An outbreak of pneumococcal meningitis among older children (≥5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana

BMC Infectious Diseases, Oct 2016

Background An outbreak of pneumococcal meningitis among non-infant children and adults occurred in the Brong-Ahafo region of Ghana between December 2015 and April 2016 despite the recent nationwide implementation of a vaccination programme for infants with the 13-valent pneumococcal conjugate vaccine (PCV13). Methods Cerebrospinal fluid (CSF) specimens were collected from patients with suspected meningitis in the Brong-Ahafo region. CSF specimens were subjected to Gram staining, culture and rapid antigen testing. Quantitative PCR was performed to identify pneumococcus, meningococcus and Haemophilus influenzae. Latex agglutination and molecular serotyping were performed on samples. Antibiogram and whole genome sequencing were performed on pneumococcal isolates. Results Eight hundred eighty six patients were reported with suspected meningitis in the Brong-Ahafo region during the period of the outbreak. In the epicenter district, the prevalence was as high as 363 suspected cases per 100,000 people. Over 95 % of suspected cases occurred in non-infant children and adults, with a median age of 20 years. Bacterial meningitis was confirmed in just under a quarter of CSF specimens tested. Pneumococcus, meningococcus and Group B Streptococcus accounted for 77 %, 22 % and 1 % of confirmed cases respectively. The vast majority of serotyped pneumococci (80 %) belonged to serotype 1. Most of the pneumococcal isolates tested were susceptible to a broad range of antibiotics, with the exception of two pneumococcal serotype 1 strains that were resistant to both penicillin and trimethoprim-sulfamethoxazole. All sequenced pneumococcal serotype 1 strains belong to Sequence Type (ST) 303 in the hypervirulent ST217 clonal complex. Conclusion The occurrence of a pneumococcal serotype 1 meningitis outbreak three years after the introduction of PCV13 is alarming and calls for strengthening of meningitis surveillance and a re-evaluation of the current vaccination programme in high risk countries.

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An outbreak of pneumococcal meningitis among older children (≥5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana

Kwambana-Adams et al. BMC Infectious Diseases An outbreak of pneumococcal meningitis among older children (≥5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana Brenda Anna Kwambana-Adams 0 Franklin Asiedu-Bekoe 3 Badu Sarkodie 3 Osei Kuffour Afreh 2 George Khumalo Kuma 7 Godfred Owusu-Okyere 6 Ebenezer Foster-Nyarko 0 Sally-Ann Ohene 5 Charles Okot 5 Archibald Kwame Worwui 0 Catherine Okoi 0 Madikay Senghore 0 Jacob Kweku Otu 0 Chinelo Ebruke 0 Richard Bannerman 2 Kwame Amponsa-Achiano 3 David Opare 6 Gemma Kay 1 Timothy Letsa 2 Owen Kaluwa 5 Ebenezer Appiah-Denkyira 3 Victor Bampoe 9 Syed M. A. Zaman 4 8 Mark J. Pallen 1 Umberto D'Alessandro 4 8 10 Jason M. Mwenda 11 Martin Antonio 0 1 4 0 Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia , P.O Box 273, Banjul, Fajara , The Gambia 1 Microbiology and Infection Unit, Warwick Medical School , Warwick , UK 2 Brong Ahafo Regional Health Directorate , Sunyani, Brong Ahafo , Ghana 3 Ghana Health Service , Accra , Ghana 4 London School of Hygiene and Tropical Medicine , London , UK 5 WHO Country Office Ghana , Accra , Ghana 6 National Public Health Reference Laboratory, Ghana Health Service , Accra , Ghana 7 Regional Hospital Sunyani , Sunyani, Brong Ahafo Region , Ghana 8 Disease Control and Elimination Theme, Medical Research Council Unit The Gambia , Fajara , The Gambia 9 Ministry of Health , Accra , Ghana 10 Institute of Tropical Medicine , Antwerp , Belgium 11 WHO Regional Office for Africa , Brazzaville , Republic of Congo Background: An outbreak of pneumococcal meningitis among non-infant children and adults occurred in the Brong-Ahafo region of Ghana between December 2015 and April 2016 despite the recent nationwide implementation of a vaccination programme for infants with the 13-valent pneumococcal conjugate vaccine (PCV13). Methods: Cerebrospinal fluid (CSF) specimens were collected from patients with suspected meningitis in the Brong-Ahafo region. CSF specimens were subjected to Gram staining, culture and rapid antigen testing. Quantitative PCR was performed to identify pneumococcus, meningococcus and Haemophilus influenzae. Latex agglutination and molecular serotyping were performed on samples. Antibiogram and whole genome sequencing were performed on pneumococcal isolates. Results: Eight hundred eighty six patients were reported with suspected meningitis in the Brong-Ahafo region during the period of the outbreak. In the epicenter district, the prevalence was as high as 363 suspected cases per 100,000 people. Over 95 % of suspected cases occurred in non-infant children and adults, with a median age of 20 years. Bacterial meningitis was confirmed in just under a quarter of CSF specimens tested. Pneumococcus, meningococcus and Group B Streptococcus accounted for 77 %, 22 % and 1 % of confirmed cases respectively. The vast majority of serotyped pneumococci (80 %) belonged to serotype 1. Most of the pneumococcal isolates tested were susceptible to a broad range of antibiotics, with the exception of two pneumococcal serotype 1 strains that were resistant to both penicillin and trimethoprim-sulfamethoxazole. All sequenced pneumococcal serotype 1 strains belong to Sequence Type (ST) 303 in the hypervirulent ST217 clonal complex. (Continued on next page) © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. - (Continued from previous page) Conclusion: The occurrence of a pneumococcal serotype 1 meningitis outbreak three years after the introduction of PCV13 is alarming and calls for strengthening of meningitis surveillance and a re-evaluation of the current vaccination programme in high risk countries. Background Acute bacterial meningitis is most commonly caused by Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae Type b. In sub-Saharan Africa, there is a “meningitis belt” running from Ethiopia to Senegal where there is high seasonal incidence of bacterial meningitis. In West Africa, the highest incidence of bacterial meningitis occurs during the dry season (December to March) [1–3], with incidence rates in epidemics as high as 800 cases per 100,000 people [4, 5]. N. meningitidis, the meningococcus, is the leading cause of bacterial meningitis in West Africa after the first year of life, even in non-epidemic periods [1–3, 6, 7]. In the past, most West African meningococcal (...truncated)


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Brenda Kwambana-Adams, Franklin Asiedu-Bekoe, Badu Sarkodie, Osei Afreh, George Kuma, Godfred Owusu-Okyere, Ebenezer Foster-Nyarko, Sally-Ann Ohene, Charles Okot, Archibald Worwui, Catherine Okoi, Madikay Senghore, Jacob Otu, Chinelo Ebruke, Richard Bannerman, Kwame Amponsa-Achiano, David Opare, Gemma Kay, Timothy Letsa, Owen Kaluwa, Ebenezer Appiah-Denkyira, Victor Bampoe, Syed Zaman, Mark Pallen, Umberto D’Alessandro, Jason Mwenda, Martin Antonio. An outbreak of pneumococcal meningitis among older children (≥5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana, BMC Infectious Diseases, 2016, pp. 575, 16, DOI: 10.1186/s12879-016-1914-3