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. 2021 Jun 23;39(28):3737-3744.
doi: 10.1016/j.vaccine.2021.05.041. Epub 2021 May 29.

Hospital-based sentinel surveillance for bacterial meningitis in under-five children prior to the introduction of the PCV13 in India

Yuvaraj Jayaraman  1 , Balaji Veeraraghavan  2 , C P Girish Kumar  3 , Bharathy Sukumar  3 , Prabu Rajkumar  3 , Boopathi Kangusamy  3 , Valsan Philip Verghese  2 , Rosemol Varghese  2 , Ranjith Jayaraman  2 , Ambujam Nair Kapoor  4 , Nivedita Gupta  4 , K Kanagasabai  3 , Joseph K David  3 , Jayasri Rajaraman  3 , Gowtham Sockalingam  3 , Ajay Khera  5 , Pradeep Haldar  5 , M K Aggarwal  5 , Rajamohanan K Pillai  6 , Vikas Manchanda  7 , Ramani Bai Joseph Theodore  6 , Jyothi Rajahamsan  6 , Girija Mohan  8 , V Jayalekshmi  8 , Krishnamoorthy Nedunchelian  9 , N Devasena  9 , Sujatha Sridharan  10 , R Selvi  10 , T Ravinder  11 , R Narayana Babu  11 , G Mathevan  12 , C Sugumari  12 , P Sugandhi Rao  13 , Pushpa G Kini  13 , Bhagirathi Dwibedi  14 , Anil Kanga  15 , Neelam Grover  15 , Harish Narayanan  3 , Sanjay M Mehendale  16
Affiliations
Free article

Hospital-based sentinel surveillance for bacterial meningitis in under-five children prior to the introduction of the PCV13 in India

Yuvaraj Jayaraman et al. Vaccine. .
Free article

Abstract

Introduction: A hospital-based sentinel surveillance network for bacterial meningitis was established in India to estimate the burden of bacterial meningitis, and the proportion of major vaccine-preventable causative organisms. This report summarises the findings of the surveillance conducted between March 2012, and September 2016 in eleven hospitals.

Methods: We enrolled eligible children with bacterial meningitis in the age group of one to 59 months. CSF samples were collected and processed for biochemistry, culture, latex agglutination, and real-time PCR. Pneumococcal isolates were serotyped and tested for antimicrobial susceptibility.

Results: Among 12 941 enrolled suspected meningitis cases, 586 (4.5%) were laboratory confirmed. S. pneumoniae (74.2%) was the most commonly detected pathogen, followed by H. influenzae (22.2%), and N. meningitidis (3.6%). Overall 58.1% of confirmed bacterial meningitis cases were children aged between one, and 11 months. H. influenzae meningitis cases had a high (12.3%) case fatality rate. The serotypes covered in PCV13 caused 72% pneumococcal infections, and the most common serotypes were 14 (18.3%), 6B (12.7%) and 19F (9.9%). Non-susceptibility to penicillin was 57%. Forty-five (43.7%) isolates exhibited multidrug resistance, of which 37 were PCV13 serotype isolates.

Conclusions: The results are representative of the burden of bacterial meningitis among under-five children in India. The findings were useful in rolling out PCV in the National Immunization Program. The non-susceptibility to penicillin and multidrug resistance was an important observation. Timely expansion of PCV across India will significantly reduce the burden of antimicrobial resistance. Continued surveillance is needed to understand the trend after PCV expansion in India.

Keywords: Antimicrobial resistance; Bacterial meningitis; Children; Hib; Meningococcal; PCV; Pneumococcal; Serotype; Surveillance.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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