Dynamics of germs responsible for acute bacterial meningitis in Burkina Faso in the last ten years (2005-2014)

The aim of this study was to analyze ten (10) years of epidemiological surveillance data of meningitis in Burkina Faso for high risk germs patterns identification in order to contribute to the strengthening of prevention strategies.A retrospective study of the past decade (2005- 2014) of cases of acute bacterial meningitis occurred in the thirteen health regions, collected through epidemiological surveillance data meningitis in Burkina Faso. From a total of 88 057 suspected cases of acute bacterial meningitis, we recorded 9134 deaths. From the laboratory confirmed cases, the identified germs were as follows: 56.79% of Neisseria meningitidis, 41.09% of Streptococcus pneumoniae and 2.13% of Haemophilus influenzae. Among the meningococcus isolated, we observed the following distribution: 23.11% of NmA, 58.84% of NmW and 18% of NmX.Mortality associated with acute bacterial meningitis remains still high in Burkina Faso despite the complete disappearance of NmA since 2012, after the conjugate vaccine A (MenAfriVac) has been introduced in this country. However the emergence of NmX, the reemergence of NmW and the persistence of high prevalence of Streptococcus pneumoniae are a major concern in the fight against meningitis in Burkina Faso. So, it is necessary, in addition to the strengthening of surveillance, diagnosis and case management to develop and make available and accessible a conjugate trivalent vaccine against NmA the NmX and NmW serogroups.Keywords: meningococcal meningitis, W and X serogroups, Streptococcus pneumoniae, MenAfriVa

Phenotypic and genotypic characterization of meningococcal carriage and disease isolates in Burkina Faso after mass vaccination with a serogroup a conjugate vaccine

BACKGROUND: The conjugate vaccine against serogroup A Neisseria meningitidis (NmA), MenAfriVac, was first introduced in mass vaccination campaigns of the 1-29-year-olds in Burkina Faso in 2010. The aim of this study was to genetically characterize meningococcal isolates circulating in Burkina Faso before and up to 13 months after MenAfriVac mass vaccination. METHODS: A total of 1,659 meningococcal carriage isolates were collected in a repeated cross-sectional carriage study of the 1-29-year-olds in three districts of Burkina Faso in 2010 and 2011, before and up to 13 months after mass vaccination. Forty-two invasive isolates were collected through the national surveillance in Burkina Faso in the same period. All the invasive isolates and 817 carriage isolates were characterized by serogroup, multilocus sequence typing and porA-fetA sequencing. RESULTS: Seven serogroup A isolates were identified, six in 2010, before vaccination (4 from carriers and 2 from patients), and one in 2011 from an unvaccinated patient; all were assigned to sequence type (ST)-2859 of the ST-5 clonal complex. No NmA carriage isolate and no ST-2859 isolate with another capsule were identified after vaccination. Serogroup X carriage and disease prevalence increased before vaccine introduction, due to the expansion of ST-181, which comprised 48.5% of all the characterized carriage isolates. The hypervirulent serogroup W ST-11 clone that was responsible for most of meningococcal disease in 2011 and 2012 was not observed in 2010; it appeared during the epidemic season of 2011, when it represented 40.6% of the serogroup W carriage isolates. CONCLUSIONS: Successive clonal waves of ST-181 and ST-11 may explain the changing epidemiology in Burkina Faso after the virtual disappearance of NmA disease and carriage. No ST-2859 strain of any serogroup was found after vaccination, suggesting that capsule switching of ST-2859 did not occur, at least not during the first 13 months after vaccination

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

Résistance aux antibiotiques des souches de staphylococcus aureus et des enterobactéries isolés au LNSP de Ouagadougou (Burkina Faso)

