Abstract
BackgroundThe development of optimal vaccination strategies for pneumococcal conjugate vaccines requires serotype-specific data on disease incidence and carriage prevalence. This information is lacking for the African meningitis belt.MethodsWe conducted hospital-based surveillance of acute bacterial meningitis in an urban and rural population of Burkina Faso during 2007–09. Cerebrospinal fluid was evaluated by polymerase chain reaction for species and serotype. In 2008, nasopharyngeal swabs were obtained from a representative population sample (1 month to 39 years; N = 519) and additional oropharyngeal swabs from 145 participants. Swabs were evaluated by culture.ResultsAnnual pneumococcal meningitis incidence rates were highest among <6-month-old (58/100,000) and 15- to 19-year-old persons (15/100,000). Annual serotype 1 incidence was around 5/100,000 in all age groups. Pneumococcal carriage prevalence in nasopharyngeal swabs was 63% among <5-year-old children and 22% among ≥5-year-old persons, but adding oropharyngeal to nasopharyngeal swabs increased the estimated carriage prevalence by 60%. Serotype 1 showed high propensity for invasive disease, particularly among persons aged ≥5 years.ConclusionsSerotype 1 causes the majority of cases with a relatively constant age-specific incidence. Pneumococcal carriage is common in all age groups including adults. Vaccination programs in this region may need to include older target age groups for optimal impact on disease burden.
Highlights
The African meningitis belt is located at the southern border of the Sahara and extends from Senegal to Ethiopia
While meningitis epidemics are exclusively due to meningococci, seasonal hyperendemicity is due to both pneumococci and meningococci [3,4,5,6]
We evaluated whether oropharyngeal added to nasopharyngeal swabbing improved pneumococcal carriage detection
Summary
Given the high burden of pneumococcal meningitis in older children and adults in the African meningitis belt – and an unknown burden of pneumococcal pneumonia – the question arises whether the vaccination schedule for this region should be adapted to directly protect these age groups from meningitis and other pneumococcal syndromes [7]. This discussion is complex and should include biomedical, financial, logistic and sociological aspects.
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