Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.
Borgou Regional University Teaching Hospital, Parakou, Benin.
Clin Infect Dis. 2019 Sep 5;69(Suppl 2):S140-S147. doi: 10.1093/cid/ciz478.
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.
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.
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.
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.
小儿细菌性脑膜炎（PBM）仍然是非洲儿童患病的一个重要原因。我们描述了 2011-2016 年贝宁共和国三个监测点小于 5 岁儿童细菌性脑膜炎监测的结果。
来自 Parakou、Natitingou 和 Tanguieta 监测医院疑似脑膜炎的患儿被纳入研究，采集其脑脊液。采用快速诊断检测、微生物培养和/或聚合酶链反应鉴定肺炎链球菌（肺炎球菌）、流感嗜血杆菌和脑膜炎奈瑟菌（脑膜炎球菌）；如有可能，进行血清分型/群。
共有 10919 例疑似脑膜炎患儿被收入监测医院。大多数患儿年龄在 0-11 个月（4863[44.5%]），住院死亡 542 例（5.0%）。共筛查 4168 例脑脊液样本，确诊 194 例（4.7%）PBM 病例，主要由肺炎球菌引起（98[50.5%]）。2011 年引入肺炎球菌结合疫苗（PCV）后，每年疑似脑膜炎病例和死亡人数（病死率）从 2012 年的 2534 例和 164 例（6.5%）分别下降到 1359 例和 14 例（1.0%），2016 年分别下降到 1359 例和 14 例（1.0%）（P <.001）。此外，由肺炎球菌引起的脑膜炎病例比例也逐渐下降，从 2011 年的 77.3%（17/22）下降到 2016 年的 32.4%（11/34）（比值比，7.11[95%置信区间，2.08-24.30]）。流感嗜血杆菌脑膜炎在监测期间波动，2016 年成为主要病原体（16/34[47.1%]）。
PCV 引入后肺炎球菌性脑膜炎的减少可能表明贝宁小儿细菌性脑膜炎病因学模式的改变。保持警惕和有效的监测对于了解这些变化及其更广泛的公共卫生意义至关重要。
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