Page Anne-Laure, Coldiron Matthew E, Gamougam Kadidja, Acyl Mahmaat Ali, Tamadji Mbaihol, Lastrucci Céline, Hurtado Northan, Tehoua François-Charles, Fermon Florence, Caugant Dominique A, Porten Klaudia
Epicentre, Paris, France.
Hôpital Général de Référence National, N'Djamena, Chad.
Trop Med Int Health. 2017 Dec;22(12):1561-1568. doi: 10.1111/tmi.12987. Epub 2017 Oct 26.
Case-based surveillance of bacterial meningitis in sentinel districts has been recommended after the introduction of the conjugated vaccine against Neisseria meningitidis serogroup A (NmA), MenAfriVac, in the African meningitis belt. Here we report data and lessons learnt from four years of surveillance in the district of Moissala, Chad.
All suspected cases of meningitis were referred free of charge to the district hospital for lumbar puncture and treatment. Cerebrospinal fluid samples were tested with Pastorex latex agglutination in Moissala, and inoculated trans-isolate media were used for culture and PCR at the national reference laboratory and/or at the Norwegian Institute of Public Health.
From July 2012 to December 2016, 237 suspected cases of meningitis were notified, and a specimen was collected from 224. Eighty-three samples were positive for a bacterial pathogen by culture, PCR or Pastorex, including 58 cases due to Streptococcus pneumoniae with only 28 of 49 pneumococcal meningitis confirmed by culture or PCR correctly identified by Pastorex. Four cases of NmA were detected by Pastorex, but none were confirmed by PCR.
Implementation of case-based surveillance for meningitis is feasible in Chad, but has required political and technical engagement. Given the high proportion of S. pneumoniae and its poor detection by Pastorex, continued use of PCR is warranted for surveillance outside of outbreaks, and efforts to accelerate the introduction of pneumococcal conjugate vaccines are needed. Introduction of MenAfriVac in routine immunisation and future availability of a pentavalent meningococcal conjugate vaccine will be key elements for the sustained reduction in meningitis outbreaks in the area.
在非洲脑膜炎带引入针对A群脑膜炎奈瑟菌（NmA）的结合疫苗MenAfriVac后，建议在哨点地区开展基于病例的细菌性脑膜炎监测。在此，我们报告在乍得穆伊萨拉地区进行的四年监测数据及经验教训。
所有疑似脑膜炎病例均被免费转诊至地区医院进行腰椎穿刺和治疗。穆伊萨拉地区的脑脊液样本采用Pastorex乳胶凝集试验进行检测，接种后的分离培养基用于在国家参考实验室和/或挪威公共卫生研究所进行培养和PCR检测。
2012年7月至2016年12月，共报告237例疑似脑膜炎病例，采集了224例的样本。83份样本通过培养、PCR或Pastorex检测出细菌病原体呈阳性，其中58例由肺炎链球菌引起，49例肺炎球菌性脑膜炎中只有28例通过培养或PCR确诊，并被Pastorex正确识别。Pastorex检测出4例NmA，但均未通过PCR确诊。
在乍得实施基于病例的脑膜炎监测是可行的，但需要政治和技术方面的参与。鉴于肺炎链球菌比例高且Pastorex对其检测效果不佳，在疫情暴发之外的监测中继续使用PCR是必要的，并且需要努力加速引入肺炎球菌结合疫苗。在常规免疫中引入MenAfriVac以及未来提供五价脑膜炎球菌结合疫苗将是该地区持续减少脑膜炎疫情的关键因素。
