The Global Landscape of Pediatric Bacterial Meningitis Data Reported to the World Health Organization-Coordinated Invasive Bacterial Vaccine-Preventable Disease Surveillance Network, 2014-2019.

BACKGROUND: The World Health Organization (WHO) coordinates the Global Invasive Bacterial Vaccine-Preventable Diseases (IB-VPD) Surveillance Network to support vaccine introduction decisions and use. The network was established to strengthen surveillance and laboratory confirmation of meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. METHODS: Sentinel hospitals report cases of children 137 000 suspected meningitis cases were reported by 58 participating countries, with 44.6% (n = 61 386) reported from countries in the WHO African Region. More than half (56.6%, n = 77 873) were among children <1 year of age, and 4.0% (n = 4010) died among those with reported disease outcome. Among suspected meningitis cases, 8.6% (n = 11 798) were classified as probable bacterial meningitis. One of 3 bacterial pathogens was identified in 30.3% (n = 3576) of these cases, namely S. pneumoniae (n = 2177 [60.9%]), H. influenzae (n = 633 [17.7%]), and N. meningitidis (n = 766 [21.4%]). Among confirmed bacterial meningitis cases with outcome reported, 11.0% died; case fatality ratio varied by pathogen (S. pneumoniae, 12.2%; H. influenzae, 6.1%; N. meningitidis, 11.0%). Among the 277 children who died with confirmed bacterial meningitis, 189 (68.2%) had confirmed S. pneumoniae. The proportion of pneumococcal cases with pneumococcal conjugate vaccine (PCV) serotypes decreased as the number of countries implementing PCV increased, from 77.8% (n = 273) to 47.5% (n = 248). Of 397 H. influenzae specimens serotyped, 49.1% (n = 195) were type b. Predominant N. meningitidis serogroups varied by region. CONCLUSIONS: This multitier, global surveillance network has supported countries in detecting and serotyping the 3 principal invasive bacterial pathogens that cause pediatric meningitis. Streptococcus pneumoniae was the most common bacterial pathogen detected globally despite the growing number of countries that have nationally introduced PCV. The large proportions of deaths due to S. pneumoniae reflect the high proportion of meningitis cases caused by this pathogen. This global network demonstrated a strong correlation between PCV introduction status and reduction in the proportion of pneumococcal meningitis infections caused by vaccine serotypes. Maintaining case-based, active surveillance with laboratory confirmation for prioritized vaccine-preventable diseases remains a critical component of the global agenda in public health.The World Health Organization (WHO)-coordinated Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Network reported data from 2014 to 2019, contributing to the estimates of the disease burden and serotypes of pediatric meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis

Surveillance of impact of PCV-10 vaccine on pneumococcal meningitis in Mozambique, 2013 – 2015

<div><p>Background</p><p>Vaccination using the 10-valent conjugate vaccine (PCV-10) was introduced into the Extended Program on Immunization in Mozambique in March 2013, however its impact on pediatric pneumococcal meningitis is unknown. In this study, we assessed for the first time the impact of PCV10 on the burden of pneumococcal meningitis in children less than 5 years of age at the three largest hospitals in Mozambique.</p><p>Method</p><p>Between March 2013 and December 2015, a total of 744 cerebrospinal fluid (CSF) samples were collected from eligible children, of which 160 (21.5%) were positive for <i>S</i>. <i>pneumoniae</i>. Of these, only 86 samples met the criteria for serotyping and were subsequently serotyped using sequential multiplex PCR (SM-PCR), but 17 samples were non-typable.</p><p>Results</p><p>The proportion of cases of pneumococcal meningitis decreased from 33.6% (124 of 369) in 2013 to 1.9% (3 of 160) in 2015 (<i>p</i> < 0.001). The relative frequency of PCV10 serotype cases also decreased from 84.2% (48 of 57) in 2013 to 0% (0 of 3) in 2015 (<i>p</i> = 0.006). Between 2013 and 2015, serotype coverage of PCV-10 and PCV13 vaccine formulations was 66.7% and 81.2%, respectively.</p><p>Conclusion</p><p>Altogether, our findings shows that introduction of PCV-10 immunization resulted in rapid decline of pneumococcal meningitis children less than 5 years old in Mozambique. This decline was accompanied by substantial changes in the pattern of circulating pneumococcal serotypes.</p></div

Flowchart of sample collection and testing.

<p>The flow chart depicts the number of CSF samples collected and tested between March 2013 and December 2015. CSF: Cerebrospinal fluid; HCM: Hospital Central de Maputo; HCB: Hospital Central da Beira; HCN: Hospital Central de Nampula; SM-PCR: sequential multiplex polymerase chain reaction; NMRL: National Reference Microbiology Laboratory.</p

Age and gender distribution of enrolled patients between 2013 and 2015.

<p>Age and gender distribution of enrolled patients between 2013 and 2015.</p

Proportions of isolates causing pediatric pneumococcal meningitis stratified by pneumococcal serotype and age.

<p>Each bar represents the relative frequency of each serotype of <i>S</i>. <i>pneumoniae</i>.</p

Detection of <i>S</i>. <i>pneumoniae</i> by PCR from 2013–2015, Mozambique.

<p>Figure depicts the annual variation of the relative frequency of <i>S</i>. <i>pneumoniae</i> causing pneumococcal meningitis and also the variation in the number of CSF samples collected from children <5 years. Frequency of <i>S</i>. <i>pneumoniae</i> was determined using polymerase chain reaction (PCR). CSF: cerebrospinal fluid.</p

Distribution of serotypes of <i>S</i>. <i>pneumoniae</i> and vaccine coverage rates for PCV-7, PCV-10 and PCV-13 vaccine formulations.

<p>Each bar represents the relative frequency of each serotype of <i>S</i>. <i>pneumoniae</i>. The value in the arrows above the bars depicts the vaccine coverage rates for PCV-7, PCV-10 and PCV-13, respectively NV, serotypes not included in 13-valent pneumococcal conjugate vaccine. NV, nonvaccine serotypes (serotypes 12F/12A/12B/44/46, 8, 22F/22A and 15B/C).</p

Annual serotypes distribution of <i>Streptococcus pneumoniae</i> from pneumococcal meningitis in Mozambique, 2013–2015.

<p>Annual serotypes distribution of <i>Streptococcus pneumoniae</i> from pneumococcal meningitis in Mozambique, 2013–2015.</p