Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine

Beckie N Tagbo; Rowan E Bancroft; Iretiola Fajolu; Mohammed B Abdulkadir; Muhammad F Bashir; Olusola P Okunola; Ayodeji H Isiaka; Namadi M Lawal; Benedict O Edelu; Ngozi Onyejiaka; Chinonyerem J Ihuoma; Florence Ndu; Uchenna C Ozumba; Frances Udeinya; Folasade Ogunsola; Aishat O Saka; Abayomi Fadeyi; Sunday A Aderibigbe; Jimoh Abdulraheem; Adamu G Yusuf; Peter Sylvanus Ndow; Philomena Ogbogu; Chinomnso Kanu; Velly Emina; Olajumoke J Makinwa; Florian Gehre; Kabir Yusuf; Fiona Braka; Jason M Mwenda; Johnson M Ticha; Dorothy Nwodo; Archibald Worwui; Joseph N Biey; Brenda A Kwambana-Adams; Martin Antonio

doi:10.1093/cid/ciz474

Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine

Clin Infect Dis. 2019 Sep 5;69(Suppl 2):S81-S88. doi: 10.1093/cid/ciz474.

Authors

Beckie N Tagbo^{1

2}, Rowan E Bancroft³, Iretiola Fajolu^{4

5}, Mohammed B Abdulkadir⁶, Muhammad F Bashir⁷, Olusola P Okunola⁸, Ayodeji H Isiaka⁹, Namadi M Lawal¹⁰, Benedict O Edelu², Ngozi Onyejiaka¹¹, Chinonyerem J Ihuoma¹², Florence Ndu¹³, Uchenna C Ozumba¹², Frances Udeinya¹², Folasade Ogunsola¹¹, Aishat O Saka⁶, Abayomi Fadeyi¹⁴, Sunday A Aderibigbe¹⁵, Jimoh Abdulraheem¹⁴, Adamu G Yusuf¹⁶, Peter Sylvanus Ndow³, Philomena Ogbogu¹⁷, Chinomnso Kanu¹⁸, Velly Emina¹⁹, Olajumoke J Makinwa¹¹, Florian Gehre^{2

20}, Kabir Yusuf¹⁰, Fiona Braka²¹, Jason M Mwenda²², Johnson M Ticha⁹, Dorothy Nwodo⁹, Archibald Worwui³, Joseph N Biey²², Brenda A Kwambana-Adams³, Martin Antonio^{3

23}

Affiliations

¹ Institute of Child Health, University of Nigeria Teaching Hospital, Ituku-Ozalla, and.
² Department of Paediatrics University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State.
³ World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul.
⁴ Department of Paediatrics, Lagos University Teaching Hospital.
⁵ Department of Paediatrics, College of Medicine, University of Lagos.
⁶ Department of Paediatrics and Child Health, University of Ilorin Teaching Hospital.
⁷ Department of Paediatrics, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi.
⁸ Department of Child Health, University of Benin Teaching Hospital.
⁹ WHO Country office, Abuja.
¹⁰ Department of Disease Control and Immunization, National Primary Health Care Development Agency, Abuja.
¹¹ Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital.
¹² Department of Microbiology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State.
¹³ Mother of Christ Specialist Hospital Enugu.
¹⁴ Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Kwara.
¹⁵ Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Kwara.
¹⁶ Medical Microbiology Department, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi.
¹⁷ Department of Medical Microbiology, University of Benin Teaching Hospital.
¹⁸ Department of Community Health, University of Benin Teaching Hospital, and.
¹⁹ Department of Community Health and Primary Care, Lagos University Teaching Hospital, Nigeria.
²⁰ Department of Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.
²¹ WHO, Nigeria EPI Cluster Lead.
²² WHO Regional Office for Africa WHO/AFRO, Republic of Congo, Brazzaville.
²³ Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.

Abstract

Background: Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM).

Methods: From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM.

Results: A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively.

Conclusions: Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the country.

Keywords: Nigeria; meningitis; meningococcus; neumococcus; pediatric.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child, Preschool
Cost of Illness
Female
Haemophilus influenzae / classification
Hospitalization / statistics & numerical data*
Humans
Infant
Infant, Newborn
Longitudinal Studies
Male
Meningitis, Bacterial / epidemiology*
Meningitis, Bacterial / mortality
Meningitis, Bacterial / prevention & control*
Neisseria meningitidis / classification
Nigeria
Pneumococcal Vaccines / administration & dosage*
Sentinel Surveillance*
Serogroup
Streptococcus pneumoniae / classification

Substances

10-valent pneumococcal conjugate vaccine
Pneumococcal Vaccines