Declines in Pediatric Bacterial Meningitis in the Republic of Benin Following Introduction of Pneumococcal Conjugate Vaccine: Epidemiological and Etiological Findings, 2011-2016

Background: Pediatric bacterial meningitis (PBM) remains an important cause of disease in children in Africa. We describe findings from sentinel site bacterial meningitis surveillance in children <5 years of age in the Republic of Benin, 2011–2016. Methods: Cerebrospinal fluid (CSF) was collected from children admitted to Parakou, Natitingou, and Tanguieta sentinel hospitals with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus) was performed by rapid diagnostic tests, microbiological culture, and/or polymerase chain reaction; where possible, serotyping/grouping was performed. Results. A total of 10 919 suspected cases of meningitis were admitted to the sentinel hospitals. Most patients were 0–11 months old (4863 [44.5%]) and there were 542 (5.0%) in-hospital deaths. Overall, 4168 CSF samples were screened for pathogens and a total of 194 (4.7%) PBM cases were confirmed, predominantly caused by pneumococcus (98 [50.5%]). Following pneumococcal conjugate vaccine (PCV) introduction in 2011, annual suspected meningitis cases and deaths (case fatality rate) progressively declined from 2534 to 1359 and from 164 (6.5%) to 14 (1.0%) in 2012 and 2016, respectively (P < .001). Additionally, there was a gradual decline in the proportion of meningitis cases caused by pneumococcus, from 77.3% (17/22) in 2011 to 32.4% (11/34) in 2016 (odds ratio, 7.11 [95% confidence interval, 2.08–24.30]). Haemophilus influenzae meningitis fluctuated over the surveillance period and was the predominant pathogen (16/34 [47.1%]) by 2016. Conclusions: The observed decrease in pneumococcal meningitis after PCV introduction may be indicative of changing patterns of PBM etiology in Benin. Maintaining vigilant and effective surveillance is critical for understanding these changes and their wider public health implications

Declines in Pediatric Bacterial Meningitis in the Republic of Benin Following Introduction of Pneumococcal Conjugate Vaccine: Epidemiological and Etiological Findings, 2011-2016.

BACKGROUND: Pediatric bacterial meningitis (PBM) remains an important cause of disease in children in Africa. We describe findings from sentinel site bacterial meningitis surveillance in children <5 years of age in the Republic of Benin, 2011-2016. METHODS: Cerebrospinal fluid (CSF) was collected from children admitted to Parakou, Natitingou, and Tanguieta sentinel hospitals with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus) was performed by rapid diagnostic tests, microbiological culture, and/or polymerase chain reaction; where possible, serotyping/grouping was performed. RESULTS: A total of 10 919 suspected cases of meningitis were admitted to the sentinel hospitals. Most patients were 0-11 months old (4863 [44.5%]) and there were 542 (5.0%) in-hospital deaths. Overall, 4168 CSF samples were screened for pathogens and a total of 194 (4.7%) PBM cases were confirmed, predominantly caused by pneumococcus (98 [50.5%]). Following pneumococcal conjugate vaccine (PCV) introduction in 2011, annual suspected meningitis cases and deaths (case fatality rate) progressively declined from 2534 to 1359 and from 164 (6.5%) to 14 (1.0%) in 2012 and 2016, respectively (P < .001). Additionally, there was a gradual decline in the proportion of meningitis cases caused by pneumococcus, from 77.3% (17/22) in 2011 to 32.4% (11/34) in 2016 (odds ratio, 7.11 [95% confidence interval, 2.08-24.30]). Haemophilus influenzae meningitis fluctuated over the surveillance period and was the predominant pathogen (16/34 [47.1%]) by 2016. CONCLUSIONS: The observed decrease in pneumococcal meningitis after PCV introduction may be indicative of changing patterns of PBM etiology in Benin. Maintaining vigilant and effective surveillance is critical for understanding these changes and their wider public health implications