Le contexte africain est marqué par l’absence de réseau de surveillance de la résistance bactérienne aux antibiotiques. Des études indiquent pourtant des niveaux élevés de prévalence de Staphylococcus aureus résistant à la méticiline (SARM) et des Entérobactéries productrices de β lactamases à spectre étendu (E-BLSE) dans les prélèvements provenant de patients hospitalisés ou en communauté. Le but de la présente étude est de décrire les phénotypes de résistances de Staphyloccocus aureus et des entérobactéries afin d’améliorer la prise en charge des maladies bactériennes. Il s’est agi d’une étude transversale réalisée du 10 Septembre 2014 au 10 Mars 2015, à partir des isolats de S. aureus et d’entérobactéries provenant de prélèvements biologiques reçus au Laboratoire National de Santé Publique (LNSP). La sensibilité aux antibiotiques des souches bactériennes a été réalisée selon les recommandations du Comité de l’Antibiogramme de la Société Française de Microbiologie (CA.SFM) 2014. La recherche de la résistance de S. aureus à la meticilline a été réalisée par l’oxacilline 5μg ; la sécrétion de β Lactamase à Spectre Elargie (BLSE) a été confirmée après observation d’une image en « bouchon de champagne ». Au total, 665 échantillons ont été traités et 197 souches pathogènes, ont été identifiées dont 160 entérobactéries et 37 Staphylococcus aureus. Globalement, 32 % des Staphylococcus aureus étaient résistants à la méticiline. Toutes les souches étaient sensibles aux aminosides. Parmi les entérobactéries, 98,3 % des E. coli et 94,7 % de K. pneumoniae étaient résistantes à l’amoxicilline + acide clavulanique et 36,4 % de E. coli et 26,3 % K. pneumoniae présentaient une résistance aux céphalosporines de 3e génération. Les entérobactéries productrices de BLSE étaient de 35 %. L’imipenème restait actif sur 100 % des entérobactéries. Cette étude interpelle les autorités sanitaires à l’instauration d’un système de surveillance des pharmaco résistances et les agents de santé sur la promotion du bon usage des antibiotiques et les bonnes pratiques d’hygiène hospitalière.Mots-clés: Entérobactéries, Staphylococcus aureus, antibiotiques, sensibilité, résistanceEnglish Title: Antibiotic resistance of staphylococcus aureus strains and insulated enterobacteries at the Ouagadougou LNSP (Burkina Faso)English AbstractThe African context is marked by the absence of a surveillance network for bacterial resistance to antibiotics. However, studies indicate high levels of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase-producing Enterobacteriaceae (E-ESBLs) in inpatient and community samples. The aim of this study was to describe the resistance phenotypes of S. aureus and enterobacteria in order to improve bacterial diseases management. This was a cross-sectional study conducted from September 10, 2014 to March 10, 2015, on isolates of S. aureus and enterobacteria from biological samples sent to the National Laboratory of Public Health (LNSP). The antibiotic susceptibility of bacterial strains was carried out according to the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA.SFM) 2014. The search for S. aureus resistance to meticillin was carried out by the oxacillin 5μg; the secretion of ESBL was retained after observation of a "champagne cork" image. A total of 665 samples were processed and 197 pathogenic strains were identified, including 160 Enterobacteriaceae and 37 Staphylococcus aureus. Overall 32% of Staphylococcus aureus were meticillin resistant. All strains were susceptible to aminoglycosides. Among the Enterobacteriaceae, 98.3% of E. coli and 94.7% of K. pneumoniae were resistant to clavulanic acid amoxicillin and 36.4% of E. coli and 26.3% K. pneumoniae were resistant to 3rd generation cephalosporins. ESBL-producing enterobacteria were 35%. Imipenem remained active on 100% of Enterobacteriaceae. This study calls on the health authorities to establish a surveillance system for drug resistance and health workers to promote the proper use of antibiotics and good hospital hygiene practices.Keywords: Enterobacteriaceae, Staphylococcus aureus, antibiotics, sensitivity, resistanc

Bio-behavioural HIV survey in prisons on men and women in Burkina Faso.

BackgroundDespite the severity of the human immunodeficiency virus (HIV) epidemic in Burkina Faso, data on specific groups are scant especially concerning prisoners. AimsThe objective of this study was to determine HIV prevalence and risky behavior in Burkina Faso prisons in order to assist in HIV prevention and AIDS case management decision making among prisoners. Methods This was a cross-sectional study carried out from September 3–10, 2014 among 18 years aged and over prisoners, in prisons of each of the 13 administrative regions of Burkina Faso with prisoners’ informed consent. Data were collected using a questionnaire that covered general informations on HIV/autoimmune insufficiency syndrome (AIDS) and sexually transmitted infections (STIs), coupled with blood samples collection, for HIV laboratory analysis purpose.Results A total of 1,079 prisoners participated in this study. The participation rate for interviews was and blood samples collections were 100 per cent. The majority of participants (97.8 per cent) were men, among whom 9.7 per cent reported a history of STIs. Nearly 50 per cent of these took no precautions to avoid infecting their sexual partners. Implementation of HIV/AIDS prevention and control activities in prisons was low (43.2 per cent). Condom use was also low (11.2 per cent). HIV infection Screening was insufficient: only two out of five prisoners had at least one HIV screening. HIV screening opportunities was uncommon and prisoners pointed out the lack of organization of screening campaigns in prisons. HIV prevalence was nearly 3 per cent. ConclusionThe exposure level of prisoners to HIV transmission prevention interventions was low. Specific measures are needed to increase condom use for HIV/AIDS and STIs prevention in prisons

