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Bita Fouda AA, Latt A, Sinayoko A, Mboussou FFR, Pezzoli L, Fernandez K, Lingani C, Miwanda B, Bulemfu D, Baelongandi F, Likita PM, Kikoo Bora MJ, Sabiti M, Folefack Tengomo GL, Kabambi Kabangu E, Kalambayi Kabamba G, Alassani I, Taha MK, Bwaka AM, Wiysonge CS, Impouma B. The Bacterial Meningitis Epidemic in Banalia in the Democratic Republic of Congo in 2021. Vaccines (Basel) 2024; 12:461. [PMID: 38793712 PMCID: PMC11125935 DOI: 10.3390/vaccines12050461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The Banalia health zone in the Democratic Republic of Congo reported a meningitis epidemic in 2021 that evolved outside the epidemic season. We assessed the effects of the meningitis epidemic response. METHODS The standard case definition was used to identify cases. Care was provided to 2651 in-patients, with 8% of them laboratory tested, and reactive vaccination was conducted. To assess the effects of reactive vaccination and treatment with ceftriaxone, a statistical analysis was performed. RESULTS Overall, 2662 suspected cases of meningitis with 205 deaths were reported. The highest number of cases occurred in the 30-39 years age group (927; 38.5%). Ceftriaxone contributed to preventing deaths with a case fatality rate that decreased from 70.4% before to 7.7% after ceftriaxone was introduced (p = 0.001). Neisseria meningitidis W was isolated, accounting for 47/57 (82%), of which 92% of the strains belonged to the clonal complex 11. Reactive vaccination of individuals in Banalia aged 1-19 years with a meningococcal multivalent conjugate (ACWY) vaccine (Menactra®) coverage of 104.6% resulted in an 82% decline in suspected meningitis cases (incidence rate ratio, 0.18; 95% confidence interval, 0.02-0.80; p = 0.041). CONCLUSION Despite late detection (two months) and reactive vaccination four months after crossing the epidemic threshold, interventions implemented in Banalia contributed to the control of the epidemic.
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Affiliation(s)
| | - Anderson Latt
- World Health Organization Emergencies Hub, Dakar P.O. Box 36, Senegal
| | - Abdoulaye Sinayoko
- World Health Organization Country Office Kinshasa, DRC, Kinshasa P.O. Box 06, Congo
| | | | | | | | - Clement Lingani
- World Health Organization Inter-Country Support West Africa, Ouagadougou 03 BP 7019, Burkina Faso
| | - Berthe Miwanda
- Institut National de Recherche Biomédicale, DRC, Kinshasa P.O. Box 1192, Congo
| | - Dorothée Bulemfu
- Ministry of Public Health Hygiene and Prevention, DRC, Kinshasa P.O. Box 1192, Congo
| | - Francis Baelongandi
- Ministry of Public Health Hygiene and Prevention, DRC, Kinshasa P.O. Box 1192, Congo
| | - Patrick Mbenga Likita
- Ministry of Public Health Hygiene and Prevention, DRC, Kinshasa P.O. Box 1192, Congo
| | - Marie-José Kikoo Bora
- Ministry of Public Health Hygiene and Prevention, DRC, Kinshasa P.O. Box 1192, Congo
| | - Marcel Sabiti
- Ministry of Public Health Hygiene and Prevention, DRC, Kinshasa P.O. Box 1192, Congo
| | | | | | | | - Issifou Alassani
- World Health Organization Country Office, Lome P.O. Box 1504, Togo
| | | | - Ado Mpia Bwaka
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Charles Shey Wiysonge
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Benido Impouma
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
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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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Obaro S, Hassan-Hanga F, Medugu N, Olaosebikan R, Olanipekun G, Jibir B, Gambo S, Ajose T, Duru C, Ebruke B, Davies HD. Comparison of bacterial culture with BioFire® FilmArray® multiplex PCR screening of archived cerebrospinal fluid specimens from children with suspected bacterial meningitis in Nigeria. BMC Infect Dis 2023; 23:641. [PMID: 37784010 PMCID: PMC10544496 DOI: 10.1186/s12879-023-08645-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Diagnosis of bacterial meningitis remains a challenge in most developing countries due to low yield from bacterial culture, widespread use of non-prescription antibiotics, and weak microbiology laboratories. The objective of this study was to compare the yield from standard bacterial culture with the multiplex nested PCR platform, the BioFire® FilmArray® Meningitis/Encephalitis Panel (BioFire ME Panel), for cases with suspected acute bacterial meningitis. METHODS Following Gram stain and bacterial culture on cerebrospinal fluid (CSF) collected from children aged less than 5 years with a clinical suspicion of acute bacterial meningitis (ABM) as defined by the WHO guidelines, residual CSF specimens were frozen and later tested by BioFire ME Panel. RESULTS A total of 400 samples were analyzed. Thirty-two [32/400 (8%)] of the specimens were culture positive, consisting of; three Salmonella spp. (2 Typhi and 1 non-typhi), three alpha hemolytic Streptococcus, one Staphylococcus aureus, six Neisseria meningitidis, seven Hemophilus influenzae, 11 Streptococcus pneumoniae and 368 were culture negative. Of the 368 culture-negative specimens, the BioFire ME Panel detected at least one bacterial pathogen in 90 (24.5%) samples, consisting of S. pneumoniae, N. meningitidis and H. influenzae, predominantly. All culture positive specimens for H. influenzae, N. meningitidis and S. pneumoniae also tested positive with the BioFire ME Panel. In addition, 12 specimens had mixed bacterial pathogens identified. For the first time in this setting, we have data on the viral agents associated with meningitis. Single viral agents were detected in 11 (2.8%) samples while co-detections with bacterial agents or other viruses occurred in 23 (5.8%) of the samples. CONCLUSIONS The BioFire® ME Panel was more sensitive and rapid than culture for detecting bacterial pathogens in CSF. The BioFire® ME Panel also provided for the first time, the diagnosis of viral etiologic agents that are associated with meningoencephalitis in this setting. Institution of PCR diagnostics is recommended as a routine test for suspected cases of ABM to enhance early diagnosis and optimal treatment.
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Affiliation(s)
- S Obaro
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, US
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - F Hassan-Hanga
- Department of Pediatrics, Aminu Kano Teaching Hospital, Bayero University/ Bayero University, Kano, Nigeria
| | - N Medugu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria.
- Department of Medical Microbiology and Immunology, Nile University of Nigeria, Abuja, Nigeria.
| | - R Olaosebikan
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, US
| | - G Olanipekun
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - B Jibir
- Hasiya Bayero Pediatric Hospital, Kano, Nigeria
| | - S Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Theresa Ajose
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - Carissa Duru
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - B Ebruke
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - H D Davies
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, US
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4
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Mbaeyi S, Sampo E, Dinanibè K, Yaméogo I, Congo-Ouédraogo M, Tamboura M, Sawadogo G, Ouattara K, Sanou M, Kiemtoré T, Dioma G, Sanon B, Somlaré H, Kyetega A, Ba AK, Aké F, Tarbangdo F, Aboua FA, Donnou Y, Kamaté I, Patel JC, Schmink S, Spiller MW, Topaz N, Novak R, Wang X, Bicaba B, Sangaré L, Ouédraogo-Traoré R, Kristiansen PA. Meningococcal carriage 7 years after introduction of a serogroup A meningococcal conjugate vaccine in Burkina Faso: results from four cross-sectional carriage surveys. THE LANCET. INFECTIOUS DISEASES 2020; 20:1418-1425. [PMID: 32653071 PMCID: PMC7689286 DOI: 10.1016/s1473-3099(20)30239-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/05/2020] [Accepted: 03/12/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND In the first 2 years after a nationwide mass vaccination campaign of 1-29-year-olds with a meningococcal serogroup A conjugate vaccine (MenAfriVac) in Burkina Faso, carriage and disease due to serogroup A Neisseria meningitidis were nearly eliminated. We aimed to assess the long-term effect of MenAfriVac vaccination on meningococcal carriage and herd immunity. METHODS We did four cross-sectional studies of meningococcal carriage in people aged 9 months to 36 years in two districts of Burkina Faso between May 2, 2016, and Nov 6, 2017. Demographic information and oropharyngeal swabs were collected. Meningococcal isolates were characterised using whole-genome sequencing. FINDINGS Of 14 295 eligible people, 13 758 consented and had specimens collected and laboratory results available, 1035 of whom were meningococcal carriers. Accounting for the complex survey design, prevalence of meningococcal carriage was 7·60% (95% CI 5·67-9·52), including 6·98% (4·86-9·11) non-groupable, 0·48% (0·01-0·95) serogroup W, 0·10% (0·01-0·18) serogroup C, 0·03% (0·00-0·80) serogroup E, and 0% serogroup A. Prevalence ranged from 5·44% (95% CI 4·18-6·69) to 9·14% (6·01-12·27) by district, from 4·67% (2·71-6·64) to 11·17% (6·75-15·59) by round, and from 3·39% (0·00-8·30) to 10·43% (8·08-12·79) by age group. By clonal complex, 822 (88%) of 934 non-groupable isolates were CC192, all 83 (100%) serogroup W isolates were CC11, and nine (69%) of 13 serogroup C isolates were CC10217. INTERPRETATION Our results show the continued effect of MenAfriVac on serogroup A meningococcal carriage, for at least 7 years, among vaccinated and unvaccinated cohorts. Carriage prevalence of epidemic-prone serogroup C CC10217 and serogroup W CC11 was low. Continued monitoring of N meningitidis carriage will be crucial to further assess the effect of MenAfriVac and inform the vaccination strategy for future multivalent meningococcal vaccines. FUNDING Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
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Affiliation(s)
- Sarah Mbaeyi
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Kambiré Dinanibè
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Issaka Yaméogo
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | | | - Mamadou Tamboura
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Guetawendé Sawadogo
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Kalifa Ouattara
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Mahamadou Sanou
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Tanga Kiemtoré
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Gerard Dioma
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Barnabé Sanon
- Centre Hospitalier Régional de Kaya, Kaya, Burkina Faso
| | - Hermann Somlaré
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Augustin Kyetega
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Absatou Ky Ba
- Centre Hospitalier Universitaire du Bogodogo, Ouagadougou, Burkina Faso
| | - Flavien Aké
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | - Félix Tarbangdo
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | | | - Yvette Donnou
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | - Idrissa Kamaté
- World Health Organization, Intercountry Support Team, Ouagadougou, Burkina Faso
| | - Jaymin C Patel
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susanna Schmink
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael W Spiller
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nadav Topaz
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ryan Novak
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brice Bicaba
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Lassana Sangaré
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Tagbo BN, Bancroft RE, Fajolu I, Abdulkadir MB, Bashir MF, Okunola OP, Isiaka AH, Lawal NM, Edelu BO, Onyejiaka N, Ihuoma CJ, Ndu F, Ozumba UC, Udeinya F, Ogunsola F, Saka AO, Fadeyi A, Aderibigbe SA, Abdulraheem J, Yusuf AG, Sylvanus Ndow P, Ogbogu P, Kanu C, Emina V, Makinwa OJ, Gehre F, Yusuf K, Braka F, Mwenda JM, Ticha JM, Nwodo D, Worwui A, Biey JN, Kwambana-Adams BA, Antonio M. Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine. Clin Infect Dis 2020; 69:S81-S88. [PMID: 31505626 PMCID: PMC6736152 DOI: 10.1093/cid/ciz474] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). Methods From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. Results A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. Conclusions Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the country.
