title: Streptococcus pneumoniae and Haemophilus influenzae in paediatric meningitis patients at Goroka General Hospital, Papua New Guinea: serotype distribution and antimicrobial susceptibility in the pre-vaccine era.
abstract: BACKGROUND
  Bacterial meningitis remains an important infection globally, with the greatest burden in children in low-income settings, including Papua New Guinea (PNG). We present serotype, antimicrobial susceptibility and outcome data from paediatric meningitis patients prior to introduction of Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines (PCVs) in PNG, providing a baseline for evaluation of immunisation programs.
  
  
  METHODS
  Cerebrospinal fluid (CSF) was collected from children admitted to Goroka General Hospital with suspected meningitis between 1996 and 2005. Culture and sensitivity was conducted, and pneumococci and H. influenzae were serotyped. Laboratory findings were linked to clinical outcomes.
  
  
  RESULTS
  We enrolled 1884 children. A recognised pathogen was identified in 375 children (19.9%). Streptococcus pneumoniae (n = 180) and Hib (n = 153) accounted for 88.8% of pathogens isolated. 24 different pneumococcal serogroups were identified; non-PCV types 2, 24 and 46 accounted for 31.6% of pneumococcal meningitis. 10- and 13-valent PCVs would cover 44.1% and 45.4% of pneumococcal meningitis respectively. Pneumococcal isolates were commonly resistant to penicillin (21.5%) and 23% of Hib isolates were simultaneously resistant to ampicillin, co-trimoxazole and chloramphenicol. The case fatality rate in patients with a recognised bacterial pathogen was 13.4% compared to 8.5% in culture-negative patients.
  
  
  CONCLUSIONS
  If implemented in routine expanded programme of immunisation (EPI) with high coverage, current PCVs could prevent almost half of pneumococcal meningitis cases. Given the diversity of circulating serotypes in PNG serotype replacement is of concern. Ongoing surveillance is imperative to monitor the impact of vaccines. In the longer term vaccines providing broader protection against pneumococcal meningitis will be needed.
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. andrew.greenhill@federation.edu.au.|Telethon Kids Institute, The University of Western Australia, Perth, Australia. andrew.greenhill@federation.edu.au.|School of Applied and Biomedical Sciences, Federation University, Churchill, Australia. andrew.greenhill@federation.edu.au.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Greenhill
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. suparatp@hotmail.com.|The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia. suparatp@hotmail.com.
authors.forename: Suparat
authors.initials: S
authors.lastname: Phuanukoonnon
authors.forename: Audrey
authors.initials: A
authors.lastname: Michael
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. mition.yoannes@pngimr.org.pg.
authors.forename: Mition
authors.initials: M
authors.lastname: Yoannes
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. tilda.orami@pngimr.org.pg.
authors.forename: Tilda
authors.initials: T
authors.lastname: Orami
authors.affiliation: Queensland Department of Health, Forensic and Scientific Services, Coopers Plains, Australia. Helen.Smith4@health.qld.gov.au.
authors.forename: Helen
authors.initials: H
authors.lastname: Smith
authors.affiliation: Queensland Department of Health, Forensic and Scientific Services, Coopers Plains, Australia.
authors.forename: Denise
authors.initials: D
authors.lastname: Murphy
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, Australia. christopher.blyth@uwa.edu.au.|School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia. christopher.blyth@uwa.edu.au.|Princess Margaret Hospital for Children, Perth, Australia. christopher.blyth@uwa.edu.au.|PathWest Laboratory Medicine, Perth, Western Australia, Australia. christopher.blyth@uwa.edu.au.
authors.forename: Christopher
authors.initials: C
authors.lastname: Blyth
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. reederj@who.int.|Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. reederj@who.int.
authors.forename: John
authors.initials: J
authors.lastname: Reeder
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. peter.siba@pngimr.org.pg.
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. william.pomat@pngimr.org.pg.
authors.forename: William
authors.initials: W
authors.lastname: Pomat
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, Australia. Deborah.Lehmann@telethonkids.org.au.
authors.forename: Deborah
authors.initials: D
authors.lastname: Lehmann
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D005260:Female; D019741:Haemophilus influenzae type b / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D006769:Hospitals, General; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000276:immunology / Q000382:microbiology* / Q000517:prevention & control; D008586:Meningitis, Pneumococcal / Q000276:immunology / Q000382:microbiology* / Q000517:prevention & control; D008826:Microbial Sensitivity Tests; D010219:Papua New Guinea; D022242:Pneumococcal Vaccines / Q000494:pharmacology; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology; D018074:Vaccines, Conjugate / Q000494:pharmacology
chemical_list: C538862:13-valent pneumococcal vaccine; D000890:Anti-Infective Agents; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate; D015662:Trimethoprim, Sulfamethoxazole Drug Combination