays as a gold standard. Trans R Soc Trop Med Hyg 2013; 108:6-12. [DOI: 10.1093/trstmh/trt104] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
17
|
Elliott I, Dittrich S, Paris D, Sengduanphachanh A, Phoumin P, Newton PN. The use of dried cerebrospinal fluid filter paper spots as a substrate for PCR diagnosis of the aetiology of bacterial meningitis in the Lao PDR. Clin Microbiol Infect 2013; 19:E466-72. [PMID: 23738720 PMCID: PMC4285853 DOI: 10.1111/1469-0691.12260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/24/2013] [Accepted: 04/29/2013] [Indexed: 11/29/2022]
Abstract
We investigated whether dried cerebrospinal fluid (CSF) conserved on filter paper can be used as a substrate for accurate PCR diagnosis of important causes of bacterial meningitis in the Lao PDR. Using mock CSF, we investigated and optimized filter paper varieties, paper punch sizes, elution volumes and quantities of DNA template to achieve sensitive and reliable detection of bacterial DNA from filter paper specimens. FTA Elute Micro Card™ (Whatman, Maidstone, UK) was the most sensitive, consistent and practical variety of filter paper. Following optimization, the lower limit of detection for Streptococcus pneumoniae from dried mock CSF spots was 14 genomic equivalents (GE)/μL (interquartile range 5.5 GE/μL) or 230 (IQR 65) colony forming units/mL. A prospective clinical evaluation for S. pneumoniae, S. suis and Neisseria meningitidis was performed. Culture and PCR performed on fresh liquid CSF from patients admitted with a clinical diagnosis of meningitis (n = 73) were compared with results derived from dried CSF spots. Four of five fresh PCR-positive CSF samples also tested PCR positive from dried CSF spots, with one patient under the limit of detection. In a retrospective study of S. pneumoniae samples (n = 20), the median (IQR; range) CSF S. pneumoniae bacterial load was 1.1 × 10(4) GE/μL (1.2 × 10(5) ; 1 to 6.1 × 10(6) DNA GE/μL). Utilizing the optimized methodology, we estimate an extrapolated sensitivity of 90%, based on the range of CSF genome counts found in Laos. Dried CSF filter paper spots could potentially help us to better understand the epidemiology of bacterial meningitis in resource-poor settings and guide empirical treatments and vaccination policies.
Collapse
Affiliation(s)
- I Elliott
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | | | | | | | | | | |
Collapse
|
18
|
Collard JM, Alio Sanda AK, Jusot JF. Determination of pneumococcal serotypes in meningitis cases in Niger, 2003-2011. PLoS One 2013; 8:e60432. [PMID: 23555971 PMCID: PMC3610823 DOI: 10.1371/journal.pone.0060432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 02/26/2013] [Indexed: 11/19/2022] Open
Abstract
Background The epidemiology of pneumococcal meningitis in the African ‘meningitis belt’ is poorly studied. In order to ensure an effective vaccination strategy and post-vaccination surveillance, we examined the serotype distribution patterns of pneumococcal meningitis in Niger over the period 2003–2011. Methods Cerebrospinal fluid (CSF) samples were collected from different health facilities throughout Niger in the frame of the national microbiological surveillance of meningitis. Determination of the serotype of CSF positive for pneumococci was performed using a sequential multiplex PCR method (SM-PCR) adapted with a national algorithm in which 32 different serotypes were covered and grouped into eight consecutive PCR. Results The SM-PCR assay could predict the Sp serotype for 779 CSF (88.7%), 98 CSF (11.3%) were not-typeable in our national-adapted algorithm. In total, 26 different serotypes were identified. Serotype 1 (n = 393) was the most prevalent and accounted for 45.3% of infections, followed by serogroups/serotypes 12F/(12A)/(44)/(46) (7.3%), 6/(6A/6B/6C/6D) (5.4%), 14 (5.2%), 5 (4.6%), 23F (4.2%), 45 (3.6%), 2 (3.1%), 18/(18A/18B/18C/18F) (2.9%) and 17 others serotypes with a prevalence of less than 2%. The proportion of serotype 1 in infants(<2 years old) represented only 4.3% of the cases affected by this serotype. In contrast, serotypes 5, 6, 14, 19A and 23F were only detected in very young children. Conclusions The proportion of serotype 1 in the pneumococcal meningitis cases and the theoretical vaccine coverage across all age groups advocates for the introduction of a conjugate vaccine (PCV10 or 13) into the Expanded Programme on Immunization (EPI) in Niger. Post-vaccine introduction surveillance supported by molecular approaches will be essential to provide a comprehensive picture of the impact of the vaccine on the burden reduction of pneumococcal meningitis and on pneumococcal serotype distribution.
