title: An outbreak of serotype 1 Streptococcus pneumoniae meningitis in northern Ghana with features that are characteristic of Neisseria meningitidis meningitis epidemics.
abstract: BACKGROUND
  The Kassena-Nankana District (KND) of northern Ghana lies in the African meningitis belt, where epidemics of bacterial meningitis have been reoccurring every 8-12 years. These epidemics are generally caused by Neisseria meningitidis, an organism that is considered to be uniquely capable of causing meningitis epidemics.
  
  
  METHODS
  We recruited all patients with suspected meningitis in the KND between 1998 and 2003. Cerebrospinal fluid samples were collected and analyzed by standard microbiological techniques. Bacterial isolates were subjected to serotyping, multilocus sequence typing (MLST), and antibiotic-resistance testing.
  
  
  RESULTS
  A continual increase in the incidence of pneumococcal meningitis was observed from 2000 to 2003. This outbreak exhibited strong seasonality, a broad host age range, and clonal dominance, all of which are characteristic of meningococcal meningitis epidemics in the African meningitis belt. The case-fatality rate for pneumococcal meningitis was 44.4%; the majority of pneumococcal isolates were antibiotic sensitive and expressed the serotype 1 capsule. MLST revealed that these isolates belonged to a clonal complex dominated by sequence type (ST) 217 and its 2 single-locus variants, ST303 and ST612.
  
  
  CONCLUSIONS
  The S. pneumoniae ST217 clonal complex represents a hypervirulent lineage with a high propensity to cause meningitis, and our results suggest that this lineage might have the potential to cause an epidemic. Serotype 1 is not included in the currently licensed pediatric heptavalent pneumococcal vaccine. Mass vaccination with a less complex conjugate vaccine that targets hypervirulent serotypes should, therefore, be considered.
authors.affiliation: Swiss Tropical Institute, Basel, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Leimkugel
authors.forename: Abudulai
authors.initials: A
authors.lastname: Adams Forgor
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gagneux
authors.forename: Valentin
authors.initials: V
authors.lastname: Pflüger
authors.forename: Christian
authors.initials: C
authors.lastname: Flierl
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Awine
authors.forename: Martin
authors.initials: M
authors.lastname: Naegeli
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Dangy
authors.forename: Tom
authors.initials: T
authors.lastname: Smith
authors.forename: Abraham
authors.initials: A
authors.lastname: Hodgson
authors.forename: Gerd
authors.initials: G
authors.lastname: Pluschke
mesh_terms: D024881:Drug Resistance, Bacterial; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016920:Meningitis, Bacterial / Q000453:epidemiology*; D008589:Meningococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D008826:Microbial Sensitivity Tests; D009345:Neisseria meningitidis / Q000145:classification / Q000187:drug effects; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D011891:Rain; D012621:Seasons; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects