TY - JOUR
T1 - 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
AU - Kwambana-Adams, Brenda Anna
AU - Asiedu-Bekoe, Franklin
AU - Sarkodie, Badu
AU - Afreh, Osei Kuffour
AU - Kuma, George Khumalo
AU - Owusu-Okyere, Godfred
AU - Foster-Nyarko, Ebenezer
AU - Ohene, Sally-Ann
AU - Okot, Charles
AU - Worwui, Archibald Kwame
AU - Okoi, Catherine
AU - Senghore, Madikay
AU - Otu, Jacob Kweku
AU - Ebruke, Chinelo
AU - Bannerman, Richard
AU - Amponsa-Achiano, Kwame
AU - Opare, David
AU - Kay, Gemma
AU - Letsa, Timothy
AU - Kaluwa, Owen
AU - Appiah-Denkyira, Ebenezer
AU - Bampoe, Victor
AU - Zaman, Syed M. A.
AU - Pallen, Mark J.
AU - D'Alessandro, Umberto
AU - Mwenda, Jason M.
AU - Antonio, Martin
N1 - FTX; DOAJ
PY - 2016
Y1 - 2016
N2 - 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.
AB - 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.
KW - Pneumococcus
KW - Outbreak
KW - Serotype 1
KW - Ghana
KW - Meningitis belt
KW - West Africa
KW - Meningitis
KW - Pneumococcal conjugate vaccine (PCV)
KW - DETERMINING CAPSULAR SEROTYPES
KW - SEQUENTIAL MULTIPLEX PCR
KW - NURSING-HOME RESIDENTS
KW - STREPTOCOCCUS-PNEUMONIAE
KW - MENINGOCOCCAL MENINGITIS
KW - NEISSERIA-MENINGITIDIS
KW - BACTERIAL-MENINGITIS
KW - BURKINA-FASO
KW - EPIDEMIOLOGY
KW - AFRICA
U2 - 10.1186/s12879-016-1914-3
DO - 10.1186/s12879-016-1914-3
M3 - A1: Web of Science-article
SN - 1471-2334
VL - 16
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
M1 - 575
ER -