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Khaleel HA, Alhilfi RA, Rawaf S, Atwan Z, Al-Alwany AA, Raheem M, Tabche C. Determining the bacterial and viral meningitis trend in Iraq from 2007 till 2023 using joinpoint regression. Heliyon 2024; 10:e30088. [PMID: 38707473 PMCID: PMC11066402 DOI: 10.1016/j.heliyon.2024.e30088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024] Open
Abstract
Background Acute meningitis is a disease with case fatality and disability rate that is dependent on the causative agent. Objective Determine the meningitis trend in Iraq from 2007 to 2023 using a joinpoint regression at national and sub-national levels and describe the epidemiology. Methods Joinpoint regression model was used on surveillance data from Jan 2007 until May 2023, to calculate annual and average annual percent changes to determine the trend. Meningitis total count was modelled by year of reporting and province using the log transformation and Poisson variance. Best-fit model was chosen based on the weighted BIC criteria as the final point. Results Bacterial meningitis was higher than viral meningitis from 2007 to 2018, then viral meningitis started to exceed till 2023. Meningococcal meningitis was lower than other bacterial and viral meningitis from 2007 to 2023. Most meningitis cases across the years were lower than 15 years, at almost 80 %, while 20 %-40 % were lower than one year. Across all years, 55 % of the cases were males; apart from 2019, 70 % were females. Conclusion In Iraq, viral meningitis has been the predominant type since 2018. Most meningitis patients were lower than 15-year-old males. The meningitis trend in Iraq was stable from 2007 till 2023.
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Affiliation(s)
| | | | - Salman Rawaf
- WHO Collaborating Centre, Department of Primary Care and Public Health, Imperial College London, UK
| | - Zeenah Atwan
- Virology, Faculty of Medicine, University of Basrah, Iraq
| | | | - Mays Raheem
- WHO Collaborating Centre, Department of Primary Care and Public Health, Imperial College London, UK
| | - Celine Tabche
- WHO Collaborating Centre, Department of Primary Care and Public Health, Imperial College London, UK
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Al-Abri SS, Abuhasan MY, Albayat SSA, Bai X, Bastaki H, Borrow R, Caugant DA, Dbaibo G, Deghmane AE, Dinleyici EC, Ghuneim N, Sheek-Hussein M, Lucidarme J, Leng S, Koliou MG, Sáfadi MAP, Salman JA, Al-Sanouri T, Smith V, Taha MK, Vázquez J, Wright C, Yezli S. Meningococcal disease in the Middle East: A report from the Global Meningococcal Initiative. J Infect 2024; 88:71-76. [PMID: 37866792 DOI: 10.1016/j.jinf.2023.10.011] [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] [Received: 08/07/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
This review details recent findings from the Global Meningococcal Initiative's (GMI) recent meeting on the surveillance and control strategies for invasive meningococcal disease in the Middle East. The nature of case reporting and notification varies across the region, with many countries using bacterial meningitis as an IMD case definition in lieu of meningitis and septicaemia. This may overlook a significant burden associated with IMD leading to underreporting or misreporting of the disease. Based on these current definitions, IMD reported incidence remains low across the region, with historical outbreaks mainly occurring due to the Hajj and Umrah mass gatherings. The use of case confirmation techniques also varies in Middle Eastern countries. While typical microbiological techniques, such as culture and Gram staining, are widely used for characterisation, polymerase chain reaction (PCR) testing is utilised in a small number of countries. PCR testing may be inaccessible for several reasons including sample transportation, cost, or a lack of laboratory expertise. These barriers, not exclusive to PCR use, may impact surveillance systems more broadly. Another concern throughout the region is potentially widespread ciprofloxacin resistance since its use for chemoprophylaxis remains high in many countries.
