Abstract
BackgroundPneumococcal conjugate vaccine strategies in GAVI-eligible countries are focusing on infant immunization but this strategy may not be optimal in all settings. We aimed to collect all available population based data on pneumococcal meningitis throughout life in the African meningitis belt and then to model overall meningitis risk to help inform vaccine policy.MethodsAfter a systematic review of literature published from 1970 through the present, we found robust population-based Streptococcus pneumoniae (Sp) meningitis data across age strata for four African meningitis belt countries that included 35 surveillance years spanning from 1970 to 2005. Using these data we modeled disease risk for a hypothetical cohort of 100,000 persons followed throughout life.ResultsSimilar to meningococcal meningitis, laboratory-confirmed pneumococcal meningitis was seasonal, occurring primarily in the dry season. The mean annual Sp meningitis incidence rates were 98, 7.8 to 14, and 5.8 to 12 per 100,000 among persons <1, 1 through 19, and 20 to 99 years of age, respectively, which (in the absence of major epidemics) were higher than meningococcal meningitis incidences for persons less than 1 and over 20 years of age. Mean Sp meningitis case fatality ratios (CFR) among hospitalized patients ranged from 36-66% depending on the age group, with CFR exceeding 60% for all age groups beyond 40 years; depending on the age group, Sp meningitis mortality incidences were 2 to 12-fold greater than those for meningococcal meningitis. The lifetime risks of pneumococcal meningitis disease and death were 0.6% (1 in 170) and 0.3% (1 in 304), respectively. The incidences of these outcomes were highest among children age <1 year. However, the cumulative risk was highest among persons age 5 to 59 years who experienced 59% of pneumococcal meningitis outcomes. After age 5 years and depending on the country, 59-79% of meningitis cases were caused by serotype 1.ConclusionsIn the African meningitis belt, Sp is as important a cause of meningitis as Neisseria meningitidis, particularly among older children and working age adults. The meningitis belt population needs an effective serotype 1 containing vaccine and policy discussions should consider vaccine use outside of early childhood.
Highlights
Pneumococcal conjugate vaccine strategies in Global Alliance for Vaccines and Immunization (GAVI)-eligible countries are focusing on infant immunization but this strategy may not be optimal in all settings
Data we collected from an exhaustive polymerase chain reaction-based surveillance system in and around Bobo-Dioulasso, Burkina Faso, during 20027 suggest that high pneumococcal meningitis burden extends throughout life and is associated with a high case fatality ratio [4,5,6]
These estimates were made for a hypothetical population of 100,000 persons in the African meningitis belt followed from birth through age 99 years [4,5,7,8,9]
Summary
Pneumococcal conjugate vaccine strategies in GAVI-eligible countries are focusing on infant immunization but this strategy may not be optimal in all settings. We aimed to collect all available population based data on pneumococcal meningitis throughout life in the African meningitis belt and to model overall meningitis risk to help inform vaccine policy. Data we collected from an exhaustive polymerase chain reaction-based surveillance system in and around Bobo-Dioulasso, Burkina Faso, during 20027 suggest that high pneumococcal meningitis burden extends throughout life and is associated with a high case fatality ratio [4,5,6]. The current report aims to summarize and model data on pneumococcal meningitis burden in the African meningitis belt and to discuss implications for vaccine policy
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.