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. 2019 Oct 31;220(220 Suppl 4):S165-S174.
doi: 10.1093/infdis/jiz358.

Bacterial Meningitis Epidemiology in Five Countries in the Meningitis Belt of Sub-Saharan Africa, 2015-2017

Heidi M Soeters  1 , Alpha Oumar Diallo  1 , Brice W Bicaba  2 , Goumbi Kadadé  3 , Assétou Y Dembélé  4 , Mahamat A Acyl  5 , Christelle Nikiema  6 , Adodo Yao Sadji  6 , Alain N Poy  7 , Clement Lingani  8 , Haoua Tall  9 , Souleymane Sakandé  9 , Félix Tarbangdo  10 , Flavien Aké  10 , Sarah A Mbaeyi  1 , Jennifer Moïsi  11 , Marietou F Paye  1 , Yibayiri Osee Sanogo  1 , Jeni T Vuong  1 , Xin Wang  1 , Olivier Ronveaux  12 , Ryan T Novak  1 ; MenAfriNet Consortium
Affiliations

Bacterial Meningitis Epidemiology in Five Countries in the Meningitis Belt of Sub-Saharan Africa, 2015-2017

Heidi M Soeters et al. J Infect Dis. .

Abstract

Background: The MenAfriNet Consortium supports strategic implementation of case-based meningitis surveillance in key high-risk countries of the African meningitis belt: Burkina Faso, Chad, Mali, Niger, and Togo. We describe bacterial meningitis epidemiology in these 5 countries in 2015-2017.

Methods: Case-based meningitis surveillance collects case-level demographic and clinical information and cerebrospinal fluid (CSF) laboratory results. Neisseria meningitidis, Streptococcus pneumoniae, or Haemophilus influenzae cases were confirmed and N. meningitidis/H. influenzae were serogrouped/serotyped by real-time polymerase chain reaction, culture, or latex agglutination. We calculated annual incidence in participating districts in each country in cases/100 000 population.

Results: From 2015-2017, 18 262 suspected meningitis cases were reported; 92% had a CSF specimen available, of which 26% were confirmed as N. meningitidis (n = 2433; 56%), S. pneumoniae (n = 1758; 40%), or H. influenzae (n = 180; 4%). Average annual incidences for N. meningitidis, S. pneumoniae, and H. influenzae, respectively, were 7.5, 2.5, and 0.3. N. meningitidis incidence was 1.5 in Burkina Faso, 2.7 in Chad, 0.4 in Mali, 14.7 in Niger, and 12.5 in Togo. Several outbreaks occurred: NmC in Niger in 2015-2017, NmC in Mali in 2016, and NmW in Togo in 2016-2017. Of N. meningitidis cases, 53% were NmC, 30% NmW, and 13% NmX. Five NmA cases were reported (Burkina Faso, 2015). NmX increased from 0.6% of N. meningitidis cases in 2015 to 27% in 2017.

Conclusions: Although bacterial meningitis epidemiology varied widely by country, NmC and NmW caused several outbreaks, NmX increased although was not associated with outbreaks, and overall NmA incidence remained low. An effective low-cost multivalent meningococcal conjugate vaccine could help further control meningococcal meningitis in the region.

Keywords: Haemophilus influenzae; bacterial meningitis; epidemiology; meningitis belt; meningococcal meningitis; pneumococcal meningitis; surveillance.

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Conflict of interest statement

Declaration of interests

J. C. M. participated in the MenAfriNet Consortium while working at Agence de Médecine Préventive but is now an employee of Pfizer, Inc. All other authors: No reported conflicts of interest.

Figures

Fig 1.
Fig 1.. Epidemic curve of suspected meningitis cases reported per month to case-based meningitis surveillance in MenAfriNet districts, by country, 2015–2017.
Note: As Mali began data collection in 2015 and 2016 was the first complete year of surveillance, only 2016–2017 data are included. Similarly, only 2017 data from Chad are included.
Fig 2.
Fig 2.. Adjusted annual incidence of bacterial meningitis by pathogen, MenAfriNet, 2015–2017.
A) 3 main bacterial meningitis pathogens: N. meningitidis (Nm), S. pneumoniae (Sp), and H. influenzae (Hi). B) Meningococcal serogroups: serogroup X (NmX), serogroup C (NmC), serogroup W (NmW), and serogroup A (NmA). Note: As Mali began data collection in 2015 and 2016 was the first complete year of surveillance, only 2016–2017 data are included. Similarly, only 2017 data from Chad are included.
Fig 3.
Fig 3.. Average adjusted annual incidence of laboratory-confirmed meningitis by pathogen and age group, MenAfriNet, 2015–2017.
Abbreviations: Hi, H. influenzae; NmA, N. meningitidis serogroup A; NmC, N. meningitidis serogroup C; NmInd, N. meningitidis with indeterminate serogroup; NmW, N. meningitidis serogroup W; NmX, N. meningitidis serogroup X; NmY, N. meningitidis serogroup Y; Sp, S. pneumoniae.
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