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Affiliation(s)
| | | | | | - Xilian Bai
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Hamad Bastaki
- Communicable Disease Control Division at Ministry of Health, Kuwait
| | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK.
| | | | - Ghassan Dbaibo
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | - Ala-Eddine Deghmane
- Institut Pasteur, Université Paris Cité, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
| | | | | | - Mohamud Sheek-Hussein
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jay Lucidarme
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Sean Leng
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Marco A P Sáfadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | | | | | | | - Muhamed-Kheir Taha
- Institut Pasteur, Université Paris Cité, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
| | - Julio Vázquez
- National Centre of Microbiology, Institute of Health Carlos III, Madrid, Spain
| | | | - Saber Yezli
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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3
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Mohammad R, Maoldomhnaigh CÓ, Crimmins D. Clinical characteristics and outcomes of children with non-sinogenic Brain infections. Br J Neurosurg 2023:1-9. [PMID: 38149672 DOI: 10.1080/02688697.2023.2297877] [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: 05/15/2023] [Accepted: 12/16/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Central Nervous System (CNS) suppurative infections are serious but rare conditions in the paediatric population. Data on long-term neurocognitive and quality of life outcomes in children recovering from these infections are lacking. METHODS A retrospective cohort review of children <16 years with non-sinogenic infections undergoing neurosurgery was conducted. Data for patients admitted to Children's Health Ireland at Temple St between 2008-2021 were analysed for clinical and microbiological profiles. Follow-up reviews evaluating neurological and academic sequelae and quality of life were performed. Categorical variables were analysed for unfavourable outcome with a p < 0.05 significance value. RESULTS Forty patients were included with a mean age of 4.5 years and equal gender distribution. Fever (68%) and vomiting (58%) were the most common presenting complaints. Only fourteen (35%) patients presented with the classic triad of fever, headache, and focal neurological deficit. Meningitis/Encephalitis was the most common cause of suppurative infection (40%). Predisposing factors included congenital heart disease (18%), prematurity (15%) and immunocompromised status (10%). More patients received an initial Burr hole aspiration (73%) than Craniotomy (27%). The re-operation rate was higher in the craniotomy group (45%) compared to the burr hole group (34%), but this was not statistically significant (p = 0.522). Four patients died (10%) including two intra-hospital deaths (5%). Male gender (p = 0.047) and multiple abscesses (p = 0.041) were associated with unfavourable outcome at discharge. Mobility impairment was the most affected determinant of quality of life. CONCLUSION CNS suppurative infections are associated with long-term neurocognitive sequelae in children. Multiple abscesses and male gender are associated with unfavourable GOS on discharge. Children are still left with mobility impairment (25%), personality changes (23%) and intellectual disability (18%) at an average of 5 years. Long-term follow up with multidisciplinary input is required. Further research should focus on evaluating long-term HRQoL in children.
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Affiliation(s)
- Retaj Mohammad
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
- Department of Neurosurgery, Temple St Children's University Hospital, Ireland
| | - Cilian Ó Maoldomhnaigh
- Department of Paediatric Infectious Diseases, Temple St Children's University Hospital, Ireland
| | - Darach Crimmins
- Department of Neurosurgery, Temple St Children's University Hospital, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Al Awaidy S, Ozudogru O, Badur S. Meningococcal disease within the Gulf Cooperation Council Countries. Hum Vaccin Immunother 2023; 19:2193120. [PMID: 37051899 PMCID: PMC10158544 DOI: 10.1080/21645515.2023.2193120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
This review reports on the recent epidemiology of invasive meningococcal disease (IMD) within the Gulf Cooperation Council (GCC) Countries (focusing from 2012 onwards), the existing immunization strategies and the potential for IMD resurgence. MenACWY vaccination is now established in infant or adolescent immunization programs in Saudi Arabia, Bahrain, Kuwait, and the United Arab Emirates. At present, GCC Countries do not include MenB immunization. National health surveillance reports indicate a total of 156 IMD cases reported across the GCC Countries between 2012 and 2021; between 30% and 80% of cases were reported in individuals aged ≥15 years. Lack of serogroup data hinders the assessment of vaccine impact and decision-making on additional vaccine introductions (e.g. MenB immunization). Hajj/Umrah pilgrimage and the increasing number of large-scale commercial and social events held in the GCC Countries pose a potential risk for future IMD outbreaks. Immunization policies for such events could be strengthened.
