Abstract
BackgroundPediatric bacterial meningitis (PBM) remains an important cause of disease in children in Africa. We describe findings from sentinel site bacterial meningitis surveillance in children <5 years of age in the Republic of Benin, 2011–2016.MethodsCerebrospinal fluid (CSF) was collected from children admitted to Parakou, Natitingou, and Tanguieta sentinel hospitals with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus) was performed by rapid diagnostic tests, microbiological culture, and/or polymerase chain reaction; where possible, serotyping/grouping was performed.ResultsA total of 10 919 suspected cases of meningitis were admitted to the sentinel hospitals. Most patients were 0–11 months old (4863 [44.5%]) and there were 542 (5.0%) in-hospital deaths. Overall, 4168 CSF samples were screened for pathogens and a total of 194 (4.7%) PBM cases were confirmed, predominantly caused by pneumococcus (98 [50.5%]). Following pneumococcal conjugate vaccine (PCV) introduction in 2011, annual suspected meningitis cases and deaths (case fatality rate) progressively declined from 2534 to 1359 and from 164 (6.5%) to 14 (1.0%) in 2012 and 2016, respectively (P < .001). Additionally, there was a gradual decline in the proportion of meningitis cases caused by pneumococcus, from 77.3% (17/22) in 2011 to 32.4% (11/34) in 2016 (odds ratio, 7.11 [95% confidence interval, 2.08–24.30]). Haemophilus influenzae meningitis fluctuated over the surveillance period and was the predominant pathogen (16/34 [47.1%]) by 2016.ConclusionsThe observed decrease in pneumococcal meningitis after PCV introduction may be indicative of changing patterns of PBM etiology in Benin. Maintaining vigilant and effective surveillance is critical for understanding these changes and their wider public health implications.
Highlights
MethodsCerebrospinal fluid (CSF) was collected from children admitted to Parakou, Natitingou, and Tanguieta sentinel hospitals with suspected meningitis
Pediatric bacterial meningitis (PBM) remains an important cause of disease in children in Africa
The observed decrease in pneumococcal meningitis after pneumococcal conjugate vaccines (PCVs) introduction may be indicative of changing patterns of PBM etiology in Benin
Summary
Cerebrospinal fluid (CSF) was collected from children admitted to Parakou, Natitingou, and Tanguieta sentinel hospitals with suspected meningitis. Hospital-based surveillance was conducted at 3 hospitals, the Centre Hospitalier Universitaire Départemental du Borgou/ Alibori in Parakou, L’hopital Saint Jean de Dieu de Tanguieta and the Centre Hospitalier Départemental de l’Atacoralocated in Natitingou, located in northern Benin. These hospitals serve as referral centers, receiving patients referred from other health facilities within and outside the city as well as self-referred patients who are seen at the emergency department or the outpatient clinics. Both hospitals provide 24-hour emergency medical care to the public including for patients with suspected meningitis
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