Collapse
|
19
|
Mueller JE. Conjugate vaccine introduction in the African meningitis belt: meeting surveillance objectives. Trop Med Int Health 2012; 18:58-64. [DOI: 10.1111/tmi.12009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Greenwood B, Chiarot E, MacLennan CA, O'Ryan M. Can we defeat meningococcal disease in low and middle income countries? Vaccine 2012; 30 Suppl 2:B63-6. [PMID: 22607901 DOI: 10.1016/j.vaccine.2011.12.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/10/2011] [Accepted: 12/13/2011] [Indexed: 12/21/2022]
Abstract
The development of multivalent conjugate and protein-based meningococcal vaccines may make global control of meningococcal disease possible. However, achieving control of meningococcal disease in low and middle income countries will be challenging. In low income countries whose vaccination programmes receive financial support from the Global Alliance for Vaccination and Immunisation, the main challenge is lack of sufficient epidemiological information to allow rational decisions on vaccine introduction to be made and, in these countries, enhanced surveillance is needed. In middle income countries, financial challenges predominate. These could be met by demonstration of the cost effectiveness of new meningococcal vaccines and through the introduction of a tiered-pricing system.
Collapse
Affiliation(s)
- Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK.
| | | | | | | |
Collapse
|
21
|
Bottomley MJ, Serruto D, Sáfadi MAP, Klugman KP. Future challenges in the elimination of bacterial meningitis. Vaccine 2012; 30 Suppl 2:B78-86. [PMID: 22607903 DOI: 10.1016/j.vaccine.2011.12.099] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/19/2011] [Accepted: 12/20/2011] [Indexed: 01/13/2023]
Abstract
Despite the widespread implementation of several effective vaccines over the past few decades, bacterial meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis and Group B Streptococcus (GBS) still results in unacceptably high levels of human mortality and morbidity. A residual disease burden due to bacterial meningitis is also apparent due to a number of persistent or emerging pathogens, including Mycobacterium tuberculosis, Escherichia coli, Staphylococcus aureus, Salmonella spp. and Streptococcus suis. Here, we review the current status of bacterial meningitis caused by these pathogens, highlighting how past and present vaccination programs have attempted to counter these pathogens. We discuss how improved pathogen surveillance, implementation of current vaccines, and development of novel vaccines may be expected to further reduce bacterial meningitis and related diseases in the future.
Collapse
|
22
|
A broad range assay for rapid detection and etiologic characterization of bacterial meningitis: performance testing in samples from sub-Sahara. Diagn Microbiol Infect Dis 2012; 74:22-7. [PMID: 22809694 DOI: 10.1016/j.diagmicrobio.2012.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/10/2012] [Accepted: 05/14/2012] [Indexed: 11/22/2022]
Abstract
This study aimed to conduct a pilot evaluation of broad-based multiprobe polymerase chain reaction (PCR) in clinical cerebrospinal fluid (CSF) samples compared to local conventional PCR/culture methods used for bacterial meningitis surveillance. A previously described PCR consisting of initial broad-based detection of Eubacteriales by a universal probe, followed by Gram typing, and pathogen-specific probes was designed targeting variable regions of the 16S rRNA gene. The diagnostic performance of the 16S rRNA assay in ""127 CSF samples was evaluated in samples from patients from Togo, Africa, by comparison to conventional PCR/culture methods. Our probes detected Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Uniprobe sensitivity and specificity versus conventional PCR were 100% and 54.6%, respectively. Sensitivity and specificity of uniprobe versus culture methods were 96.5% and 52.5%, respectively. Gram-typing probes correctly typed 98.8% (82/83) and pathogen-specific probes identified 96.4% (80/83) of the positives. This broad-based PCR algorithm successfully detected and provided species level information for multiple bacterial meningitis agents in clinical samples.
Collapse
|
23
|
Paireau J, Girond F, Collard JM, Maïnassara HB, Jusot JF. Analysing spatio-temporal clustering of meningococcal meningitis outbreaks in Niger reveals opportunities for improved disease control. PLoS Negl Trop Dis 2012; 6:e1577. [PMID: 22448297 PMCID: PMC3308932 DOI: 10.1371/journal.pntd.0001577] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 02/09/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Meningococcal meningitis is a major health problem in the "African Meningitis Belt" where recurrent epidemics occur during the hot, dry season. In Niger, a central country belonging to the Meningitis Belt, reported meningitis cases varied between 1,000 and 13,000 from 2003 to 2009, with a case-fatality rate of 5-15%. METHODOLOGY/PRINCIPAL FINDINGS In order to gain insight in the epidemiology of meningococcal meningitis in Niger and to improve control strategies, the emergence of the epidemics and their diffusion patterns at a fine spatial scale have been investigated. A statistical analysis of the spatio-temporal distribution of confirmed meningococcal meningitis cases was performed between 2002 and 2009, based on health centre catchment areas (HCCAs) as spatial units. Anselin's local Moran's I test for spatial autocorrelation and Kulldorff's spatial scan statistic were used to identify spatial and spatio-temporal clusters of cases. Spatial clusters were detected every year and most frequently occurred within nine southern districts. Clusters most often encompassed few HCCAs within a district, without expanding to the entire district. Besides, strong intra-district heterogeneity and inter-annual variability in the spatio-temporal epidemic patterns were observed. To further investigate the benefit of using a finer spatial scale for surveillance and disease control, we compared timeliness of epidemic detection at the HCCA level versus district level and showed that a decision based on threshold estimated at the HCCA level may lead to earlier detection of outbreaks. CONCLUSIONS/SIGNIFICANCE Our findings provide an evidence-based approach to improve control of meningitis in sub-Saharan Africa. First, they can assist public health authorities in Niger to better adjust allocation of resources (antibiotics, rapid diagnostic tests and medical staff). Then, this spatio-temporal analysis showed that surveillance at a finer spatial scale (HCCA) would be more efficient for public health response: outbreaks would be detected earlier and reactive vaccination would be better targeted.
