Abstract
BackgroundBacterial meningitis is a major cause of mortality among children under 5 years of age. Senegal is part of World Health Organization–coordinated sentinel site surveillance for pediatric bacterial meningitis surveillance. We conducted this analysis to describe the epidemiology and etiology of bacterial meningitis among children less than 5 years in Senegal from 2010 and to 2016.MethodsChildren who met the inclusion criteria for suspected meningitis at the Centre Hospitalier National d’Enfants Albert Royer, Senegal, from 2010 to 2016 were included. Cerebrospinal fluid specimens were collected from suspected cases examined by routine bacteriology and molecular assays. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed.ResultsA total of 1013 children were admitted with suspected meningitis during the surveillance period. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus accounted for 66% (76/115), 25% (29/115), and 9% (10/115) of all confirmed cases, respectively. Most of the suspected cases (63%; 639/1013) and laboratory-confirmed (57%; 66/115) cases occurred during the first year of life. Pneumococcal meningitis case fatality rate was 6-fold higher than that of meningococcal meningitis (28% vs 5%). The predominant pneumococcal lineage causing meningitis was sequence type 618 (n = 7), commonly found among serotype 1 isolates. An ST 2174 lineage that included serotypes 19A and 23F was resistant to trimethoprim-sulfamethoxazole.ConclusionsThere has been a decline in pneumococcal meningitis post–pneumococcal conjugate vaccine introduction in Senegal. However, disease caused by pathogens covered by vaccines in widespread use still persists. There is need for continued effective monitoring of vaccine-preventable meningitis.
Highlights
Bacterial meningitis is a major cause of mortality among children under 5 years of age
There has been a decline in pneumococcal meningitis post–pneumococcal conjugate vaccine introduction in Senegal
A suspected meningitis case was defined as sudden onset of fever (>38°C axillary or >38.5°C rectal temperature), with a combination of any of the following clinical symptoms: altered consciousness, stiff neck, sensitivity to light and bulging of the fontanelle if the child is less than 1 year old; a confirmed case was defined as any suspected meningitis case that is laboratory confirmed by culture or polymerase chain reaction (PCR) [15]
Summary
Children who met the inclusion criteria for suspected meningitis at the Centre Hospitalier National d’Enfants Albert Royer, Senegal, from 2010 to 2016 were included. Cerebrospinal fluid specimens were collected from suspected cases examined by routine bacteriology and molecular assays. Hospital-based sentinel surveillance of bacterial meningitis is ongoing at the Centre Hospitalier National d’Enfants Albert Royer (CHNEAR) located in Dakar, the capital city of Senegal. Senegal has an estimated population of 15.85 million and a gross national per capita income of US $950 [14]. The hot and dry Harmattan winds last from November until the onset of the rains in mid-May. All children less than 5 years old who presented with suspected meningitis between 2010 and 2016 underwent a lumbar puncture as part of the routine diagnostic procedures. Information on demographic, clinical, and vaccination status was captured by trained surveillance personnel
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