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Affiliation(s)
- Beckie N Tagbo
- Institute of Child Health, University of Nigeria Teaching Hospital, Ituku-Ozalla, and.,Department of Paediatrics University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State
| | - Rowan E Bancroft
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul
| | - Iretiola Fajolu
- Department of Paediatrics, Lagos University Teaching Hospital.,Department of Paediatrics, College of Medicine, University of Lagos
| | | | - Muhammad F Bashir
- Department of Paediatrics, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
| | | | | | - Namadi M Lawal
- Department of Disease Control and Immunization, National Primary Health Care Development Agency, Abuja
| | - Benedict O Edelu
- Department of Paediatrics University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State
| | - Ngozi Onyejiaka
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital
| | - Chinonyerem J Ihuoma
- Department of Microbiology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State
| | | | - Uchenna C Ozumba
- Department of Microbiology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State
| | - Frances Udeinya
- Department of Microbiology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State
| | - Folasade Ogunsola
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital
| | - Aishat O Saka
- Department of Paediatrics and Child Health, University of Ilorin Teaching Hospital
| | - Abayomi Fadeyi
- Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Kwara
| | - Sunday A Aderibigbe
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Kwara
| | - Jimoh Abdulraheem
- Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Kwara
| | - Adamu G Yusuf
- Medical Microbiology Department, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
| | - Peter Sylvanus Ndow
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul
| | - Philomena Ogbogu
- Department of Medical Microbiology, University of Benin Teaching Hospital
| | - Chinomnso Kanu
- Department of Community Health, University of Benin Teaching Hospital, and
| | - Velly Emina
- Department of Community Health and Primary Care, Lagos University Teaching Hospital, Nigeria
| | - Olajumoke J Makinwa
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital
| | - Florian Gehre
- Department of Paediatrics University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State.,Department of Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Kabir Yusuf
- Department of Disease Control and Immunization, National Primary Health Care Development Agency, Abuja
| | | | - Jason M Mwenda
- WHO Regional Office for Africa WHO/AFRO, Republic of Congo, Brazzaville
| | | | | | - Archibald Worwui
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul
| | - Joseph N Biey
- WHO Regional Office for Africa WHO/AFRO, Republic of Congo, Brazzaville
| | - Brenda A Kwambana-Adams
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul
| | - Martin Antonio
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Sanogo YO, Guindo I, Diarra S, Retchless AC, Abdou M, Coulibaly S, Maiga MF, Coumaré M, Diarra B, Chen A, Chang HY, Vuong JT, Acosta AM, Sow S, Novak RT, Wang X. A New Sequence Type of Neisseria meningitidis Serogroup C Associated With a 2016 Meningitis Outbreak in Mali. J Infect Dis 2020; 220:S190-S197. [PMID: 31671437 DOI: 10.1093/infdis/jiz272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In 2016, Mali reported a bacterial meningitis outbreak consisting of 39 suspected cases between epidemiologic weeks 9 and 17 with 15% case fatality ratio in the health district of Ouéléssebougou, 80 kilometers from the capital Bamako. Cerebrospinal fluid specimens from 29 cases were tested by culture and real-time polymerase chain reaction; 22 (76%) were positive for bacterial meningitis pathogens, 16 (73%) of which were Neisseria meningitidis (Nm). Of the Nm-positive specimens, 14 (88%) were N meningitidis serogroup C (NmC), 1 was NmW, and 1 was nongroupable. Eight NmC isolates recovered by culture from the outbreak were characterized using whole genome sequencing. Genomics analysis revealed that all 8 isolates belonged to a new sequence type (ST) 12446 of clonal complex 10217 that formed a distinct clade genetically similar to ST-10217, a NmC strain that recently caused large epidemics of meningitis in Niger and Nigeria. The emergence of a new ST of NmC associated with an outbreak in the African meningitis belt further highlights the need for continued molecular surveillance in the region.
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Affiliation(s)
- Yibayiri Osee Sanogo
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ibréhima Guindo
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Seydou Diarra
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Adam C Retchless
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mahamadou Abdou
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | | | | | | | | | - Alexander Chen
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - How-Yi Chang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeni T Vuong
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna M Acosta
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samba Sow
- Ministère de la Santé, Mali.,Centre National d'Appui et de Lutte contre les Maladies/Centre des Vaccins en Dévelopement, Mali
| | - Ryan T Novak
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Novak RT, Ronveaux O, Bita AF, Aké HF, Lessa FC, Wang X, Bwaka AM, Fox LM. Future Directions for Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Sub-Saharan Africa. J Infect Dis 2019; 220:S279-S285. [PMID: 31671452 PMCID: PMC6822967 DOI: 10.1093/infdis/jiz421] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In sub-Saharan Africa, bacterial meningitis remains a significant public health problem, especially in the countries of the meningitis belt, where Neisseria meningitidis serogroup A historically caused large-scale epidemics. In 2014, MenAfriNet was established as a consortium of partners supporting strategic implementation of case-based meningitis surveillance to monitor meningitis epidemiology and impact of meningococcal serogroup A conjugate vaccine (MACV). MenAfriNet improved data quality through use of standardized tools, procedures, and laboratory diagnostics. MenAfriNet surveillance and study data provided evidence of ongoing MACV impact, characterized the burden of non-serogroup A meningococcal disease (including the emergence of a new epidemic clone of serogroup C), and documented the impact of pneumococcal conjugate vaccine. New vaccines and schedules have been proposed for future implementation to address the remaining burden of meningitis. To support the goals of "Defeating Meningitis by 2030," MenAfriNet will continue to strengthen surveillance and support research and modeling to monitor the impact of these programs on meningitis burden in sub-Saharan Africa.