Collapse
Affiliation(s)
- Juliette Paireau
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France.
| | | | | | | | | |
Collapse
|
24
|
Abstract
Despite current advances in antibiotic therapy and vaccines, meningococcal disease serogroup C (MDC) remains a serious threat to global health, particularly in countries in North and Latin America, Europe, and Asia. MDC is a leading cause of morbidity, mortality, and neurological sequelae and it is a heavy economic burden. At the individual level, despite advances in antibiotics and supportive therapies, case fatality rate remains nearly 10% and severe neurological sequelae are frequent. At the population level, prevention and control of infection is more challenging. The main approaches include health education, providing information to the public, specific treatment, chemoprophylaxis, and the use of vaccines. Plain and conjugate meningococcal C polysaccharide vaccines are considered safe, are well tolerated, and have been used successfully for over 30 years. Most high-income countries use vaccination as a part of public health strategies, and different meningococcal C vaccination schedules have proven to be effective in reducing incidence. This is particularly so with conjugate vaccines, which have been found to induce immunogenicity in infants (the age group with the highest incidence rates of disease), stimulate immunologic memory, have longer effects, not lead to hyporesponsiveness with repeated dosing, and decrease acquisition of nasopharyngeal carriage, inducing herd immunity. Antibiotics are considered a cornerstone of MDC treatment and must be administered empirically as soon as possible. The choice of which antibiotic to use should be made based on local antibiotic resistance, availability, and circulating strains. Excellent options for a 7-day course are penicillin, ampicillin, chloramphenicol, and third-generation cephalosporins (ceftriaxone and cefotaxime) intravenously, although the latter are considerably more expensive than the others. The use of steroids as adjunctive therapy for MDC is still controversial and remains a topic of debate. A combination of all of the aforementioned approaches is useful in the prevention and control of MDC, and each country should tailor its public health policy to its own particular needs and knowledge of disease burden.
Collapse
|
25
|
Sacchi CT, Fukasawa LO, Gonçalves MG, Salgado MM, Shutt KA, Carvalhanas TR, Ribeiro AF, Kemp B, Gorla MCO, Albernaz RK, Marques EGL, Cruciano A, Waldman EA, Brandileone MCC, Harrison LH. Incorporation of real-time PCR into routine public health surveillance of culture negative bacterial meningitis in São Paulo, Brazil. PLoS One 2011; 6:e20675. [PMID: 21731621 PMCID: PMC3120771 DOI: 10.1371/journal.pone.0020675] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 05/09/2011] [Indexed: 01/03/2023] Open
Abstract
Real-time (RT)-PCR increases diagnostic yield for bacterial meningitis and is ideal for incorporation into routine surveillance in a developing country. We validated a multiplex RT-PCR assay for Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae in Brazil. Risk factors for being culture-negative, RT-PCR positive were determined. The sensitivity of RT-PCR in cerebrospinal fluid (CSF) was 100% (95% confidence limits, 96.0%-100%) for N. meningitidis, 97.8% (85.5%-99.9%) for S. pneumoniae, and 66.7% (9.4%-99.2%) for H. influenzae. Specificity ranged from 98.9% to 100%. Addition of RT-PCR to routine microbiologic methods increased the yield for detection of S. pneumoniae, N. meningitidis, and H. influenzae cases by 52%, 85%, and 20%, respectively. The main risk factor for being culture negative and RT-PCR positive was presence of antibiotic in CSF (odds ratio 12.2, 95% CI 5.9-25.0). RT-PCR using CSF was highly sensitive and specific and substantially added to measures of meningitis disease burden when incorporated into routine public health surveillance in Brazil.
Collapse
Affiliation(s)
- Claudio T Sacchi
- Division of Medical Biology, Department of Immunology, Instituto Adolfo Lutz, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Microbiological and epidemiological investigation of the Neisseria meningitidis serogroup A epidemic in Niger in 2009: last wave before the introduction of the serogroup A meningococcal conjugate vaccine? Epidemiol Infect 2011; 139:1656-60. [PMID: 21251346 DOI: 10.1017/s0950268810003092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The 2009 meningitis season in Niger was characterized by an early onset, beginning in the very first weeks of the year and peaking from the 12th to the 15th week with 5655 clinical cases over the 4 weeks. From 1 January 2009 to 28 June 2009 (week 26), a total of 13,733 clinical cases of meningitis were reported to the national epidemiological surveillance system with a case-fatality rate of 4·2%. During the season 25 of the 42 health districts reached the epidemic threshold and 11 the alert threshold. Reactive mass vaccination campaigns involving a total of 5 166,741 doses of the polysaccharide meningococcal bivalent (A+C) vaccine progressively controlled the outbreak in most parts of the country. A total of 3755 cerebrospinal fluid samples representing 28·1% of the suspected meningitis cases were analysed. Serogroup A meningococci were the causative agent in 97·5% of the meningococcal cases. Multi-locus sequence typing of 26 meningococal serogroup A strains showed 25 sequence type (ST)7 and one ST2859, both sequence types belonging to the ST5 clonal complex (CC5) of subgroup III. This is the largest epidemic observed in Niger since those of 1995-1996 (59,948 notified cases) and 2000 (14,633 notified cases).
