Nationwide Trends in Bacterial Meningitis before the Introduction of 13-Valent Pneumococcal Conjugate Vaccine-Burkina Faso, 2011-2013.
BACKGROUND
Following introduction of Haemophilus influenzae type b vaccine in 2006 and serogroup A meningococcal conjugate vaccine in 2010, Streptococcus pneumoniae (Sp) became the leading cause of bacterial meningitis in Burkina Faso. We describe bacterial meningitis epidemiology, focusing on pneumococcal meningitis, before 13-valent pneumococcal conjugate vaccine (PCV13) introduction in the pediatric routine immunization program in October 2013.


METHODS
Nationwide population-based meningitis surveillance collects case-level demographic and clinical information and cerebrospinal fluid (CSF) laboratory results. Sp infections are confirmed by culture, real-time polymerase chain reaction (rt-PCR), or latex agglutination, and CSF serotyped using real-time and conventional PCR. We calculated incidence rates in cases per 100,000 persons, adjusting for age and proportion of cases with CSF tested at national reference laboratories, and case fatality ratios (CFR).


RESULTS
During 2011-2013, 1,528 pneumococcal meningitis cases were reported. Average annual adjusted incidence rates were 26.9 (<1 year), 5.4 (1-4 years), 7.2 (5-14 years), and 3.0 (≥15 years). Overall CFR was 23% and highest among children aged <1 year (32%) and adults ≥30 years (30%). Of 1,528 cases, 1,036 (68%) were serotyped: 71% were PCV13-associated serotypes, 14% were non-PCV13-associated serotypes, and 15% were non-typeable by PCR. Serotypes 1 (45%) and 12F/12A/12B/44/46 (8%) were most common. Among children aged <1 year, serotypes 5 (15%), 6A/6B (13%) and 1 (12%) predominated.


CONCLUSIONS
In Burkina Faso, the highest morbidity and mortality due to pneumococcal meningitis occurred among children aged <1 year. The majority of cases were due to PCV13-associated serotypes; introduction of PCV13 should substantially decrease this burden.
Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.
Dinanibè
D
Kambiré
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.|National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Heidi M
http://orcid.org/0000-0002-9415-9340
HM
Soeters
Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.
Rasmata
R
Ouédraogo-Traoré
Ministère de la Santé, Ouagadougou, Burkina Faso.
Isaïe
I
Medah
Centre Hospitalier Universitaire-Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
Lassana
L
Sangare
Ministère de la Santé, Ouagadougou, Burkina Faso.
Issaka
I
Yaméogo
Ministère de la Santé, Ouagadougou, Burkina Faso.
Guetawendé
G
Sawadogo
Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso.
Abdoul-Salam
AS
Ouédraogo
Centre Muraz, Bobo-Dioulasso, Burkina Faso.
Soumeya
S
Hema-Ouangraoua
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Lesley
L
McGee
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Velusamy
V
Srinivasan
CDC Foundation, Ouagadougou, Burkina Faso.
Flavien
F
Aké
Centre Hospitalier Universitaire-Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
Malika
M
Congo-Ouédraogo
Centre Muraz, Bobo-Dioulasso, Burkina Faso.
Soufian
S
Sanou
Laboratoire National de Santé Publique, Ouagadougou, Burkina Faso.
Absatou Ky
AK
Ba
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Ryan T
RT
Novak
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Chris
C
Van Beneden
D000293:Adolescent; D000328:Adult; D002050:Burkina Faso / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification; D018074:Vaccines, Conjugate / Q000627:therapeutic use*; D055815:Young Adult
C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate