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

Molecular characterization of invasive meningococcal isolates in Burkina Faso as the relative importance of serogroups X and W increases, 2008–2012

Abstract Background Neisseria meningitidis serogroup A disease in Burkina Faso has greatly decreased following introduction of a meningococcal A conjugate vaccine in 2010, yet other serogroups continue to pose a risk of life-threatening disease. Capsule switching among epidemic-associated serogroup A N. meningitidis strains could allow these lineages to persist despite vaccination. The introduction of new strains at the national or sub-national levels could affect the epidemiology of disease. Methods Isolates collected from invasive meningococcal disease in Burkina Faso between 2008 and 2012 were characterized by serogrouping and molecular typing. Genome sequences from a subset of isolates were used to infer phylogenetic relationships. Results The ST-5 clonal complex (CC5) was identified only among serogroup A isolates, which were rare after 2010. CC181 and CC11 were the most common clonal complexes after 2010, having serogroup X and W isolates, respectively. Whole-genome phylogenetic analysis showed that the CC181 isolates collected during and after the epidemic of 2010 formed a single clade that was closely related to isolates collected in Niger during 2005 and Burkina Faso during 2007. Geographic population structure was identified among the CC181 isolates, where pairs of isolates collected from the same region of Burkina Faso within a single year had less phylogenetic diversity than the CC181 isolate collection as a whole. However, the reduction of phylogenetic diversity within a region did not extend across multiple years. Instead, CC181 isolates collected during the same year had lower than average diversity, even when collected from different regions, indicating geographic mixing of strains across years. The CC11 isolates were primarily collected during the epidemic of 2012, with sparse sampling during 2011. These isolates belong to a clade that includes previously described isolates collected in Burkina Faso, Mali, and Niger from 2011 to 2015. Similar to CC181, reduced phylogenetic diversity was observed among CC11 isolate pairs collected from the same regions during a single year. Conclusions The population of disease-associated N. meningitidis strains within Burkina Faso was highly dynamic between 2008 and 2012, reflecting both vaccine-imposed selection against serogroup A strains and potentially complex clonal waves of serogroup X and serogroup W strains

Missed Opportunities for Early Access to Care of HIV-Infected Infants in Burkina Faso

International audienceObjective: The World Health Organization (WHO) has recommended a universal antiretroviral therapy (ART) for all HIV-infected children before the age of two since 2010, but this implies an early identification of these infants. We described the Prevention of Mother-to-Child HIV Transmission (PMTCT) cascade, the staffing and the quality of infrastructures in pediatric HIV care facilities, in Ouagadougou, Burkina Faso.Methods: We conducted a cross-sectional survey in 2011 in all health care facilities involved in PMTCT and pediatric HIV care in Ouagadougou. We assessed them according to their coverage in pediatric HIV care and WHO standards, through a desk review of medical registers and a semi-structured questionnaire administered to health-care workers (HCW).Results: In 2011, there was no offer of care in primary health care facilities for HIV-infected children in Ouagadougou. Six district hospitals and two university hospitals provided pediatric HIV care. Among the 67 592 pregnant women attending antenatal clinics in 2011, 85.9% were tested for HIV. The prevalence of HIV was 1.8% (95% Confidence Interval: 1.7%-1.9%). Among the 1 064 HIV-infected pregnant women attending antenatal clinics, 41.4% received a mother-to-child HIV transmission prevention intervention. Among the HIV-exposed infants, 313 (29.4%) had an early infant HIV test, and 306 (97.8%) of these infants tested received their result within a four-month period. Among the 40 children initially tested HIV-infected, 33 (82.5%) were referred to a health care facility, 3 (9.0%) were false positive, and 27 (90.0%) were initiated on ART. Although health care facilities were adequately supplied with HIV drugs, they were hindered by operational challenges such as shortage of infrastructures, laboratory reagents, and trained HCW.Conclusions: The PMTCT cascade revealed bottle necks in PMTCT intervention and HIV early infant diagnosis. The staffing in HIV care and quality of health care infrastructures were also insufficient in 2011 in Ouagadougou

Additional file 1: of Molecular characterization of invasive meningococcal isolates in Burkina Faso as the relative importance of serogroups X and W increases, 2008–2012

(PDF) Unrooted phylogeny of international NmW CC11 isolates. The 128 isolates from this study are identified by black squares, the Hajj-related outbreak isolate is identified by a black star, and the remaining 470 isolates are identified according to the categories defined by from Lucidarme et al. [23]. Arrows mark isolates that are not in the same category as the most closely related isolates: the Hajj-related outbreak isolate (M07149) and an “Anglo/French Hajj strain” isolate collected in France during 2014 (M14 240,446). The tree is scaled by the number of parsimonious substitutions per branch, identified by kSNP3. Branches with bootstrap support < 70% have been deleted. (PDF 33 kb

Reasons for Ouagadougou laboratory non conformance in 2010.

<p>Reasons for Ouagadougou laboratory non conformance in 2010.</p

Staff involved in HIV pediatric care per health district or university hospitals, and qualification, in Ouagadougou, in 2010.

<p>Others: pharmacy assistants and laboratory assistants.</p><p>Staff involved in HIV pediatric care per health district or university hospitals, and qualification, in Ouagadougou, in 2010.</p

Conformance of Ouagadougou hospitals according to WHO standards, in 2010.

<p>*The university hospitals are located in the center region, but patients are referred from the whole country.</p><p>Conformance of Ouagadougou hospitals according to WHO standards, in 2010.</p

The PMTCT cascade until HIV pediatric care in Ouagadougou, 2011.

<p>100% is the reference number.</p><p>DNA PCR  =  deoxyribonucleic acid polymerase chain reaction.</p><p>DBS  =  dried blood spot.</p><p>The PMTCT cascade until HIV pediatric care in Ouagadougou, 2011.</p

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