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Affiliation(s)
- Ryan T Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - André F Bita
- WHO Regional Office for Africa, Brazzaville, Congo
| | | | - Fernanda C Lessa
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ado M Bwaka
- WHO Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | - LeAnne M Fox
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Balarabe SA. Epidemics of meningococcal meningitis in Northern Nigeria focus on preventive measures. Ann Afr Med 2019; 17:163-167. [PMID: 30588927 PMCID: PMC6330781 DOI: 10.4103/aam.aam_62_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Throughout the past 200 years, epidemics of meningococcal infection have been noted in Northern Nigeria. Consequently, control of meningococcal meningitis is one of the major priorities in infection control in the region. The proportions of cases of invasive meningococcal disease (IMD) caused by the five common serotypes (A, B, C, Y, and W135) vary among different regions and within specific geographic locations. Hence, effective and comprehensive disease control can only be achieved with the use of vaccines that target all of these disease-causing serotypes. Vaccines for the majority of meningococcal serogroups implicated in causing IMD are available in developed countries and have proven effective in reducing the disease incidence. However, the overall success of a vaccine depends on its coverage of the at-risk population as well as safety and effectiveness of the vaccine at preventing disease. Therefore, maximizing the global impact of these vaccines requires having them made available in regions with the high incidence of the disease, like Northern Nigeria, where rates of meningococcal disease are several times higher than in industrialized nations, and the reported mortality is usually high.
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9
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Whaley MJ, Joseph SJ, Retchless AC, Kretz CB, Blain A, Hu F, Chang HY, Mbaeyi SA, MacNeil JR, Read TD, Wang X. Whole genome sequencing for investigations of meningococcal outbreaks in the United States: a retrospective analysis. Sci Rep 2018; 8:15803. [PMID: 30361650 PMCID: PMC6202316 DOI: 10.1038/s41598-018-33622-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/13/2018] [Indexed: 01/14/2023] Open
Abstract
Although rare in the U.S., outbreaks due to Neisseria meningitidis do occur. Rapid, early outbreak detection is important for timely public health response. In this study, we characterized U.S. meningococcal isolates (N = 201) from 15 epidemiologically defined outbreaks (2009-2015) along with temporally and geographically matched sporadic isolates using multilocus sequence typing, pulsed-field gel electrophoresis (PFGE), and six whole genome sequencing (WGS) based methods. Recombination-corrected maximum likelihood (ML) and Bayesian phylogenies were reconstructed to identify genetically related outbreak isolates. All WGS analysis methods showed high degree of agreement and distinguished isolates with similar or indistinguishable PFGE patterns, or the same strain genotype. Ten outbreaks were caused by a single strain; 5 were due to multiple strains. Five sporadic isolates were phylogenetically related to 2 outbreaks. Analysis of 9 outbreaks using timed phylogenies identified the possible origin and estimated the approximate time that the most recent common ancestor emerged for outbreaks analyzed. U.S. meningococcal outbreaks were caused by single- or multiple-strain introduction, with organizational outbreaks mainly caused by a clonal strain and community outbreaks by divergent strains. WGS can infer linkage of meningococcal cases when epidemiological links are uncertain. Accurate identification of outbreak-associated cases requires both WGS typing and epidemiological data.
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Affiliation(s)
- Melissa J Whaley
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandeep J Joseph
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adam C Retchless
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cecilia B Kretz
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy Blain
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fang Hu
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - How-Yi Chang
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah A Mbaeyi
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica R MacNeil
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Timothy D Read
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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10
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Bozio CH, Vuong J, Dokubo EK, Fallah MP, McNamara LA, Potts CC, Doedeh J, Gbanya M, Retchless AC, Patel JC, Clark TA, Kohar H, Nagbe T, Clement P, Katawera V, Mahmoud N, Djingarey HM, Perrocheau A, Naidoo D, Stone M, George RN, Williams D, Gasasira A, Nyenswah T, Wang X, Fox LM. Outbreak of Neisseria meningitidis serogroup C outside the meningitis belt-Liberia, 2017: an epidemiological and laboratory investigation. THE LANCET. INFECTIOUS DISEASES 2018; 18:1360-1367. [PMID: 30337259 DOI: 10.1016/s1473-3099(18)30476-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/26/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND On April 25, 2017, a cluster of unexplained illnesses and deaths associated with a funeral was reported in Sinoe County, Liberia. Molecular testing identified Neisseria meningitidis serogroup C (NmC) in specimens from patients. We describe the epidemiological investigation of this cluster and metagenomic characterisation of the outbreak strain. METHODS We collected epidemiological data from the field investigation and medical records review. Confirmed, probable, and suspected cases were defined on the basis of molecular testing and signs or symptoms of meningococcal disease. Metagenomic sequences from patient specimens were compared with 141 meningococcal isolate genomes to determine strain lineage. FINDINGS 28 meningococcal disease cases were identified, with dates of symptom onset from April 21 to April 30, 2017: 13 confirmed, three probable, and 12 suspected. 13 patients died. Six (21%) patients reported fever and 23 (82%) reported gastrointestinal symptoms. The attack rate for confirmed and probable cases among funeral attendees was 10%. Metagenomic sequences from six patient specimens were similar to a sequence type (ST) 10217 (clonal complex [CC] 10217) isolate genome from Niger, 2015. Multilocus sequencing identified five of seven alleles from one specimen that matched ST-9367, which is represented in the PubMLST database by one carriage isolate from Burkina Faso, in 2011, and belongs to CC10217. INTERPRETATION This outbreak featured high attack and case fatality rates. Clinical presentation was broadly consistent with previous meningococcal disease outbreaks, but predominance of gastrointestinal symptoms was unusual compared with previous African meningitis epidemics. The outbreak strain was genetically similar to NmC CC10217, which caused meningococcal disease outbreaks in Niger and Nigeria. CC10217 had previously been identified only in the African meningitis belt. FUNDING US Global Health Security.
