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. 2019 Sep 5;69(Suppl 2):S133-S139.
doi: 10.1093/cid/ciz598.

Pediatric Bacterial Meningitis Surveillance in Niger: Increased Importance of Neisseria meningitidis Serogroup C, and a Decrease in Streptococcus pneumoniae Following 13-Valent Pneumococcal Conjugate Vaccine Introduction

Mamadou Kourna Hama  1 , Dam Khan  2 , Boubou Laouali  1 , Catherine Okoi  2 , Abdoulaye Yam  3 , Moussa Haladou  3 , Archibald Worwui  2 , Peter Sylvanus Ndow  2 , Ricardo Nse Obama  3 , Jason M Mwenda  4 , Joseph Biey  4 , Bernard Ntsama  5 , Brenda A Kwambana-Adams  2 , Martin Antonio  2   6
Affiliations

Pediatric Bacterial Meningitis Surveillance in Niger: Increased Importance of Neisseria meningitidis Serogroup C, and a Decrease in Streptococcus pneumoniae Following 13-Valent Pneumococcal Conjugate Vaccine Introduction

Mamadou Kourna Hama et al. Clin Infect Dis. .

Abstract

Background: Meningitis is endemic in Niger. Haemophilus influenzae type b (Hib) vaccine and the 13-valent pneumococcal conjugate vaccine (PCV13) were introduced in 2008 and 2014, respectively. Vaccination campaign against Neisseria meningitidis serogroup A was carried out in 2010-2011. We evaluated changes in pathogen distribution using data from hospital-based surveillance in Niger from 2010 through 2016.

Methods: Cerebrospinal fluid (CSF) specimens from children <5 years old with suspected meningitis were tested to detect vaccine-preventable bacterial pathogens. Confirmatory identification and serotyping/grouping of Streptococcus pneumoniae, N. meningitidis, and H. influenzae were done. Antimicrobial susceptibility testing and whole genome sequencing were performed on S. pneumoniae isolates.

Results: The surveillance included 2580 patients with suspected meningitis, of whom 80.8% (2085/2580) had CSF collected. Bacterial meningitis was confirmed in 273 patients: 48% (131/273) was N. meningitidis, 45% (123/273) S. pneumoniae, and 7% (19/273) H. influenzae. Streptococcus pneumoniae meningitis decreased from 34 in 2014, to 16 in 2016. PCV13 serotypes made up 88% (7/8) of S. pneumoniae meningitis prevaccination and 20% (5/20) postvaccination. Neisseria meningitidis serogroup C (NmC) was responsible for 59% (10/17) of serogrouped N. meningitidis meningitis. Hib caused 67% (2/3) of the H. influenzae meningitis isolates serotyped. Penicillin resistance was found in 16% (4/25) of S. pneumoniae isolates. Sequence type 217 was the most common lineage among S. pneumoniae isolates.

Conclusions: Neisseria meningitidis and S. pneumoniae remain important causes of meningitis in children in Niger. The decline in the numbers of S. pneumoniae meningitis post-PCV13 is encouraging and should continue to be monitored. NmC is the predominant serogroup causing N. meningitidis meningitis.

Keywords: N. meningitidis; S. pneumoniae; Niger; cerebrospinal fluid; meningitis.

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Figures

Figure 1.
Figure 1.
Bar graph showing yearly distribution of Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. The line graph on the secondary axis shows the case fatality rate of the 3 pathogens.
Figure 2.
Figure 2.
Outcome of meningitis cases by year.
Figure 3.
Figure 3.
Maximum likelihood whole genome phylogenetic tree of Streptococcus pneumoniae isolates recovered from cerebrospinal fluid. Tree annotation from left to right: vaccine type; serotype; multilocus sequence type; year of admission; vaccine era (pneumococcal conjugate vaccine); phenotypic antibiotic resistance profiles to chloramphenicol, trimethoprim-sulfamethoxazole (SXT), tetracycline, oxacillin, and erythromycin; and the presence/absence of the antibiotic resistance genes catQ (chloramphenicol), folA/ folP (SXT), tetM (tetracycline), PBP (penicillin), and ermB (erythromycin). Abbreviations: C, chloramphenicol; E, erythromycin; OX, oxacillin; PCV, pneumococcal conjugate vaccine; SXT, trimethoprim-sulfamethoxazole; TE, tetracycline.
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