Evaluation of pneumococcal meningitis clusters in Burkina Faso and implications for potential reactive vaccination. Issue 35 (31st July 2020)

• Record Type: Journal Article
• Authors: Soeters, Heidi M.; Kambiré, Dinanibè; Sawadogo, Guetawendé; Ouédraogo-Traoré, Rasmata; Bicaba, Brice; Medah, Isaïe; Sangaré, Lassana; Ouédraogo, Abdoul-Salam; Ouangraoua, Soumeya; Yaméogo, Issaka; Congo-Ouédraogo, Malika; Ky Ba, Absatou; Aké, Flavien; Velusamy, Srinivasan; McGee, Lesley; Van Beneden, Chris; Whitney, Cynthia G.
• Is Part Of: Vaccine. Volume 38:Issue 35(2020)
• Page Start: 5726
• Page End: 5733
• Publication Date: 2020-07-31
• Subjects: Burkina Faso -- Pneumococcal meningitis -- Pneumococcal conjugate vaccine -- Outbreaks -- Surveillance; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2020.06.002
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: From 2011 to 2017, Burkina Faso had 20 pneumococcal meningitis clusters of ≥ 5 cases per district/week. Clusters had a maximum weekly incidence of 7 cases and a maximum duration of 4 weeks. Most clusters occurred prior to 13-valent pneumococcal conjugate vaccine introduction. Clusters were caused by a mixture of serotypes, with serotype 1 being most common. Due to the limited cluster size and duration, there were no clear indications for reactive vaccination. Abstract: Background: To better understand how to prevent and respond to pneumococcal meningitis outbreaks in the meningitis belt, we retrospectively examined Burkina Faso's case-based meningitis surveillance data for pneumococcal meningitis clusters and assessed potential usefulness of response strategies. Methods: Demographic and clinical information, and cerebrospinal fluid laboratory results for meningitis cases were collected through nationwide surveillance. Pneumococcal cases were confirmed by culture, polymerase chain reaction (PCR), or latex agglutination; strains were serotyped using PCR. We reviewed data from 2011 to 2017 to identify and describe clusters of ≥ 5 confirmed pneumococcal meningitis cases per week in a single district. We assessed whether identified clusters met the 2016 WHO provisional pneumococcal meningitis outbreak definition: a district with a weekly incidence of >5 suspected meningitis cases/100, 000 persons, >60% of confirmed meningitis cases caused by Streptococcus pneumoniae, and >10 confirmed pneumococcal meningitis cases. Results: Twenty pneumococcal meningitis clusters were identified, with a maximum weekly incidence of 7 cases and a maximum duration of 4 weeks. Most identified clusters (15/20; 75%) occurred before nationwide introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in October 2013. Most cases were due to serotype 1 (74%), 10% were due to PCV13 serotypes besides serotype 1, and 8 clusters had >1 serotype . While 6 identified clusters had a weekly incidence of >5 suspected cases/100, 000 and all 20 clusters had >60% of confirmed meningitis cases due to S. pneumoniae, no cluster had >10 confirmed pneumococcal meningitis cases in a single week. Conclusions: Following PCV13 introduction, pneumococcal meningitis clusters were rarely detected, and none met the WHO provisional pneumococcal outbreak definition. Due to the limited cluster size and duration, there were no clear instances where reactive vaccination could have been useful. More data are needed to inform potential response strategies.