title: Prospective multi-centre sentinel surveillance for Haemophilus influenzae type b & other bacterial meningitis in Indian children.
abstract: OBJECTIVE
  Haemophilus influenzae type b (Hib) is one of the leading bacterial causes of invasive disease in populations without access to Hib conjugate vaccines (Hib-CV). India has recently decided to introduce Hib-CV into the routine immunization programme in selected States. Longitudinal data quantifying the burden of bacterial meningitis and the proportion of disease caused by various bacteria are needed to track the impact of Hib-CV once introduced. A hospital-based sentinel surveillance network was established at four places in the country and this study reports the results of this ongoing surveillance.
  
  
  METHODS
  Children aged 1 to 23 months with suspected bacterial meningitis were enrolled in Chennai, Lucknow, New Delhi, and Vellore between July 2008 and June 2010. All cerebrospinal fluid (CSF) samples were tested using cytological, biochemical, and culture methods. Samples with abnormal CSF (≥10 WBC per μl) were tested by latex agglutination test for common paediatric bacterial meningitis pathogens.
  
  
  RESULTS
  A total of 708 patients with abnormal CSF were identified, 89 of whom had a bacterial pathogen confirmed. Hib accounted for the majority of bacteriologically confirmed cases, 62 (70%), while Streptococcus pneumoniae and group B Streptococcus were identified in 12 (13%) and seven (8%) cases, respectively. The other eight cases were a mix of other bacteria. The proportion of abnormal CSF and probable bacterial meningitis that was caused by Hib was 74 and 58 per cent lower at Christian Medical College (CMC), Vellore, which had a 41 per cent coverage of Hib-CV among all suspected meningitis cases, compared to the combined average proportion at the other three centres where a coverage between 1 and 8 per cent was seen (P<0.001 and P= 0.05, respectively).
  
  
  CONCLUSIONS
  Hib was found to be the predominant cause of bacterial meningitis in young children in diverse geographic locations in India. Possible indications of herd immunity was seen at CMC compared to sites with low immunization coverage with Hib-CV. As Hib is the most common pathogen in bacterial meningitis, Hib-CV would have a large impact on bacterial meningitis in Indian children.
authors.affiliation: Institute of Child Health & Hospital for Children, Chennai, India. ramachandran_dr@rediffmail.com
authors.forename: Padmanabhan
authors.initials: P
authors.lastname: Ramachandran
authors.forename: Sean Patrick
authors.initials: SP
authors.lastname: Fitzwater
authors.forename: Satinder
authors.initials: S
authors.lastname: Aneja
authors.forename: Valsan Philip
authors.initials: VP
authors.lastname: Verghese
authors.forename: Vishwajeet
authors.initials: V
authors.lastname: Kumar
authors.forename: Krishnamoorthy
authors.initials: K
authors.lastname: Nedunchelian
authors.forename: Nitya
authors.initials: N
authors.lastname: Wadhwa
authors.forename: Balaji
authors.initials: B
authors.lastname: Veeraraghavan
authors.forename: Rashmi
authors.initials: R
authors.lastname: Kumar
authors.forename: Mohamed
authors.initials: M
authors.lastname: Meeran
authors.forename: Arti
authors.initials: A
authors.lastname: Kapil
authors.forename: Sudha
authors.initials: S
authors.lastname: Jasmine
authors.forename: Aarti
authors.initials: A
authors.lastname: Kumar
authors.forename: Saradha
authors.initials: S
authors.lastname: Suresh
authors.forename: Shinjini
authors.initials: S
authors.lastname: Bhatnagar
authors.forename: Kurien
authors.initials: K
authors.lastname: Thomas
authors.forename: Shally
authors.initials: S
authors.lastname: Awasthi
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Aruna
authors.initials: A
authors.lastname: Chandran
mesh_terms: D016667:Bacterial Capsules; D005260:Female; D018073:Haemophilus Vaccines; D019741:Haemophilus influenzae type b / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D017589:Immunization Programs; D007194:India; D007223:Infant; D008297:Male; D008583:Meningitis, Haemophilus / Q000134:cerebrospinal fluid* / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D018571:Sentinel Surveillance; D013290:Streptococcal Infections / Q000134:cerebrospinal fluid / Q000382:microbiology; D013292:Streptococcus agalactiae / Q000302:isolation & purification / Q000472:pathogenicity; D013296:Streptococcus pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity
chemical_list: D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine