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. 2019 Sep 5;69(Suppl 2):S140-S147.
doi: 10.1093/cid/ciz478.

Declines in Pediatric Bacterial Meningitis in the Republic of Benin Following Introduction of Pneumococcal Conjugate Vaccine: Epidemiological and Etiological Findings, 2011-2016

Joseph Agossou  1   2 , Chinelo Ebruke  3 , Alphonse Noudamadjo  1   2 , Julien D Adédémy  1   2 , Eric Y Dènon  4 , Honoré S Bankolé  4 , Mariam A Dogo  4 , Rolande Assogba  5 , Moussa Alassane  5 , Abdoullah Condé  1   2 , Falilatou Agbeille Mohamed  1   2 , Gérard Kpanidja  1   2 , Moutawakilou Gomina  2 , François Hounsou  4 , Basile G Aouanou  4   5 , Catherine Okoi  3 , Claire Oluwalana  3 , Archibald Worwui  3 , Peter S Ndow  3 , Jean Nounagnon  5 , Jason M Mwenda  6 , Rock A Sossou  7 , Brenda A Kwambana-Adams  3 , Martin Antonio  3   8
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Declines in Pediatric Bacterial Meningitis in the Republic of Benin Following Introduction of Pneumococcal Conjugate Vaccine: Epidemiological and Etiological Findings, 2011-2016

Joseph Agossou et al. Clin Infect Dis. .

Abstract

Background: Pediatric bacterial meningitis (PBM) remains an important cause of disease in children in Africa. We describe findings from sentinel site bacterial meningitis surveillance in children <5 years of age in the Republic of Benin, 2011-2016.

Methods: Cerebrospinal fluid (CSF) was collected from children admitted to Parakou, Natitingou, and Tanguieta sentinel hospitals with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus) was performed by rapid diagnostic tests, microbiological culture, and/or polymerase chain reaction; where possible, serotyping/grouping was performed.

Results: A total of 10 919 suspected cases of meningitis were admitted to the sentinel hospitals. Most patients were 0-11 months old (4863 [44.5%]) and there were 542 (5.0%) in-hospital deaths. Overall, 4168 CSF samples were screened for pathogens and a total of 194 (4.7%) PBM cases were confirmed, predominantly caused by pneumococcus (98 [50.5%]). Following pneumococcal conjugate vaccine (PCV) introduction in 2011, annual suspected meningitis cases and deaths (case fatality rate) progressively declined from 2534 to 1359 and from 164 (6.5%) to 14 (1.0%) in 2012 and 2016, respectively (P < .001). Additionally, there was a gradual decline in the proportion of meningitis cases caused by pneumococcus, from 77.3% (17/22) in 2011 to 32.4% (11/34) in 2016 (odds ratio, 7.11 [95% confidence interval, 2.08-24.30]). Haemophilus influenzae meningitis fluctuated over the surveillance period and was the predominant pathogen (16/34 [47.1%]) by 2016.

Conclusions: The observed decrease in pneumococcal meningitis after PCV introduction may be indicative of changing patterns of PBM etiology in Benin. Maintaining vigilant and effective surveillance is critical for understanding these changes and their wider public health implications.

Keywords: Benin; bacterial meningitis; pediatric; pneumococcus; vaccines.

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Figures

Figure 1.
Figure 1.
Yearly distribution of outcomes for suspected meningitis cases admitted to hospital in the Republic of Benin, 2011–2016.
Figure 2.
Figure 2.
Distribution of pathogens isolated and suspected meningitis cases admitted to hospital in the Republic of Benin by month and year for the period 2011–2016.
See this image and copyright information in PMC

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