title: Surveillance of pneumococcal meningitis among children in Sindh, southern Pakistan.
abstract: BACKGROUND
  Information about the burden of invasive pneumococcal disease among children in Pakistan is limited.
  
  
  METHODS
  Surveillance of bacterial meningitis among children aged <5 years was set up at 18 hospitals in southern Pakistan that fulfilled the following criteria: (1) >30 pediatric admissions weekly, (2) skilled personnel to perform lumbar punctures, and (3) close proximity to an Aga Khan University Hospital laboratory collection point.
  
  
  RESULTS
  A total of 2690 children were admitted to the hospital with suspected acute bacterial meningitis, and 2646 (98%) underwent lumbar puncture. Of the 2646 cerebrospinal fluid specimens obtained, 412 (16%) were purulent, and pathogens were detected by culture or latex agglutination testing in 83 (20.1%) of the purulent specimens. Of the 83 isolates detected, 48 (57.8%) were Haemophilus influenzae type b, 32 (38.5%) were Streptococcus pneumoniae, and 3 (3.6%) were Neisseria meningiditis. Overall, 81% of the pathogens detected were from children aged <1 year. More than 50% of families reported definite prior antimicrobial use. The minimum detected incidence rates of purulent meningitis in Hyderabad were 112 cases per 100,000 children aged <1 year and 45.3 cases per 100,000 children aged <5 years. After adjustment for limitations in access to care and the low sensitivity of cerebrospinal fluid culture, the adjusted incidence rates of pneumococcal meningitis were 81 cases per 100,000 children aged <1 year (95% confidence interval, 26.2-190.5 cases per 100,000) and 20 cases per 100,000 children aged <5 years (95% confidence interval, 7.3-43.7 cases per 100,000). Of the 32 children with pneumococcal meningitis, 8 (25%) died during hospitalization.
  
  
  CONCLUSIONS
  Our surveillance system detected a substantial burden of purulent meningitis among infants and children in southern Pakistan. H. influenzae type b and S. pneumoniae accounted for >90% of detected pathogens. The use of vaccines against these 2 pathogens could prevent a substantial portion of disease and deaths in Pakistan.
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan. Anita.zaidi@aku.edu
authors.forename: Anita K M
authors.initials: AK
authors.lastname: Zaidi
authors.forename: Hassan
authors.initials: H
authors.lastname: Khan
authors.forename: Razzaq
authors.initials: R
authors.lastname: Lasi
authors.forename: Waheed
authors.initials: W
authors.lastname: Mahesar
mesh_terms: D000942:Antigens, Bacterial / Q000134:cerebrospinal fluid; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002673:Child, Hospitalized; D002675:Child, Preschool; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007841:Latex Fixation Tests; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology*; D010154:Pakistan / Q000453:epidemiology; D013129:Spinal Puncture; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*
chemical_list: D000942:Antigens, Bacterial