Abstract
BackgroundThe epidemiology of meningococcal disease in Mozambique and other African countries located outside the “meningitis belt” remains widely unknown. With the event of upcoming vaccines microbiological and epidemiological information is urgently needed.MethodsProspective surveillance for invasive bacterial infections was conducted at the Manhiça District hospital (rural Mozambique) among hospitalized children below 15 years of age. Available Neisseria meningitidis isolates were serogrouped and characterized by Multilocus Sequence Typing (MLST). Antibiotic resistance was also determined.ResultsBetween 1998 and 2008, sixty-three cases of confirmed meningococcal disease (36 meningitis, 26 sepsis and 1 conjunctivitis) were identified among hospitalized children. The average incidence rate of meningococcal disease was 11.6/100,000 (8/100,000 for meningitis and 3.7/100,000 for meningococcemia, respectively). There was a significant rise on the number of meningococcal disease cases in 2005–2006 that was sustained till the end of the surveillance period. Serogroup was determined for 43 of the 63 meningococcal disease cases: 38 serogroup W-135, 3 serogroup A and 2 serogroup Y. ST-11 was the most predominant sequence type and strongly associated with serogroup W-135. Two of the three serogroup A isolates were ST-1, and both serogroup Y isolates were ST-175. N. meningitidis remained highly susceptible to all antibiotics used for treatment in the country, although the presence of isolates presenting intermediate resistance to penicillin advocates for continued surveillance.ConclusionsOur data show a high rate of meningococcal disease in Manhiça, Mozambique, mainly caused by serogroup W-135 ST-11 strains, and advocates for the implementation of a vaccination strategy covering serogroup W-135 meningococci in the country.
Highlights
Neisseria meningitidis is a major cause of meningitis and septicaemia worldwide that often leaves survivors with severe sequelae [1]
In the African meningitis belt, which comprises all countries stretching across Africa from Ethiopia to Senegal [4], incidence rates reach over 55/100,000 population [5] and can surpass 1,000/100,000 during the large-scale epidemics that are a unique characteristic of the belt [6]
In Manhica, a rural village in Southern Mozambique, invasive bacterial infections are monitored by the Centro de Investigacao em Saude da Manhica (CISM) among children hospitalized at the Manhica District Hospital (MDH) since 1998 [21,22,23]
Summary
Neisseria meningitidis is a major cause of meningitis and septicaemia worldwide that often leaves survivors with severe sequelae [1]. Effective vaccination strategies have contributed to maintain the rate of meningococcal disease (MD) low in industrialized countries [2,3]. In the African meningitis belt, which comprises all countries stretching across Africa from Ethiopia to Senegal [4], incidence rates reach over 55/100,000 population [5] and can surpass 1,000/100,000 during the large-scale epidemics that are a unique characteristic of the belt [6]. Despite concerns of a possible expansion of the meningitis belt [15], data on MD from African countries outside this former area are still scarce. Surveillance data revealed Streptococcus pneumoniae and Haemophilus influenzae type b as the major cause of acute bacterial meningitis in Manhica among children #15 years of age, with N. meningitidis being the third. The epidemiology of meningococcal disease in Mozambique and other African countries located outside the ‘‘meningitis belt’’ remains widely unknown. With the event of upcoming vaccines microbiological and epidemiological information is urgently needed
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