Collapse
|
27
|
Collard JM, Maman Z, Yacouba H, Djibo S, Nicolas P, Jusot JF, Rocourt J, Maitournam R. Increase in Neisseria meningitidis serogroup W135, Niger, 2010. Emerg Infect Dis 2010; 16:1496-8. [PMID: 20735947 PMCID: PMC3294991 DOI: 10.3201/eid1609.100510] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
28
|
Abstract
We piloted a low-cost approach to measure the disease burden of Streptococcus pneumoniae, Hib and Salmonella Typhi by leveraging the existing infrastructure of high performing microbiology laboratories at two large paediatric hospitals in Dhaka Bangladesh, and assessing the hospital utilization of the catchment population of these hospitals for different syndromes. S. Typhi was the most common bacterium identified in culture and accounted for an estimated 211 hospitalizations per 100,000 children <5 years of age per year. Meningitis due to S. pneumoniae was the most common cause of mortality accounting for 8.0 deaths per 100,000 children <5 years of age per year. This low-cost approach can provide data to support vaccine introduction and the health impact of newly introduced vaccines.
Collapse
|
29
|
Rose AMC, Mueller JE, Gerstl S, Njanpop-Lafourcade BM, Page AL, Nicolas P, Traoré RO, Caugant DA, Guerin PJ. Meningitis dipstick rapid test: evaluating diagnostic performance during an urban Neisseria meningitidis serogroup A outbreak, Burkina Faso, 2007. PLoS One 2010; 5:e11086. [PMID: 20552035 PMCID: PMC2884039 DOI: 10.1371/journal.pone.0011086] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 05/20/2010] [Indexed: 11/18/2022] Open
Abstract
Meningococcal meningitis outbreaks occur every year during the dry season in the “meningitis belt” of sub-Saharan Africa. Identification of the causative strain is crucial before launching mass vaccination campaigns, to assure use of the correct vaccine. Rapid agglutination (latex) tests are most commonly available in district-level laboratories at the beginning of the epidemic season; limitations include a short shelf-life and the need for refrigeration and good technical skills. Recently, a new dipstick rapid diagnostic test (RDT) was developed to identify and differentiate disease caused by meningococcal serogroups A, W135, C and Y. We evaluated the diagnostic performance of this dipstick RDT during an urban outbreak of meningitis caused by N. meningitidis serogroup A in Ouagadougou, Burkina Faso; first against an in-country reference standard of culture and/or multiplex PCR; and second against culture and/or a highly sensitive nested PCR technique performed in Oslo, Norway. We included 267 patients with suspected acute bacterial meningitis. Using the in-country reference standard, 50 samples (19%) were positive. Dipstick RDT sensitivity (N = 265) was 70% (95%CI 55–82) and specificity 97% (95%CI 93–99). Using culture and/or nested PCR, 126/259 (49%) samples were positive; dipstick RDT sensitivity (N = 257) was 32% (95%CI 24–41), and specificity was 99% (95%CI 95–100). We found dipstick RDT sensitivity lower than values reported from (i) assessments under ideal laboratory conditions (>90%), and (ii) a prior field evaluation in Niger [89% (95%CI 80–95)]. Specificity, however, was similar to (i), and higher than (ii) [62% (95%CI 48–75)]. At this stage in development, therefore, other tests (e.g., latex) might be preferred for use in peripheral health centres. We highlight the value of field evaluations for new diagnostic tests, and note relatively low sensitivity of a reference standard using multiplex vs. nested PCR. Although the former is the current standard for bacterial meningitis surveillance in the meningitis belt, nested PCR performed in a certified laboratory should be used as an absolute reference when evaluating new diagnostic tests.
Collapse
|
30
|
Nikièma A, Toé L, Adjami G, Ouédraogo Traoré R. [Effectiveness of a polymerase chain reaction using seminested and multiplex strategy for the identification of the three main bacteria responsible for meningitis in Burkina Faso]. BULLETIN DE LA SOCIETE DE PATHOLOGIE EXOTIQUE (1990) 2010; 103:8-13. [PMID: 20084483 DOI: 10.1007/s13149-009-0003-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 03/17/2009] [Indexed: 05/28/2023]
Abstract
A prospective study (from August 2006 to April 2007) was carried out with 214 cerebrospinal fluid samples with suspicion of bacterial meningitis. The aim of the study was to assess the effectiveness of the simultaneous detection of Neisseria meningitidis, Streptococcus sp. and Haemophilus influenzae using seminested polymerase chain reaction strategy. Among the 214 samples tested by both PCR and culture, the overall confirmation rate was 64% for PCR and 40.1% for culture (P = 2 x 10⁻⁶). Taking culture method as the standard reference, the overall sensitivity of PCR was 98.8% and specificity, 59.4%. The sensitivity of PCR was 100, 97.3 and 100% respectively for N. meningitidis, Streptococcus sp. and H. influenzae with respective specificities of 70, 93.2 and 97.2%. In conclusion, the seminested PCR strategy is a sensitive method and it can be implemented in the reference public health laboratories for an exhaustive microbiological surveillance of bacterial meningitis.
