Toward Establishing Integrated, Comprehensive, and Sustainable Meningitis Surveillance in Africa to Better Inform Vaccination Strategies.

Large populations across sub-Saharan Africa remain at risk of devastating acute bacterial meningitis epidemics and endemic disease. Meningitis surveillance is a cornerstone of disease control, essential for describing temporal changes in disease epidemiology, the rapid detection of outbreaks, guiding vaccine introduction and monitoring vaccine impact. However, meningitis surveillance in most African countries is weak, undermined by parallel surveillance systems with little to no synergy and limited laboratory capacity. African countries need to implement comprehensive meningitis surveillance systems to adapt to the rapidly changing disease trends and vaccine landscapes. The World Health Organization and partners have developed a new investment case to restructure vaccine-preventable disease surveillance. With this new structure, countries will establish comprehensive and sustainable meningitis surveillance systems integrated with greater harmonization between population-based and sentinel surveillance systems. There will also be stronger linkage with existing surveillance systems for vaccine-preventable diseases, such as polio, measles, yellow fever, and rotavirus, as well as with other epidemic-prone diseases to leverage their infrastructure, transport systems, equipment, human resources and funding. The implementation of these concepts is currently being piloted in a few countries in sub-Saharan Africa with support from the World Health Organization and other partners. African countries need to take urgent action to improve synergies and coordination between different surveillance systems to set joint priorities that will inform action to control devastating acute bacterial meningitis effectively

Genome sequencing and the diagnosis of novel coronavirus (SARS-COV-2) in Africa: how far are we?

The coronavirus disease (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has become a pandemic. There is currently no vaccine or effective treatment for COVID-19. Early diagnosis and management is key to favourable outcomes. In order to prevent more widespread transmission of the virus, rapid detection and isolation of confirmed cases is of utmost importance. Real time reverse transcriptase polymerase chain reaction (RT-PCR) is currently the "gold standard" for the detection of SARS-COV-2. There are several challenges associated with this test from sample collection to processing and the longer turnaround time for the results to be available. More rapid and faster diagnostic tests that may produce results within minutes to a few hours will be instrumental in controlling the disease. Serological tests that detect specific antibodies to the virus may be such options. In this review, we extensively searched for studies that compared RT-PCR with serological tests for the diagnosis of COVID-19. We extracted the data from the various selected studies that compared the different tests and summarised the available evidence to determine which test is more appropriate especially in Africa. We also reviewed the current evidence and the challenges for the genome sequencing of SARS-COV-2 in Africa. Finally, we discuss the relevance of the different diagnostic tests and the importance of genome sequencing in identifying potential therapeutic options for the control of COVID-19 in Africa

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