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Affiliation(s)
- Catherine H Bozio
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeni Vuong
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E Kainne Dokubo
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Monrovia, Liberia
| | - Mosoka P Fallah
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Lucy A McNamara
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Caelin C Potts
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Doedeh
- Liberia Ministry of Health, Monrovia, Liberia
| | | | - Adam C Retchless
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jaymin C Patel
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas A Clark
- Division of Reproductive Health, National Center for Chronic Diseases Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Henry Kohar
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Thomas Nagbe
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Peter Clement
- World Health Organization-Liberia, Monrovia, Liberia
| | | | - Nuha Mahmoud
- World Health Organization-Liberia, Monrovia, Liberia
| | | | | | | | - Mardia Stone
- World Health Organization-Liberia, Monrovia, Liberia
| | | | - Desmond Williams
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Monrovia, Liberia
| | - Alex Gasasira
- World Health Organization-Liberia, Monrovia, Liberia
| | | | - Xin Wang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - LeAnne M Fox
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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11
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Kwambana-Adams BA, Amaza RC, Okoi C, Rabiu M, Worwui A, Foster-Nyarko E, Ebruke B, Sesay AK, Senghore M, Umar AS, Usman R, Atiku A, Abdullahi G, Buhari Y, Sani R, Bako HU, Abdullahi B, Yarima AI, Sikiru B, Moses AO, Popoola MO, Ekeng E, Olayinka A, Mba N, Kankia A, Mamadu IN, Okudo I, Stephen M, Ronveaux O, Busuttil J, Mwenda JM, Abdulaziz M, Gummi SA, Adedeji A, Bita A, Omar L, Djingarey MH, Alemu W, D'Alessandro U, Ihekweazu C, Antonio M. Meningococcus serogroup C clonal complex ST-10217 outbreak in Zamfara State, Northern Nigeria. Sci Rep 2018; 8:14194. [PMID: 30242204 PMCID: PMC6155016 DOI: 10.1038/s41598-018-32475-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/10/2018] [Indexed: 12/03/2022] Open
Abstract
After the successful roll out of MenAfriVac, Nigeria has experienced sequential meningitis outbreaks attributed to meningococcus serogroup C (NmC). Zamfara State in North-western Nigeria recently was at the epicentre of the largest NmC outbreak in the 21st Century with 7,140 suspected meningitis cases and 553 deaths reported between December 2016 and May 2017. The overall attack rate was 155 per 100,000 population and children 5–14 years accounted for 47% (3,369/7,140) of suspected cases. The case fatality rate (CFR) among children 5–9 years was 10%, double that reported among adults ≥ 30 years (5%). NmC and pneumococcus accounted for 94% (172/184) and 5% (9/184) of the laboratory-confirmed cases, respectively. The sequenced NmC belonged to the ST-10217 clonal complex (CC). All serotyped pneumococci were PCV10 serotypes. The emergence of NmC ST-10217 CC outbreaks threatens the public health gains made by MenAfriVac, which calls for an urgent strategic action against meningitis outbreaks.
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Affiliation(s)
- Brenda A Kwambana-Adams
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | | | - Catherine Okoi
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Murtala Rabiu
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | - Archibald Worwui
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Ebenezer Foster-Nyarko
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Bernard Ebruke
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Abdul K Sesay
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Madikay Senghore
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | | | - Rabi Usman
- Zamfara State Ministry of Health, Gusau, Nigeria
| | - Adamu Atiku
- Zamfara State Ministry of Health, Gusau, Nigeria
| | | | - Yahaya Buhari
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | - Rabiu Sani
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | - Husaini U Bako
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | - Bashir Abdullahi
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | - Alliyu I Yarima
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | | | | | | | - Eme Ekeng
- Nigeria Center for Disease Control, Abuja, Nigeria
| | | | - Nwando Mba
- Nigeria Center for Disease Control, Abuja, Nigeria
| | - Adamu Kankia
- World Health Organization, Country Office Nigeria, Abuja, Nigeria
| | - Ibrahim N Mamadu
- World Health Organization, Country Office Nigeria, Abuja, Nigeria
| | - Ifeanyi Okudo
- World Health Organization, Country Office Nigeria, Abuja, Nigeria
| | - Mary Stephen
- World Health Organization, Country Office Nigeria, Abuja, Nigeria
| | | | - Jason Busuttil
- UK-Public Health Rapid Support Team, Public Health England, Salisbury, UK
| | - Jason M Mwenda
- World Health Organization, Regional office for Africa, Brazzaville, Congo
| | - Mohammed Abdulaziz
- Africa Centres for Diseases Control and Prevention, Addis Ababa, Ethiopia
| | | | | | - Andre Bita
- World Health Organization Inter-Country Support Teams for West Africa, Ouagadougou, Burkina Faso
| | - Linda Omar
- World Health Organization, Regional office for Africa, Brazzaville, Congo
| | | | | | - Umberto D'Alessandro
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | | | - Martin Antonio
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia. .,Division of Microbiology & Immunity, Warwick Medical School, University of Warwick, Coventry, UK.
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12
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Lamelas A, Hamid AWM, Dangy JP, Hauser J, Jud M, Röltgen K, Hodgson A, Junghanss T, Harris SR, Parkhill J, Bentley SD, Pluschke G. Loss of Genomic Diversity in a Neisseria meningitidis Clone Through a Colonization Bottleneck. Genome Biol Evol 2018; 10:2102-2109. [PMID: 30060167 PMCID: PMC6110524 DOI: 10.1093/gbe/evy152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 01/11/2023] Open
Abstract
Neisseria meningitidis is the leading cause of epidemic meningitis in the "meningitis belt" of Africa, where clonal waves of colonization and disease are observed. Point mutations and horizontal gene exchange lead to constant diversification of meningococcal populations during clonal spread. Maintaining a high genomic diversity may be an evolutionary strategy of meningococci that increases chances of fixing occasionally new highly successful "fit genotypes". We have performed a longitudinal study of meningococcal carriage and disease in northern Ghana by analyzing cerebrospinal fluid samples from all suspected meningitis cases and monitoring carriage of meningococci by twice yearly colonization surveys. In the framework of this study, we observed complete replacement of an A: sequence types (ST)-2859 clone by a W: ST-2881 clone. However, after a gap of 1 year, A: ST-2859 meningococci re-emerged both as colonizer and meningitis causing agent. Our whole genome sequencing analyses compared the A population isolated prior to the W colonization and disease wave with the re-emerging A meningococci. This analysis revealed expansion of one clone differing in only one nonsynonymous SNP from several isolates already present in the original A: ST-2859 population. The colonization bottleneck caused by the competing W meningococci thus resulted in a profound reduction in genomic diversity of the A meningococcal population.
