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

Research Article

Osei Kuffour Afreh¹  Timothy Letsa¹  Richard Bannerman¹  Syed M. A. Zaman²  Umberto D’Alessandro³  Franklin Asiedu-Bekoe⁴  Ebenezer Appiah-Denkyira⁴  Kwame Amponsa-Achiano⁴  Badu Sarkodie⁴  Gemma Kay⁵  Mark J. Pallen⁵  Victor Bampoe⁶  David Opare⁷  Godfred Owusu-Okyere⁷  George Khumalo Kuma⁸  Archibald Kwame Worwui⁹  Brenda Anna Kwambana-Adams⁹  Ebenezer Foster-Nyarko⁹  Catherine Okoi⁹  Chinelo Ebruke⁹  Jacob Kweku Otu⁹  Madikay Senghore⁹  Martin Antonio^1,10  Charles Okot^1,11  Owen Kaluwa^1,11  Sally-Ann Ohene^1,11  Jason M. Mwenda^1,12 

[1] Brong Ahafo Regional Health Directorate, Sunyani, Brong Ahafo, Ghana;Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia;London School of Hygiene and Tropical Medicine, London, UK;Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia;London School of Hygiene and Tropical Medicine, London, UK;Institute of Tropical Medicine, Antwerp, Belgium;Ghana Health Service, Accra, Ghana;Microbiology and Infection Unit, Warwick Medical School, Warwick, UK;Ministry of Health, Accra, Ghana;National Public Health Reference Laboratory, Ghana Health Service, Accra, Ghana;Regional Hospital Sunyani, Sunyani, Brong Ahafo Region, Ghana;Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia;Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia;Microbiology and Infection Unit, Warwick Medical School, Warwick, UK;London School of Hygiene and Tropical Medicine, London, UK;WHO Country Office Ghana, Accra, Ghana;WHO Regional Office for Africa, Brazzaville, Republic of Congo;

关键词: Pneumococcus;    Outbreak;    Serotype 1;    Ghana;    Meningitis belt;    West Africa;    Meningitis;    Pneumococcal conjugate vaccine (PCV);   

DOI  :  10.1186/s12879-016-1914-3

 received in 2016-06-17, accepted in 2016-10-11,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundAn 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).MethodsCerebrospinal 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.ResultsEight 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.ConclusionThe 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.

【 授权许可】

CC BY   
© The Author(s). 2016