Collapse
Affiliation(s)
- A Nikièma
- Université de Ouagadougou, 3, BP 7021 Ouagadougou 03,Burkina Faso.
| | | | | | | |
Collapse
|
31
|
Mangham LJ, Hanson K. Scaling up in international health: what are the key issues? Health Policy Plan 2010; 25:85-96. [PMID: 20071454 DOI: 10.1093/heapol/czp066] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The term 'scaling up' is now widely used in the international health literature, though it lacks an agreed definition. We review what is meant by scaling up in the context of changes in international health and development over the last decade. We argue that the notion of scaling up is primarily used to describe the ambition or process of expanding the coverage of health interventions, though the term has also referred to increasing the financial, human and capital resources required to expand coverage. We discuss four pertinent issues in scaling up the coverage of health interventions: the costs of scaling up coverage; constraints to scaling up; equity and quality concerns; and key service delivery issues when scaling up. We then review recent progress in scaling up the coverage of health interventions. This includes a considerable increase in the volume of aid, accompanied by numerous new health initiatives and financing mechanisms. There have also been improvements in health outcomes and some examples of successful large-scale programmes. Finally, we reflect on the importance of obtaining a better understanding of how to deliver priority health interventions at scale, the current emphasis on health system strengthening and the challenges of sustaining scaling up in the prevailing global economic environment.
Collapse
Affiliation(s)
- Lindsay J Mangham
- Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | | |
Collapse
|
32
|
Rose AMC, Gerstl S, Mahamane AEH, Sidikou F, Djibo S, Bonte L, Caugant DA, Guerin PJ, Chanteau S. Field evaluation of two rapid diagnostic tests for Neisseria meningitidis serogroup A during the 2006 outbreak in Niger. PLoS One 2009; 4:e7326. [PMID: 19802392 PMCID: PMC2752163 DOI: 10.1371/journal.pone.0007326] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 08/10/2009] [Indexed: 11/19/2022] Open
Abstract
The Pastorex((R)) (BioRad) rapid agglutination test is one of the main rapid diagnostic tests (RDTs) for meningococcal disease currently in use in the "meningitis belt". Earlier evaluations, performed after heating and centrifugation of cerebrospinal fluid (CSF) samples, under good laboratory conditions, showed high sensitivity and specificity. However, during an epidemic, the test may be used without prior sample preparation. Recently a new, easy-to-use dipstick RDT for meningococcal disease detection on CSF was developed by the Centre de Recherche Médicale et Sanitaire in Niger and the Pasteur Institute in France. We estimate diagnostic accuracy in the field during the 2006 outbreak of Neisseria meningitidis serogroup A in Maradi, Niger, for the dipstick RDT and Pastorex((R)) on unprepared CSF, (a) by comparing each test's sensitivity and specificity with previously reported values; and (b) by comparing results for each test on paired samples, using McNemar's test. We also (c) estimate diagnostic accuracy of the dipstick RDT on diluted whole blood. We tested unprepared CSF and diluted whole blood from 126 patients with suspected meningococcal disease presenting at four health posts. (a) Pastorex((R)) sensitivity (69%; 95%CI 57-79) was significantly lower than found previously for prepared CSF samples [87% (81-91); or 88% (85-91)], as was specificity [81% (95%CI 68-91) vs 93% (90-95); or 93% (87-96)]. Sensitivity of the dipstick RDT [89% (95%CI 80-95)] was similar to previously reported values for ideal laboratory conditions [89% (84-93) and 94% (90-96)]. Specificity, at 62% (95%CI 48-75), was significantly lower than found previously [94% (92-96) and 97% (94-99)]. (b) McNemar's test for the dipstick RDT vs Pastorex((R)) was statistically significant (p<0.001). (c) The dipstick RDT did not perform satisfactorily on diluted whole blood (sensitivity 73%; specificity 57%).Sensitivity and specificity of Pastorex((R)) without prior CSF preparation were poorer than previously reported results from prepared samples; therefore we caution against using this test during an epidemic if sample preparation is not possible. For the dipstick RDT, sensitivity was similar to, while specificity was not as high as previously reported during a more stable context. Further studies are needed to evaluate its field performance, especially for different populations and other serogroups.