Study of Viral Load as A Predictive Marker of the Evolution of HIV Type 2 Infection in Burkina Faso

BACKGROUND: HIV - 2 infection is characterized by low sexual and vertical transmission and slow clinical and immunological progression. However, it can lead to AIDS. Viral load measurement is a predictive test of the success or failure of antiretroviral therapy. In order to evaluate the efficacy of ARV treatment, we measured plasma viral load, and CD4 T - cell counts in 68 patients, of whom 56 were HIV - 2 infected and 12 were HIV - 1/HIV - 2 co - infected. METHOD: We tested EDTA plasma samples stored at - 80 ° C, taken from patients followed in sentinel sites in the city of Ouagadougou. The sera were obtained by centrifugation, and the plasmatic viral load quantified by droplet double polymerase chain reaction (dd PCR), at a detection threshold of 10 copies/ml. Sociodemographic, clinical and therapeutic data were collected from patients charts and completed during an interview. RESULTS: Patients had a mean age of 53.8 ± 7.8 years with extremes of [38 - 72 years] and were predominantly females (57.4%), with a sex ratio of 0.80. There was a predominance of housewives and married couples with respectively 36.8% and 75.0% of patients. The majority of patients (77.9%) were Category A, that is, they were either asymptomatic or in the primary infection phase. 22.0% of patients were symptomatic, with 13.2% and 8.8% respectively belonging to categories B and C. The most observed opportunistic infections were shingles found in 7.3% of patients, oral candidiasis found in 5.9%, signs of weight loss (undernutrition) in 5.9% and genital herpes in 1.5% of patients. Four patients (4.7%) had hepatitis B. One case of tuberculosis (1.5%) was reported. The therapeutic combination of protease inhibitors (Lopinavir / ritonavir) was the most prescribed (94, 1% of patients), 58.8% of the patients had a CD4 level < 500/mm3, and 41.2% had CD4 level ≥ 500 cells/mm3. Plasma viral load was undetectable (≤ 10 copies / ml) in 70.6% of patients, 7.3% had a viral load of 10 to 50 copies / ml, and 19.1% of patients had a high viral load (≥ 101 copies / ml). Our study showed that the highest CD4 levels are observed in patients with undetectable viral load (˂ 10copies / mL). This established that the CD4 cell count and the plasma viral load value move in the opposite direction, and are two predictors of the evolution of HIV infection, and the virological and / or immunological response to HAAR

Persistent low carriage of serogroup A Neisseria meningitidis two years after mass vaccination with the meningococcal conjugate vaccine, MenAfriVac

Background The conjugate vaccine against serogroup A Neisseria meningitidis (NmA), MenAfriVac, is currently being introduced throughout the African meningitis belt. In repeated multicentre cross-sectional studies in Burkina Faso we demonstrated a significant effect of vaccination on NmA carriage for one year following mass vaccination in 2010. A new multicentre carriage study was performed in October-November 2012, two years after MenAfriVac mass vaccination. Methods Oropharyngeal samples were collected and analysed for presence of N. meningitidis (Nm) from a representative selection of 1-29-year-olds in three districts in Burkina Faso using the same procedures as in previous years. Characterization of Nm isolates included serogrouping, multilocus sequence typing, and porA and fetA sequencing. A small sample of invasive isolates collected during the epidemic season of 2012 through the national surveillance system were also analysed. Results From a total of 4964 oropharyngeal samples, overall meningococcal carriage prevalence was 7.86%. NmA prevalence was 0.02% (1 carrier), significantly lower (OR, 0.05, P = 0.005, 95% CI, 0.006-0.403) than pre-vaccination prevalence (0.39%). The single NmA isolate was sequence type (ST)-7, P1.20,9;F3-1, a clone last identified in Burkina Faso in 2003. Nm serogroup W (NmW) dominated with a carriage prevalence of 6.85%, representing 87.2% of the isolates. Of 161 NmW isolates characterized by molecular techniques, 94% belonged to the ST-11 clonal complex and 6% to the ST-175 complex. Nm serogroup X (NmX) was carried by 0.60% of the participants and ST-181 accounted for 97% of the NmX isolates. Carriage prevalence of serogroup Y and non-groupable Nm was 0.20% and 0.18%, respectively. Among the 20 isolates recovered from meningitis cases, NmW dominated (70%), followed by NmX (25%). ST-2859, the only ST with a serogroup A capsule found in Burkina Faso since 2004, was not found with another capsule, neither among carriage nor invasive isolates. Conclusions The significant reduction of NmA carriage still persisted two years following MenAfriVac vaccination, and no cases of NmA meningitis were recorded. High carriage prevalence of NmW ST-11 was consistent with the many cases of NmW meningitis in the epidemic season of 2012 and the high proportion of NmW ST-11 among the characterized invasive isolates

