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. 2016 Sep 26;11(9):e0163036.
doi: 10.1371/journal.pone.0163036. eCollection 2016.

The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012

Erika Britz  1   2   3 , Olga Perovic  3   4 , Claire von Mollendorf  3   4 , Anne von Gottberg  3   4 , Samantha Iyaloo  3 , Vanessa Quan  3 , Verushka Chetty  3 , Charlotte Sriruttan  3 , Nazir A Ismail  3 , Ananta Nanoo  3 , Alfred Musekiwa  5 , Carl Reddy  1 , Karien Viljoen  1 , Cheryl Cohen  3   4 , Nelesh P Govender  3   4
Affiliations

The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012

Erika Britz et al. PLoS One. .

Abstract

Introduction: Meningitis is a major cause of mortality in southern Africa. We aimed to describe the aetiologies and frequencies of laboratory-confirmed fungal and bacterial meningitis among adults in a South African province with an 11% HIV prevalence, over 4 years.

Methods: We conducted a retrospective, observational study of secondary laboratory data, extracted on all cerebrospinal fluid (CSF) specimens submitted to public-sector laboratories in Gauteng province from 2009 through 2012. We calculated cause-specific incidence rates in the general and HIV-infected populations and used Poisson regression to determine if trends were significant.

Results: We identified 11,891 (10.7%) incident cases of meningitis from 110,885 CSF specimens. Cryptococcal meningitis, tuberculous meningitis and pneumococcal meningitis accounted for 62.3% (n = 7,406), 24.6% (n = 2,928) and 10.1% (n = 1,197) of cases over the four-year period. The overall incidence (cases per 100,000 persons) of cryptococcal meningitis declined by 23% from 24.4 in 2009 to 18.7 in 2012 (p <0.001) and decreased by 19% among HIV-infected persons from 178.2 to 144.7 (p <0.001). Tuberculous meningitis decreased by 40% from 11.3 in 2009 to 6.8 in 2012 (p <0.001) and decreased by 36% among HIV-infected persons from 54.4 to 34.9 (p <0.001). Pneumococcal meningitis decreased by 41% from 4.2 in 2009 to 2.5 in 2012 (p <0.001) and decreased by 38% among HIV-infected persons from 28.0 to 17.5 (p <0.001). Among cases of other bacterial meningitis (248/11,891, 2.1%), Neisseria meningitidis (n = 93), Escherichia coli (n = 72) and Haemophilus influenzae (n = 20) were the most common organisms identified.

Conclusions: In this high HIV-prevalence province, cryptococcal meningitis was the leading cause of laboratory-confirmed meningitis among adults. Over a 4-year period, there was a significant decrease in incidence of cryptococcal, tuberculous and pneumococcal meningitis. This coincided with expansion of the national antiretroviral treatment programme, enhanced tuberculosis control programme and routine childhood immunisation with pneumococcal conjugate vaccines.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: CVM has received speaker honoraria from Pfizer. AVG has received research grant funds from Pfizer. CC has received grants from Pfizer and Sanofi. NPG has received speaker honoraria from Pfizer, Astellas and MSD (Pty) Ltd, travel grants from MSD (Pty) Ltd, has provided educational materials for TerraNova and has acted as a temporary consultant for Fujifilm Pharmaceuticals. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Diagram illustrating cases of meningitis among adults, as extracted from the National Health Laboratory Service Corporate Data Warehouse, Gauteng, South Africa, 2009–2012.
CSF = cerebrospinal fluid. CM = cryptococcal meningitis. PM = pneumococcal meningitis. TBM = tuberculous meningitis. OBM = other bacterial meningitis.
Fig 2
Fig 2. Incidence of cryptococcal meningitis and pneumococcal meningitis, by age group and gender, 2012.
CM = cryptococcal meningitis, PM = pneumococcal meningitis.
Fig 3
Fig 3. Number of cases and percentages of cryptococcal, tuberculous, pneumococcal and other bacterial meningitis among adults in Gauteng province, South Africa, 2009–2012 (n = 11,891).
Mixed infections = a combination of any of the four groups of meningitis.
Fig 4
Fig 4. Population incidence of cryptococcal, tuberculous and pneumococcal meningitis among adults in Gauteng province, South Africa, showing key treatment interventions, 2009–2012 (n = 11,531).
PCV-7 = seven-valent pneumococcal conjugate vaccine introduction. PCV-13 = thirteen-valent pneumococcal conjugate vaccine introduction. GeneXpert = GeneXpert MTB/Rif assay introduction. CrAg screening = introduction of cryptococcal antigen screening and treatment intervention.
See this image and copyright information in PMC

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