Collapse
|
33
|
Trotter CL, Maiden MCJ. Meningococcal vaccines and herd immunity: lessons learned from serogroup C conjugate vaccination programs. Expert Rev Vaccines 2009; 8:851-61. [PMID: 19538112 PMCID: PMC3988355 DOI: 10.1586/erv.09.48] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Effective vaccines provide direct protection to immunized individuals, but may also provide benefits to unvaccinated individuals by reducing transmission and thereby lowering the risk of infection. Such herd immunity effects have been demonstrated following the introduction of meningococcal serogroup C conjugate (MCC) vaccines, with reductions in disease attack rates in unimmunized individuals and significantly lower serogroup C carriage attributable to the vaccine introduction. In the UK, targeting teenagers for immunization was crucial in maximizing indirect effects, as most meningococcal transmission occurs in this age group. Questions remain regarding the duration of herd protection and the most appropriate long-term immunization strategies. The magnitude of the herd effects following MCC vaccination was largely unanticipated, and has important consequences for the design and evaluation of new meningococcal vaccines.
Collapse
Affiliation(s)
- Caroline L Trotter
- Department of Social Medicine, University of Bristol, Canynge Hall, Bristol, UK.
| | | |
Collapse
|
34
|
Carbonnelle E. Apport des examens biologiques dans le diagnostic positif, la détermination de l’étiologie et le suivi d’une méningite suspectée bactérienne. Med Mal Infect 2009; 39:581-605. [DOI: 10.1016/j.medmal.2009.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 01/03/2023]
|
35
|
Abstract
As reviewed in this paper, meningococcal disease epidemiology varies substantially by geographic area and time. The disease can occur as sporadic cases, outbreaks, and large epidemics. Surveillance is crucial for understanding meningococcal disease epidemiology, as well as the need for and impact of vaccination. Despite limited data from some regions of the world and constant change, current meningococcal disease epidemiology can be summarized by region. By far the highest incidence of meningococcal disease occurs in the meningitis belt of sub-Saharan Africa. During epidemics, the incidence can approach 1000 per 100,000, or 1% of the population. Serogroup A has been the most important serogroup in this region. However, serogroup C disease has also occurred, as has serogroup X disease and, most recently, serogroup W-135 disease. In the Americas, the reported incidence of disease, in the range of 0.3-4 cases per 100,000 population, is much lower than in the meningitis belt. In addition, in some countries such as the United States, the incidence is at an historical low. The bulk of the disease in the Americas is caused by serogroups C and B, although serogroup Y causes a substantial proportion of infections in some countries and W-135 is becoming increasingly problematic as well. The majority of meningococcal disease in European countries, which ranges in incidence from 0.2 to 14 cases per 100,000, is caused by serogroup B strains, particularly in countries that have introduced serogroup C meningococcal conjugate vaccines. Serogroup B also predominates in Australia and New Zealand, in Australia because of the control of serogroup C disease through vaccination and in New Zealand because of a serogroup B epidemic. Based on limited data, most disease in Asia is caused by serogroup A and C strains. Although this review summarizes the current status of meningococcal disease epidemiology, the dynamic nature of this disease requires ongoing surveillance both to provide data for vaccine formulation and vaccine policy and to monitor the impact of vaccines following introduction.
Collapse
|
36
|
Boisier P, Elhaj Mahamane A, Amadou Hamidou A, Sidikou F, Djibo S, Nato F, Chanteau S. Field evaluation of rapid diagnostic tests for meningococcal meningitis in Niger. Trop Med Int Health 2009; 14:111-7. [DOI: 10.1111/j.1365-3156.2008.02192.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Laboratory-based surveillance for patients with acute meningitis in Sudan, 2004–2005. Eur J Clin Microbiol Infect Dis 2008; 28:429-35. [DOI: 10.1007/s10096-008-0643-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 10/03/2008] [Indexed: 10/21/2022]
|
38
|
|
39
|
Tuyama M, Boente RF, Rebelo MC, Igreja RP, Barroso DE. The utility of the polymerase chain reaction assay for aetiologic definition of unspecified bacterial meningitis cases. Mem Inst Oswaldo Cruz 2008; 103:138-42. [DOI: 10.1590/s0074-02762008000200003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 03/20/2008] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mari Tuyama
- Fiocruz, Brasil; Universidade Federal do Rio de Janeiro, Brasil
| | | | - Maria C Rebelo
- Instituto Estadual de Infectologia São Sebastião, Brasil
| | | | | |
Collapse
|
40
|
Detección por reacción en cadena de la polimerasa de transcriptasa inversa del virus de la fiebre amarilla en monos silvestres: una herramienta sensible para la vigilancia epidemiológica. BIOMEDICA 2007. [DOI: 10.7705/biomedica.v27i3.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
41
|
Chanteau S, Rose AMC, Djibo S, Nato F, Boisier P. Biological diagnosis of meningococcal meningitis in the African meningitis belt: Current epidemic strategy and new perspectives. Vaccine 2007; 25 Suppl 1:A30-6. [PMID: 17517452 DOI: 10.1016/j.vaccine.2007.04.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Laboratory diagnosis is an essential component in surveillance of meningococcal epidemics, as it can inform decision-makers of the Neisseria meningitidis serogroup(s) involved and the most appropriate vaccine to be selected for mass vaccination. However, countries most affected face real limitations in laboratory diagnostics, due to lack of resources. We describe current diagnostic tools and examine their cost-effectiveness for use in an epidemic context. The conclusion is that current WHO recommendations to use only the latex agglutination assay (Pastorex) at epidemic onset is cost-effective, but recently developed rapid diagnostic tests for the major epidemic-causing meningococcal serogroups may prove a breakthrough for the future.
