title: Pneumococci in the African meningitis belt: meningitis incidence and carriage prevalence in children and adults.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Annual 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.
  
  
  CONCLUSIONS
  Serotype 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.
authors.affiliation: Agence de Médecine Préventive, Paris, France.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Mueller
authors.forename: Seydou
authors.initials: S
authors.lastname: Yaro
authors.forename: Macaire S
authors.initials: MS
authors.lastname: Ouédraogo
authors.forename: Natalia
authors.initials: N
authors.lastname: Levina
authors.forename: Berthe-Marie
authors.initials: BM
authors.lastname: Njanpop-Lafourcade
authors.forename: Haoua
authors.initials: H
authors.lastname: Tall
authors.forename: Régina S
authors.initials: RS
authors.lastname: Idohou
authors.forename: Oumarou
authors.initials: O
authors.lastname: Sanou
authors.forename: Sita S
authors.initials: SS
authors.lastname: Kroman
authors.forename: Aly
authors.initials: A
authors.lastname: Drabo
authors.forename: Boubacar
authors.initials: B
authors.lastname: Nacro
authors.forename: Athanase
authors.initials: A
authors.lastname: Millogo
authors.forename: Mark
authors.initials: M
authors.lastname: van der Linden
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Gessner
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D000367:Age Factors; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D008586:Meningitis, Pneumococcal / Q000453:epidemiology* / Q000382:microbiology*; D009305:Nasopharynx / Q000382:microbiology; D015995:Prevalence; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000502:physiology*; D055815:Young Adult