Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005-2012 in Turkey. A multicenter prospective surveillance study

Abstract

Successful vaccination policies for protection from bacterial meningitis are dependent on determination of the etiology of bacterial meningitis. Cerebrospinal fluid (CSF) samples were obtained prospectively from children from 1 month to ≤18 years of age hospitalized with suspected meningitis, in order to determine the etiology of meningitis in Turkey. DNA evidence of Neisseria meningitidis (N. meningitidis), Streptococcus pneumoniae (S. pneumoniae), and Hemophilus influenzae type b (Hib) was detected using multiplex polymerase chain reaction (PCR). In total, 1452 CSF samples were evaluated and bacterial etiology was determined in 645 (44.4%) cases between 2005 and 2012; N. meningitidis was detected in 333 (51.6%), S. pneumoniae in 195 (30.2%), and Hib in 117 (18.1%) of the PCR positive samples. Of the 333 N. meningitidis positive samples 127 (38.1%) were identified as serogroup W-135, 87 (26.1%) serogroup B, 28 (8.4%) serogroup A and 3 (0.9%) serogroup Y; 88 (26.4%) were non-groupable. As vaccines against the most frequent bacterial isolates in this study are available and licensed, these results highlight the need for broad based protection against meningococcal disease in Turkey.

Keywords: Hib; Meningitis; N. meningitidis; S. pneumoniae; Turkey; epidemiology; etiologic agents; surveillance.

Figure 1.

Distribution of causative agents of bacterial meningitis and meningococcal serogroups in Turkey, 2005–2012. Of 645 PCR-confirmed cases, 333 (51.6%) were attributable to Neisseria meningitidis, 195 (30.2%) to Streptococcus pneumoniae, and 117 (18.1%) to Hemophilus influenzae type b (Hib). Among meningococcal meningitis, serogroup A, B and W-135 were 8.4%, 26.1%, and 38.1%, respectively. Serogroup Y was only detected 2.2%. Non-groupable cases were 26.4%.

Figure 2.

Age distribution of bacterial meningitis in infants in Turkey (2006–2012)

Figure 3.

Annual incidence of causative agents of bacterial meningitis per 100,000 and effect of Hib and PCV vaccinations in Turkey. Because our study centers provide service to 32% of the population of Turkey, extrapolation from the number of cases recorded was calculated for the possible number of acute bacterial meningitis cases (excluding neonatal cases) per year occur in the whole country. The population of children 1 mo through 18 y of age was calculated as 23.9 million.

Figure 4.

Regional distribution of bacterial meningitis cases in Turkey (2005—2012)