Institute of Child Health, University of Nigeria Teaching Hospital, Ituku-Ozalla, and.
Department of Paediatrics University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State.
Clin Infect Dis. 2019 Sep 5;69(Suppl 2):S81-S88. doi: 10.1093/cid/ciz474.
Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM).
From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM.
A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively.
Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the country.
尼日利亚历史上曾发生过大规模细菌性脑膜炎暴发，导致儿童死亡率居高不下。肺炎链球菌（肺炎球菌）、脑膜炎奈瑟菌（脑膜炎球菌）和流感嗜血杆菌是导致这种侵袭性疾病的主要原因。我们与世界卫生组织合作，在尼日利亚的哨点医院进行了纵向监测，以确定小儿细菌性脑膜炎（PBM）的负担。
2010 年至 2016 年，从尼日利亚 5 个州的 5 家哨点医院收治的 5 岁以下儿童中采集脑脊液。采用微生物学和乳胶凝集技术检测肺炎球菌、脑膜炎球菌和流感嗜血杆菌的存在。进行种特异性聚合酶链反应和血清分型/分组，以确定 PBM 的特定病原体。
在参与医院共纳入 5134 例疑似脑膜炎患儿；其中 153 例（2.9%）为确诊 PBM 病例。感染患儿的死亡率为 15.0%（23/153）。主要病原体是肺炎球菌（46.4%：71/153），其次是脑膜炎球菌（34.6%：53/153）和流感嗜血杆菌（19.0%：29/153）。近一半成功定型的肺炎球菌脑膜炎病例（46.4%：13/28）由 10 价肺炎球菌结合疫苗包含的血清型引起。最常见的脑膜炎球菌和流感嗜血杆菌菌株分别为血清组 W 和血清型 b。
尼日利亚 5 岁以下儿童中，疫苗型细菌性脑膜炎仍很常见。疫苗接种的引入和覆盖率方面的挑战可能解释了其中的一些发现。需要继续进行监测，以确定脑膜炎病原体血清型/组在尼日利亚的分布情况，并为该国的疫苗接种政策提供信息和支持。
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