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Affiliation(s)
| | | | - Selim Badur
- Vaccines Scientific Affairs and Public Health, GSK, Istanbul, Turkey
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Thomsen MM, Munthe-Fog L, Trier Petersen P, Hillig T, Friis-Hansen LJ, Roed C, Harboe ZB, Brandt CT. Pentraxin 3 in the cerebrospinal fluid during central nervous system infections: A retrospective cohort study. PLoS One 2023; 18:e0282004. [PMID: 36862691 PMCID: PMC9980753 DOI: 10.1371/journal.pone.0282004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/07/2023] [Indexed: 03/03/2023] Open
Abstract
The present study describes diagnostic and prognostic abilities of Cerebrospinal fluid (CSF) Pentraxin 3 (PTX3) in central nervous system (CNS) infections. CSF PTX3 was measured retrospectively from 174 patients admitted under suspicion of CNS infection. Medians, ROC curves and Youdens index was calculated. CSF PTX3 was significantly higher among all CNS infections and undetectable in most of the patients in the control group, and significantly higher in bacterial infections compared to viral and Lyme infections. No association was found between CSF PTX3 and Glasgow Outcome Score. PTX3 in the CSF can distinguish bacterial infection from viral and Lyme infections and non-CNS infections. Highest levels were found in bacterial meningitis. No prognostic abilities were found.
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Affiliation(s)
- Martin Munthe Thomsen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
- * E-mail:
| | - Lea Munthe-Fog
- Stemform/StemMedical, Cell Production and RnD, Søborg, Copenhagen Region, Denmark
| | - Pelle Trier Petersen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
| | - Lennart Jan Friis-Hansen
- Department of Clinical Biochemistry, University Hospitals Bispebjerg and Frederiksberg, University of Copenhagen, Copenhagen, Denmark
| | - Casper Roed
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
| | - Zitta Barrella Harboe
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Region, Copenhagen, Denmark
| | - Christian Thomas Brandt
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, North Zealand, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Region, Copenhagen, Denmark
- Department of Infectious Diseases, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
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Badur S, Al Dabbagh MA, Shibl AM, Farahat FM, Öztürk S, Saha D, Khalaf M. The Epidemiology of Invasive Meningococcal Disease in the Kingdom of Saudi Arabia: A Narrative Review with Updated Analysis. Infect Dis Ther 2021; 10:2035-2049. [PMID: 34390485 PMCID: PMC8363858 DOI: 10.1007/s40121-021-00467-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
Reducing invasive meningococcal disease (IMD) through MenACWY immunization is a critical healthcare strategy in the Kingdom of Saudi Arabia (KSA). Robust IMD surveillance is essential to help assess the need for additional immunization initiatives in target populations. This is particularly important in KSA, where mass gatherings accompanying Hajj/Umrah pilgrimages have been associated with IMD outbreaks within the local KSA population, and subsequent intercontinental spread via returning pilgrims. This narrative review of the published literature describes the changing epidemiology of IMD in KSA to provide a perspective on the impact of current immunization strategies and potential gaps. As recent published surveillance data are lacking, we also evaluated publicly reported data from the KSA Ministry of Health (MoH) for 2012–2019 to inform more recent IMD trends. Between 1995 and 2011, national surveillance data indicate that 1103 IMD cases were reported in KSA: 60% in 2000–2001, involving two (mainly MenW) outbreaks involving KSA citizens/residents and pilgrims focused in Mecca and Medina. Across 2002–2011, 184 cases of IMD were reported, with a higher proportion occurring in KSA citizens/residents, and with less focus within pilgrimage centers than apparent in previous years. Our analysis of MoH data found that, between 2012 and 2019, 44 IMD cases were reported, all in KSA citizens/residents, and chiefly in children or infants. No pilgrimage-associated outbreaks have occurred since 2001. Serogroup data were available for 62.5% of all cases for 2002–2011; MenW (40.0%), MenA (35.7%), and MenB (16.5%). Serogroup data for 2012–2019 remain incompletely reported, and the existing surveillance system could be improved, as some element of underestimation/underreporting of IMD may exist. While existing MenACWY immunization strategies for KSA citizens/residents and visiting pilgrims have been successful in reducing IMD due to specific serogroups, disease due to MenB remains a potential risk, and additional immunization strategies should be considered.