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Affiliation(s)
- Araceli Lamelas
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
- Red de Estudios Moleculares Avanzados, Instituto de Ecología A. C., Xalapa, Veracruz, México
| | - Abdul-Wahab M Hamid
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
- Navrongo Health Research Centre, Ministry of Health, Navrongo, Ghana
| | - Jean-Pierre Dangy
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Julia Hauser
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Maja Jud
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Katharina Röltgen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Abraham Hodgson
- Navrongo Health Research Centre, Ministry of Health, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Thomas Junghanss
- Section of Clinical Tropical Medicine, University Hospital Heidelberg, Germany
| | - Simon R Harris
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Julian Parkhill
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Stephen D Bentley
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
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13
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Potts CC, Joseph SJ, Chang HY, Chen A, Vuong J, Hu F, Jenkins LT, Schmink S, Blain A, MacNeil JR, Harrison LH, Wang X. Population structure of invasive Neisseria meningitidis in the United States, 2011-15. J Infect 2018; 77:427-434. [PMID: 29964139 DOI: 10.1016/j.jinf.2018.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Meningococcal conjugate vaccines (MenACWY) were licensed in the United States in 2005. We assessed the population structure of invasive Neisseria meningitidis (Nm) ten years after recommended use of MenACWY among adolescents. METHODS Meningococcal isolates obtained through Active Bacterial Core surveillance (ABCs) from 2000-05, 2006-10, and 2011-15 underwent whole genome or Sanger sequencing. Genome phylogenies were completed using maximum likelihood methods; and distribution of multilocus sequence typing (MLST) sequence type (ST) and clonal complex (CC), and PorA and FetA types were assessed. RESULTS Prevalent serogroups (B, C, Y and W), CCs, and PorA and FetA types were detected in all three time periods, but dynamic changes were observed. The proportion of serogroup W CC11 isolates increased in 2011-15 and were most related to South American strains. Changes in CC distribution were also observed in serogroup C and serogroup Y. Phylogenetic analysis showed that U.S. serogroup W CC11s are closely related to a subset of U.S. serogroup C isolates; combined global analysis demonstrated that some CCs, including CC11, exhibit regional clustering. CONCLUSIONS Overall, the Nm population structure has remained stable after MenACWY introduction. Dynamic changes in genotypes, unlikely related to vaccination, also occurred, highlighting the need for continued whole genome-based surveillance.
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Affiliation(s)
- Caelin C Potts
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Sandeep J Joseph
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - How-Yi Chang
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Alexander Chen
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Jeni Vuong
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Fang Hu
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Laurel T Jenkins
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Susanna Schmink
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Amy Blain
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Jessica R MacNeil
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xin Wang
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA.
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14
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Acquisition of virulence genes by a carrier strain gave rise to the ongoing epidemics of meningococcal disease in West Africa. Proc Natl Acad Sci U S A 2018; 115:5510-5515. [PMID: 29735685 PMCID: PMC6003489 DOI: 10.1073/pnas.1802298115] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Historically, Neisseria meningitidis serogroup A strains have caused large epidemics of meningitis across sub-Saharan Africa. Following mass vaccination from 2010, serogroup A outbreaks have been mostly eliminated. Starting in 2013 however, yearly epidemics of a previously unknown serogroup C strain have led to tens of thousands of cases in Nigeria and Niger. We show how this new strain evolved from a benign ancestor through the acquisition of virulence genes encoding the serogroup C capsule and a phage linked to invasiveness, illustrating that minor genetic changes in a microbe can have major public health consequences. Our reconstruction of the spatiotemporal outbreak dynamics in the Niger–Nigeria border region suggests direct epidemiological consequences of contrasting outbreak responses in the two countries. In the African meningitis belt, a region of sub-Saharan Africa comprising 22 countries from Senegal in the west to Ethiopia in the east, large epidemics of serogroup A meningococcal meningitis have occurred periodically. After gradual introduction from 2010 of mass vaccination with a monovalent meningococcal A conjugate vaccine, serogroup A epidemics have been eliminated. Starting in 2013, the northwestern part of Nigeria has been affected by yearly outbreaks of meningitis caused by a novel strain of serogroup C Neisseria meningitidis (NmC). In 2015, the strain spread to the neighboring country Niger, where it caused a severe epidemic. Following a relative calm in 2016, the largest ever recorded epidemic of NmC broke out in Nigeria in 2017. Here, we describe the recent evolution of this new outbreak strain and show how the acquisition of capsule genes and virulence factors by a strain previously circulating asymptomatically in the African population led to the emergence of a virulent pathogen. This study illustrates the power of long-read whole-genome sequencing, combined with Illumina sequencing, for high-resolution epidemiological investigations.