Collapse
Affiliation(s)
- Suzanne Chanteau
- CERMES, Réseau International Institut Pasteur, PO Box 10887, Niamey, Niger.
| | | | | | | | | |
Collapse
|
42
|
Afifi S, Wasfy MO, Azab MA, Youssef FG, Pimentel G, Graham TW, Mansour H, Elsayed N, Earhart K, Hajjeh R, Mahoney F. Laboratory-based surveillance of patients with bacterial meningitis in Egypt (1998–2004). Eur J Clin Microbiol Infect Dis 2007; 26:331-40. [PMID: 17404766 DOI: 10.1007/s10096-007-0280-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Laboratory-based surveillance for bacterial meningitis was conducted in a network of infectious disease hospitals in Egypt to better understand the epidemiology of this infection. Healthcare and laboratory personnel were trained in basic surveillance and microbiologic processing of cerebrospinal fluid (CSF) specimens. All bacterial isolates from CSF were confirmed and tested for antimicrobial susceptibility. PCR testing was performed on a random subset of purulent, culture-negative CSF specimens. Of 11,070 patients who met criteria for the case definition, 843 (8%) were culture positive (42% positive for Streptococcus pneumoniae, 20% for Haemophilus influenzae serotype b, 17% for each of Neisseria meningitidis and Mycobacterium tuberculosis, and 6% for other bacteria). Of 1,784 (46%) CSF specimens tested by PCR, 232 (13%) were positive for the first three major pathogens. Of N. meningitidis isolates, 52% belonged to serogroup A, 35% to serogroup B, and 4% to serogroup W135. S. pneumoniae isolates comprised 46 different serotypes, of which 6B, 1, 19A, 23F, and 6A were the most predominant. The overall case-fatality rate for culture-positive cases was 26% and was highest among patients with M. tuberculosis (47%). Factors significantly associated with death (p < 0.05) included admission to rural hospitals, long prodromal period, referral from other hospitals, antibiotic treatment prior to admission, and clear CSF (<100 cells/mm3). Susceptibility to ampicillin and ceftriaxone was observed in 44 and 100% of H. influenzae serotype b isolates and in 52 and 94% of S. pneumoniae isolates, respectively. This surveillance highlights the significant mortality and morbidity associated with bacterial meningitis in Egypt. Decision makers need to review current treatment guidelines and introduce appropriate vaccines for prevention and control of the disease.
Collapse
Affiliation(s)
- S Afifi
- Disease Surveillance Program, US Naval Medical Research Unit No. 3, FPO, AE 09835, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Boisier P, Nicolas P, Djibo S, Taha MK, Jeanne I, Maïnassara HB, Tenebray B, Kairo KK, Giorgini D, Chanteau S. Meningococcal meningitis: unprecedented incidence of serogroup X-related cases in 2006 in Niger. Clin Infect Dis 2007; 44:657-63. [PMID: 17278055 DOI: 10.1086/511646] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 11/25/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In Niger, epidemic meningococcal meningitis is primarily caused by Neisseria meningitidis (Nm) serogroup A. However, since 2002, Nm serogroup W135 has been considered to be a major threat that has not yet been realized, and an unprecedented incidence of Nm serogroup X (NmX) meningitis was observed in 2006. METHODS Meningitis surveillance in Niger is performed on the basis of reporting of clinically suspected cases. Cerebrospinal fluid specimens are sent to the reference laboratory in Niamey, Niger. Culture, latex agglutination, and polymerase chain reaction are used whenever appropriate. Since 2004, after the addition of a polymerase chain reaction-based nonculture assay that was developed to genogroup isolates of NmX, polymerase chain reaction testing allows for the identification of Nm serogroup A, Nm serogroup B, Nm serogroup C, NmX, Nm serogroup Y, and Nm serogroup W135. RESULTS From January to June 2006, a total of 4185 cases of meningitis were reported, and 2905 cerebrospinal fluid specimens were laboratory tested. NmX meningitis represented 51% of 1139 confirmed cases of meningococcal meningitis, but in southwestern Niger, it represented 90%. In the agglomeration of Niamey, the reported cumulative incidence of meningitis was 73 cases per 100,000 population and the cumulative incidence of confirmed NmX meningitis was 27.5 cases per 100,000 population (74.6 cases per 100,000 population in children aged 5-9 years). NmX isolates had the same phenotype (X : NT : P1.5), and all belonged to the same sequence type (ST-181) as the NmX isolates that were circulating in Niamey in the 1990s. Nm serogroup W135 represented only 2.1% of identified meningococci. CONCLUSIONS This is, to our knowledge, the first report of such a high incidence of NmX meningitis, although an unusually high incidence of NmX meningitis was also observed in the 1990s in Niamey. The increasing incidence of NmX meningitis is worrisome, because no vaccine has been developed against this serogroup. Countries in the African meningitis belt must prepare to face this potential new challenge.