Profil de sensibilité des souches de pneumocoques aux antibiotiques avant l’introduction du vaccin anti pneumococcique conjugué à treize valences (PCV-13) au Burkina Faso

Introduction: Streptococcus pneumoniae constitue un pathogène important des méningites bactériennes aiguës au Burkina Faso. Cela a justifié l’introduction du vaccin pneumococcique conjugué en Octobre 2013 dans le programme élargi de vaccination chez les enfants de moins d’un an. L’objectif de ce travail consiste à établir le profil de sensibilité aux antibiotiques des souches de S. pneumoniae isolées du liquide cérébro-spinal. Méthodologie: Du 1er Janvier 2010 au 30 Décembre 2012, 37 souches de pneumocoques ont été collectées du réseau national de surveillance de la méningite du pays. Ces souches, repiquées sur de la gélose au sang frais, ont été confirmées par le test de sensibilité à l’optochine. Le test de Quellung a déterminé les sérotypes de pneumocoques et l’antibiogramme a été réalisé selon la méthode de diffusion et interprété selon le standard « European Committee of antibiotics susceptibility testing. Résultats: Sur 37 isolats sérotypés, 77% appartenaient aux sérotypes vaccinaux. L’antibiogramme a révélé que 92% des souches sensibles à l’oxacilline, 97% à l’érythromycine et 73% à la clindamycine. Le cotrimoxazole a été actif dans 14% et la tétracycline seulement 5% des souches. Conclusion: La majorité des souches de pneumocoques isolée des méningites au Burkina Faso appartiennent aux sérotypes vaccinaux. Mots clés: Sensibilité; Antibiotiques; Pneumocoques; PCV-13 English Title: Profile of antibiotics susceptibility testing of pneumococcal strains before the introduction of the thirteen-valent conjugate pneumococcal vaccine (PCV-13) in Burkina Faso English Abstract&nbsp; Introduction: Streptococcus pneumoniae is an important pathogen of acute bacterial meningitis in Burkina Faso. This justify the introduction of the thirteen-valent pneumococcal vaccine in October 2013 in the expanded program of immunization in children under one year old. The aim of this work is to establish the antibiotics susceptibility testing profile of strains of S. pneumoniae isolated from cerebrospinal fluid. Methods: From January 1st, 2010 to December 30th, 2012, 37 strains of pneumococci were collected from the country's national meningitis surveillance network. These strains, subcultured on fresh blood agar, were confirmed by the optochin susceptibility testing. The Quellung test made it possible by determining the pneumococcal serotypes and the antibiogram carried out according to the diffusion method and interpreted according to the standard "European Committee of antibiotics susceptibility testing”. Results: Of the thirty-seven typed isolates, 77% belonged to the vaccine serotypes. Susceptibility to antibiotics reports 92% of strains susceptible to oxacillin, 97% to erythromycin and 73% to clindamycin. Cotrimoxazole was active in 14% and tetracycline only 5% of the strains. Conclusion: The majority of pneumococcal strains isolated from meningitis in Burkina Faso belong to vaccine serotypes. Keywords: Antibiotics; susceptibility testing; Pneumococci; PCV-1

Cases reported through national meningitis surveillance by age group and etiology, Burkina Faso, 2011–2013.

<p>Cases reported through national meningitis surveillance by age group and etiology, Burkina Faso, 2011–2013.</p