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15
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Meyer SA, Kristiansen PA. Household transmission of Neisseria meningitidis in the meningitis belt. LANCET GLOBAL HEALTH 2018; 4:e885-e886. [PMID: 27855859 PMCID: PMC5776745 DOI: 10.1016/s2214-109x(16)30292-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Sarah A Meyer
- Meningitis and Vaccine Preventable Diseases Branch, US Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
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16
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Balogun WG, Cobham AE, Amin A. Neuroscience in Nigeria: the past, the present and the future. Metab Brain Dis 2018; 33:359-368. [PMID: 28993966 DOI: 10.1007/s11011-017-0119-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/02/2017] [Indexed: 02/07/2023]
Abstract
The science of the brain and nervous system cuts across almost all aspects of human life and is one of the fastest growing scientific fields worldwide. This necessitates the demand for pragmatic investment by all nations to ensure improved education and quality of research in Neurosciences. Although obvious efforts are being made in advancing the field in developed societies, there is limited data addressing the state of neuroscience in sub-Saharan Africa. Here, we review the state of neuroscience development in Nigeria, Africa's most populous country and its largest economy, critically evaluating the history, the current situation and future projections. This review specifically addresses trends in clinical and basic neuroscience research and education. We conclude by highlighting potentially helpful strategies that will catalyse development in neuroscience education and research in Nigeria, among which are an increase in research funding, provision of tools and equipment for training and research, and upgrading of the infrastructure at hand.
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Affiliation(s)
- Wasiu Gbolahan Balogun
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Bertam, Penang, Malaysia.
| | - Ansa Emmanuel Cobham
- School of Biological Sciences, Monash University, Melbourne, Victoria, 3800, Australia
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Abdulbasit Amin
- Instituto Gulbenkian de Ciência, Rua. da Quinta Grande 6, 2780-156, Oeiras, Lisbon, Portugal
- Department of Physiology, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Nigeria
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17
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Abstract
The introduction of a serogroup A meningococcal conjugate vaccine in the African meningitis belt has been a remarkable success. Meningitis due to the serogroup A meningococcus, previously responsible for most epidemics, has fallen by 99% in vaccinated countries. Success must, however, not distract from the continuing burden of meningitis in this region of Africa. The number of all meningitis epidemics at health district level has fallen by 60% following vaccination, but epidemics due to other meningococcal serogroups continue and may be increasing. The introduction of low cost multivalent conjugate vaccines must be given high public health priority.
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Affiliation(s)
- James M Stuart
- a London School of Hygiene and Tropical Medicine , London , UK
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18
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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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Uadiale K, Bestman A, Kamau C, Caugant DA, Greig J. Evaluation of Pastorex meningitis kit performance for the rapid identification of Neisseria meningitidis serogroup C in Nigeria. Trans R Soc Trop Med Hyg 2017; 110:381-5. [PMID: 27496511 PMCID: PMC4975174 DOI: 10.1093/trstmh/trw046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/23/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Neisseria meningitidis serogroup C (NmC) has caused outbreaks in Nigeria of increasing size in three consecutive years since 2013. Rapid diagnostic tests (RDTs) for meningitis can facilitate quick identification of the causative pathogen; Pastorex can detect N. meningitidis serogroups A, C (NmC), Y/W135, N. meningitidis serogroup B/Escherichia coli K1, Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and group B Streptococcus. There is no published field evaluation of Pastorex in the identification of NmC. We report our experience with Pastorex in detecting NmC in field conditions. METHODS During sequential outbreaks of NmC in Nigeria in 2013, 2014 and 2015, cerebrospinal fluid (CSF) was collected from suspected cases of meningitis that met the case definition. Pastorex latex agglutination rapid test was done in the field and trans-isolate media were inoculated with CSF for culture and/or PCR, which was used as the reference standard for 63 paired samples. RESULTS The sensitivity of Pastorex for NmC was 80.0% (95% CI 65.4-90.4%) and the specificity was 94.4% (95% CI 72.7-99.9%). The positive likelihood ratio (LR) was 14.4 (95% CI 2.1-97.3) and negative LR was 0.2 (95% CI 0.1-0.4). The positive and negative predictive values (PPV and NPV) were 97.3% (95% CI 85.8-99.9) and 65.4% (95% CI 44.3-82.8), respectively, with a prevalence estimate of 71.4% (95% CI 58.6-82.1). CONCLUSION Pastorex showed good performance in detecting NmC under field conditions. Prepositioning Pastorex at peripheral health facilities during non-epidemic periods is constrained by a short shelf-life of 1 month after the kit is opened. There is need for development of RDTs that are cheaper and with less challenging requirements for storage and usage.
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Affiliation(s)
| | | | | | - Dominique A Caugant
- WHO Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | - Jane Greig
- Manson Unit, Médecins Sans Frontières, London, UK
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Nnadi C, Oladejo J, Yennan S, Ogunleye A, Agbai C, Bakare L, Abdulaziz M, Mohammed A, Stephens M, Sumaili K, Ronveaux O, Maguire H, Karch D, Dalhat M, Antonio M, Bita A, Okudo I, Nguku P, Novak R, Bolu O, Shuaib F, Ihekweazu C. Large Outbreak of Neisseria meningitidis Serogroup C - Nigeria, December 2016-June 2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:1352-1356. [PMID: 29240724 PMCID: PMC5730219 DOI: 10.15585/mmwr.mm6649a3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cost-effectiveness of expanding childhood routine immunization against Neisseria meningitidis serogroups C, W and Y with a quadrivalent conjugate vaccine in the African meningitis belt. PLoS One 2017; 12:e0188595. [PMID: 29190699 PMCID: PMC5708681 DOI: 10.1371/journal.pone.0188595] [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: 07/23/2017] [Accepted: 11/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neisseria meningitidis constitutes a major public health problem among countries in the African meningitis belt. Following regional vaccination campaigns for serogroup A and subsequent increases in protection against this serogroup, non-A serogroups such as C and W now pose significant epidemic threats, particularly in young children. OBJECTIVE To evaluate the cost-effectiveness of broadening coverage from conjugate serogroup A to quadrivalent ACWY vaccination. METHODS We developed a 40-year Markov state transition model with annual cycles to simulate costs and clinical outcomes in children aged 1 to 10 in the 26 countries of the African meningitis belt. The incidence of CWY meningitis cases among an unvaccinated population was held constant at inter-epidemic rates of 50 per 100,000/year and 150 per 100,000/year. The country-specific cost and probability of access to meningitis care, vaccine efficacy, the mortality risk among treated and untreated meningitis cases, the risk of clinical sequelae and their respective disability weights were based on published sources. Vaccination cost was based on international prices lists, presented in 2014 US$. RESULTS At an incidence rate of 50 per 100,000/year, routine conjugate vaccination is highly cost-effective in 14 out of 26 countries with a cost/DALY averted ranging from US$555-US$787. At the higher incidence rate of 150 per 100,000/year, quadrivalent vaccination is cost-effective in all 26 countries with a cost/DALY averted ranging from US$105-US$250. The annual incidence rate at which routine conjugate quadrivalent vaccination is expected to be economically justifiable ranges from 13 per 100,000/year in Nigeria to 142 per 100,000/year in Burundi. CONCLUSION Routine quadrivalent conjugate vaccination against Neisseria meningitidis is cost-effective at incidence rates well below the epidemic threshold among children living in the African meningitis belt.
