title: Determination of pneumococcal serotypes in meningitis cases in Niger, 2003-2011.
abstract: BACKGROUND
  The epidemiology of pneumococcal meningitis in the African 'meningitis belt' is poorly studied. In order to ensure an effective vaccination strategy and post-vaccination surveillance, we examined the serotype distribution patterns of pneumococcal meningitis in Niger over the period 2003-2011.
  
  
  METHODS
  Cerebrospinal fluid (CSF) samples were collected from different health facilities throughout Niger in the frame of the national microbiological surveillance of meningitis. Determination of the serotype of CSF positive for pneumococci was performed using a sequential multiplex PCR method (SM-PCR) adapted with a national algorithm in which 32 different serotypes were covered and grouped into eight consecutive PCR.
  
  
  RESULTS
  The SM-PCR assay could predict the Sp serotype for 779 CSF (88.7%), 98 CSF (11.3%) were not-typeable in our national-adapted algorithm. In total, 26 different serotypes were identified. Serotype 1 (n = 393) was the most prevalent and accounted for 45.3% of infections, followed by serogroups/serotypes 12F/(12A)/(44)/(46) (7.3%), 6/(6A/6B/6C/6D) (5.4%), 14 (5.2%), 5 (4.6%), 23F (4.2%), 45 (3.6%), 2 (3.1%), 18/(18A/18B/18C/18F) (2.9%) and 17 others serotypes with a prevalence of less than 2%. The proportion of serotype 1 in infants(<2 years old) represented only 4.3% of the cases affected by this serotype. In contrast, serotypes 5, 6, 14, 19A and 23F were only detected in very young children.
  
  
  CONCLUSIONS
  The proportion of serotype 1 in the pneumococcal meningitis cases and the theoretical vaccine coverage across all age groups advocates for the introduction of a conjugate vaccine (PCV10 or 13) into the Expanded Programme on Immunization (EPI) in Niger. Post-vaccine introduction surveillance supported by molecular approaches will be essential to provide a comprehensive picture of the impact of the vaccine on the burden reduction of pneumococcal meningitis and on pneumococcal serotype distribution.
authors.affiliation: Centre de Recherche Médicale et Sanitaire, Niamey, Niger. jmcollard@cermes.org
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Collard
authors.forename: Abdel-kader
authors.initials: AK
authors.lastname: Alio Sanda
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Jusot
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008586:Meningitis, Pneumococcal / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D009548:Niger / Q000453:epidemiology; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification*; D018074:Vaccines, Conjugate / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
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