Aspects epidemiologiques, cliniques, biologiques, therapeutiques et evolutifs des hemolyses intravasculaires de l’enfant au Chud de Parakou en 2018

Introduction : Les anémies hémolytiques surviennent majoritairement dans l’enfance. L’objectif de l’étude était de décrire les aspects&nbsp; épidémiologiques, cliniques, thérapeutiques, biologiques et évolutifs des hémolyses intravasculaires de l’enfant au CHUD Parakou en 2018. Patients et matériels : Il s’est agi d’une étude transversale descriptive avec recueil prospectif des données qui s’est déroulée du 1er avril au 31 août 2018. Ont été inclus dans l’étude les enfants âgés d’un mois à quinze ans. Les variables étudiées étaient relatives aux caractéristiques sociodémographiques, cliniques, paracliniques, thérapeutiques et évolutives. Résultats : Au total, 176 enfants ont présenté une hémolyse intravasculaire sur 997 admissions soit une fréquence hospitalière de 18,01%. L’âge moyen était de 3,25 ± 2,38 ans. Le sex-ratio était de 1,37. Les motifs d’admission étaient : la pâleur (43,75%), la fièvre (23,30%), les urines coca cola(10,23%). L’examen physique avait noté une pâleur (94,89%), l’ictère (63,07%), une splénomégalie (44,89%), une convulsion (27,84%), une malnutrition aiguë modérée (16,48%) et une malnutrition aiguë sévère (5,11%). Sur le plan biologique l’anémie était observée à 96,59% et une thrombopénie dans 70,37% (57/81) des cas. L’insuffisance rénale a été enregistrée dans 22,73% des cas. Les principales causes étaient : le paludisme (95,45%) et les infections bactériennes (47,15%). Le traitement était fait d’administration d’Artésunate (95,48%), d’antibiotiques (47,15%) de furosémide (22,72%), d’hyperhydratation (77,27%), de transfusion sanguine (75,57%) et de restriction hydrique (22,72%). La mortalité était de 2,84%. Conclusion : Environ un enfant hospitalisé sur cinq a présenté une hémolyse intravasculaire. Mots clés : Hémolyse intravasculaire, paludisme, insuffisance rénale, enfants, Bénin English Title: Epidemiological, clinical, biological, therapeutic and evolutionary aspects of intravascular haemolysis children of Chud-B/A of Parakou in 2018 Introduction: Haemolytic anemias occur mostly in childhood. If it more easy to recognize the haemolytic mechanism of anemia, the identification, of its causes may be difficult. The target of the study was to describe the epidemiological, clinical, biological, therapeutic and evolutionary aspects of this disease. Patients and Matérials: It was a cross sectional descriptive study with prospective data collection that ran from march to september 2018. It included children age from one month to 15 years admitted within the study period. Results: A total of 176 children had presented intravascular haemolysis out of 997 admissions (18.01%). The average age was 3.25 ±2.28 years. The reasons for admission were: pallor (43.75%), fever (23.30%), coca cola urine (10.23%), seizure (9.09%), coma (6.25%). Physical examination had found pallor (94.89%), jaundice (63.07%), splenomegaly (44.89%), seizure (27.84%), hepatomegaly (6.82%), oligoanuria (7.39%), moderate acute malnutrition (16.48%), severe acute malnutrition (5.11%). Anemia was found in 96.59% of cases, and thrombocytopenia in 70.37% 57/81 of cases.Kidney failure was recorded in 22.73% of cases. The pathologies involved were represented by malaria (95.45%), bacterial infections (47.15%) deficiency of G6PD (5.68%). Treatment was made of artesunate (95.48%), antibiotic (47.15%) hyperhydration (77.27%), transfusion (75.57%), water restriction (22.72%) and furosemide (22.72%). The mortality rate was 2.84%. Conclusion: About one children of five had presented intravascular haemolysis in the study period. Of them one case of five had renal failure acute. Malarie was found in more than nine cases of ten. Keywords: Intravascular haemolysis, malaria, kidney failure, children, Beni