Collapse
Affiliation(s)
- Pascal Boisier
- Centre de Recherche Médicale et Sanitaire, Réseau International des Instituts Pasteur, Niamey, Niger.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
PURPOSE OF REVIEW Bacterial meningitis is a condition in which inflammation plays a role in disease resolution and also contributes to morbidity. Markers of inflammation may be used to aid in establishing diagnoses and prognoses. Medical management aimed at modulating the inflammatory response with broadly active, potent glucocorticosteroids has proved useful as an adjunct to antimicrobial therapy in selected patient populations. Basic immunobiologists, in describing components of the immune response that define its features of specificity, recognition, activation, regulation and tolerance induction have opened the door for the development of agents with focused activity that permit selective immunomodulation. New insights regarding management may result from a better understanding of the role of inflammation in bacterial meningitis. RECENT FINDINGS Insights have been gained from recent basic and clinical scientific investigations that examine the components and consequences of inflammation in animal models and patients with bacterial meningitis. SUMMARY This issue of Current Opinion in Neurology addresses recent reports that illustrate aspects of the inflammatory responses associated with bacterial meningitis that emphasize the need for early diagnosis, and contribute to prognosis assessment, and reviews the investigations that may predict the next steps in the evolution of clinical management.
Collapse
Affiliation(s)
- Robert P Nelson
- Division of Hematology/Oncology, Hematological Malignancy/Immunology Program, Indianapolis, Indiana 46202, USA.
| |
Collapse
|
45
|
Chanteau S, Dartevelle S, Mahamane AE, Djibo S, Boisier P, Nato F. New rapid diagnostic tests for Neisseria meningitidis serogroups A, W135, C, and Y. PLoS Med 2006; 3:e337. [PMID: 16953658 PMCID: PMC1563501 DOI: 10.1371/journal.pmed.0030337] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 05/19/2006] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Outbreaks of meningococcal meningitis (meningitis caused by Neisseria meningitidis) are a major public health concern in the African "meningitis belt," which includes 21 countries from Senegal to Ethiopia. Of the several species that can cause meningitis, N. meningitidis is the most important cause of epidemics in this region. In choosing the appropriate vaccine, accurate N. meningitidis serogroup determination is key. To this end, we developed and evaluated two duplex rapid diagnostic tests (RDTs) for detecting N. meningitidis polysaccharide (PS) antigens of several important serogroups. METHODS AND FINDINGS Mouse monoclonal IgG antibodies against N. meningitidis PS A, W135/Y, Y, and C were used to develop two immunochromatography duplex RDTs, RDT1 (to detect serogroups A and W135/Y) and RDT2 (to detect serogroups C and Y). Standards for Reporting of Diagnostic Accuracy criteria were used to determine diagnostic accuracy of RDTs on reference strains and cerebrospinal fluid (CSF) samples using culture and PCR, respectively, as reference tests. The cutoffs were 10(5) cfu/ml for reference strains and 1 ng/ml for PS. Sensitivities and specificities were 100% for reference strains, and 93.8%-100% for CSF serogroups A, W135, and Y in CSF. For CSF serogroup A, the positive and negative likelihood ratios (+/- 95% confidence intervals [CIs]) were 31.867 (16.1-63.1) and 0.065 (0.04-0.104), respectively, and the diagnostic odds ratio (+/- 95% CI) was 492.9 (207.2-1,172.5). For CSF serogroups W135 and Y, the positive likelihood ratio was 159.6 (51.7-493.3) Both RDTs were equally reliable at 25 degrees C and 45 degrees C. CONCLUSIONS These RDTs are important new bedside diagnostic tools for surveillance of meningococcus serogroups A and W135, the two serogroups that are responsible for major epidemics in Africa.
Collapse
MESH Headings
- Africa/epidemiology
- Antibodies, Monoclonal
- Chromatography/methods
- Evaluation Studies as Topic
- Humans
- Likelihood Functions
- Meningitis, Meningococcal/cerebrospinal fluid
- Meningitis, Meningococcal/diagnosis
- Meningitis, Meningococcal/epidemiology
- Meningitis, Meningococcal/immunology
- Neisseria meningitidis, Serogroup A/immunology
- Neisseria meningitidis, Serogroup A/isolation & purification
- Neisseria meningitidis, Serogroup C/immunology
- Neisseria meningitidis, Serogroup C/isolation & purification
- Neisseria meningitidis, Serogroup W-135/immunology
- Neisseria meningitidis, Serogroup W-135/isolation & purification
- Neisseria meningitidis, Serogroup Y/immunology
- Neisseria meningitidis, Serogroup Y/isolation & purification
- Polymerase Chain Reaction/methods
- Predictive Value of Tests
- Prospective Studies
- Reagent Kits, Diagnostic
- Reproducibility of Results
- Sensitivity and Specificity
- Serotyping
- Time Factors
Collapse
|