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Affiliation(s)
- Selim Badur
- EM, Vaccines Scientific Affairs and Public Health, GSK, Büyükdere Caddesi No:173, 1, Levent Plaza B Blok, 34394, Istanbul, Turkey.
| | - Mona A Al Dabbagh
- Division of Infectious Diseases, Department of Pediatrics, King Abdulaziz Medical City, King Abdullah International Medical Research Centre, King Saud Bin Abdulaziz University for Health Sciences, Jidda, Saudi Arabia
| | - Atef M Shibl
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fayssal M Farahat
- Infection Prevention and Control Program, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jidda, Saudi Arabia
| | - Serdar Öztürk
- Medical & Clinical Emerging Markets, GSK, Istanbul, Turkey
| | - Debasish Saha
- Clinical Research and Development, GSK, Wavre, Belgium
| | - Mansour Khalaf
- EM Central Vaccines Medical/Clinical, GSK, Jidda, Saudi Arabia
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Al-Jardani A, Al Rashdi A, Al Jaaidi A, Al Bulushi M, Al Mahrouqi S, Al-Abri S, Al-Maani A, Kumar R. Serotype distribution and antibiotic resistance among invasive Streptococcus pneumoniae from Oman post 13-valent vaccine introduction. Int J Infect Dis 2019; 85:135-140. [PMID: 31150842 DOI: 10.1016/j.ijid.2019.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE This study was undertaken to determine the serotype distribution and drug susceptibility patterns in pneumococcal isolates recovered from patients with invasive pneumococcal disease (IPD). METHODS All invasive pneumococcal isolates received between June 2014 and June 2016 were included in the study as part of a national laboratory-based IPD surveillance program. Isolates recovered from clinical specimens of normally sterile body sites were included. RESULTS A total of 41 different serotypes were identified among the 132 pneumococcal isolates included in this study. The most prevalent serotypes/serogroups were 12 (8.3%), 15 (8.3%), 19F (7.6%), 3 (6.1%), and 19A (6.1%);. It was observed that overall vaccine coverage rates for pneumococcal conjugate vaccines (PCV), PCV7, PCV10 and PCV13 were 15.9%, 24.2% and 37.1% respectively. 56.8% (n=75) of the isolates were non-susceptible to at least one antibiotic and 40.9% (n=54) of the isolates were resistant to PEN (M). 18.9% (n=25) of the isolates were multi-drug resistant (MDR).The case fatality rate was 15.9%. CONCLUSION Our study results call for broader vaccine coverage, emphasizes the need to introduce the conjugate pneumococcal vaccine for the high risk adult population and stress the importance of continuous surveillance of serotypes and antimicrobial resistance to guide vaccine development and antimicrobial stewardship activities.
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Affiliation(s)
- Amina Al-Jardani
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman.
| | - Azza Al Rashdi
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Aisha Al Jaaidi
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Mohamed Al Bulushi
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Sara Al Mahrouqi
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Oman
| | - Amal Al-Maani
- Directorate General for Disease Surveillance and Control, Ministry of Health, Oman
| | - Rajesh Kumar
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
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