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Meyer SA, Novak RT. Effect of a vaccine to prevent serogroup A N meningitidis epidemics in Africa. THE LANCET. INFECTIOUS DISEASES 2017; 17:789-790. [PMID: 28545720 PMCID: PMC5740483 DOI: 10.1016/s1473-3099(17)30300-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Sarah A Meyer
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Ryan T Novak
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Gana GJ, Badung S, Bunza AU, Gidado S, Nguku P. OUTBREAK OF CEREBROSPINAL MENINGITIS IN KEBBI STATE, NIGERIA. Ann Ib Postgrad Med 2017; 15:23-28. [PMID: 28970767 PMCID: PMC5598438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cerebrospinal meningitis (CSM), is a major public health problem still affecting tropical countries particularly in sub-Saharan Africa. Group A and occasionally group C account for large scale epidemics in many countries in the African meningitis belt. The study aimed to describe the pattern of cerebrospinal meningitis outbreak in Kebbi state in 2015. METHOD Information on cases and deaths was collected throughout the duration of the meningitis outbreak in all affected local government areas of Kebbi state. During this outbreak, we defined a suspected case as any person with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, altered consciousness or other meningeal signs and any toddler with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, or flaccid neck, bulging fontanel, convulsion or other meningeal signs. All the data was entered into SPSS statistical software and analyzed. RESULTS A total of 1,992 suspected cases of CSM were seen within the 18 weeks that the outbreak lasted. 1127 (57.0%) were males and 865 (43.0%) were females with a case fatality rate of 4.0%. The highest proportion of cases was found among those above 15 years of age (31.0%), 1252 (62.9%) of cases were immunized against neisseria meningitides type A. Two-thirds (16) of the LGAs in the state were affected and Aliero LGA had about half (n=1106; 55.5%) of cases seen. Most (77.3%) of samples analysed were positive for Nm type C. CONCLUSION Kebbi state experienced an outbreak of cerebro-spinal Meningitis in 2015 which was massive. Effective surveillance system and mass vaccination with polyvalent vaccines containing serogroup C will prevent future occurrence.
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Affiliation(s)
- G J Gana
- Epidemiogy Unit, Department of Public Health, Ministry of Health, Birnin Kebbi, Kebbi State
| | - S Badung
- Epidemiogy Unit, Department of Public Health, Ministry of Health, Birnin Kebbi, Kebbi State
| | - A U Bunza
- Epidemiogy Unit, Department of Public Health, Ministry of Health, Birnin Kebbi, Kebbi State
| | - S Gidado
- Epidemiogy Unit, Department of Public Health, Ministry of Health, Birnin Kebbi, Kebbi State
| | - P Nguku
- Epidemiogy Unit, Department of Public Health, Ministry of Health, Birnin Kebbi, Kebbi State
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Mohammed I, Iliyasu G, Habib AG. Emergence and control of epidemic meningococcal meningitis in sub-Saharan Africa. Pathog Glob Health 2017; 111:1-6. [PMID: 28081671 PMCID: PMC5375607 DOI: 10.1080/20477724.2016.1274068] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
For more than a century, meningitis epidemics have regularly recurred across sub-Saharan Africa, involving 19 contiguous countries that constitute a 'meningitis belt' where historically the causative agent has been serogroup A meningococcus. Attempts to control epidemic meningococcal meningitis in Africa by vaccination with meningococcal polysaccharide (PS) vaccines have not been successful. This is largely because PS vaccines are poorly immunogenic in young children, do not induce immunological memory, and have little or no effect on the pharyngeal carriage. Meningococcal PS-protein conjugate vaccines overcome these deficiencies. Conjugate meningococcal vaccine against serotype A (MenAfriVac) was developed between 2001 and 2009 and deployed in 2010. So far, 262 million individuals have been immunized across the meningitis belt. The public health benefits of MenAfriVac have already been demonstrated by a sharp decline in reported cases of meningococcal disease in the countries where it has been introduced. However, serogroup replacement following mass meningitis vaccination has been noted, and in 2015 an epidemic with a novel strain of serogroup C was recorded in Niger and Nigeria for the first time since 1975. This has posed a serious challenge toward elimination of meningococcal meningitis epidemics in the African. For an effective control of meningococcal meningitis in the African meningitis belt, there is a need for an effective surveillance system, provision of rapid antigen detection kits as well as affordable vaccine that provides protection against the main serogroups causing meningitis in the sub-region.
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Affiliation(s)
| | - Garba Iliyasu
- Infectious Disease Unit, Department of Medicine, College of Health Science, Bayero University Kano, Kano, Nigeria
| | - Abdulrazaq Garba Habib
- Infectious Disease Unit, Department of Medicine, College of Health Science, Bayero University Kano, Kano, Nigeria
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