Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia.
Centre for International Health, University of Otago, Dunedin, New Zealand.
PLoS One. 2022 Aug 10;17(8):e0265299. doi: 10.1371/journal.pone.0265299. eCollection 2022.
The introduction in many countries of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited.
Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators.
We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the <2-month age group, 56 per 100,000 in the 2-23-month age group, but lower at 5 per 100,000 in the 5-14-year age group. The most common causes of ABM were Streptococcus pneumoniae (n = 44), Neisseria meningitidis (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49/169) and was highest in the <2-month age group 37% (10/27). The case fatality ratio was 8.6% (18/209) for suspected non-bacterial meningitis and 12.8% (134/1049) for clinically suspected meningitis cases.
Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care.
在许多国家引入针对流感嗜血杆菌、肺炎链球菌和脑膜炎奈瑟菌的结合疫苗后，儿童中急性细菌性脑膜炎（ABM）的发病率显著降低。然而，最近撒哈拉以南非洲地区关于 ABM 的基于人群的数据有限。
2008 年至 2017 年，在冈比亚的一个农村地区，根据人口监测进行了基于人群的脑膜炎监测，使用转诊、诊断和调查的标准化标准。我们使用人口分母计算发病率。
我们诊断了 1666 例疑似脑膜炎患者，并从 1427 例（88%）病例中采集了脑脊液（n = 1121）和/或血液（n = 1070）。我们确定了 169 例 ABM、209 例疑似细菌性脑膜炎（SNBM）和 1049 例临床疑似脑膜炎（CSM）病例。<2 个月年龄组 ABM 的估计年平均发病率很高，为 145 例/10 万人，2-23 个月年龄组为 56 例/10 万人，5-14 岁年龄组为 5 例/10 万人。ABM 最常见的病因是肺炎链球菌（n = 44）、脑膜炎奈瑟菌（n = 42）和革兰氏阴性肠杆菌科细菌（n = 26）。22 例包含在 PCV13 中的肺炎球菌血清型引起的 18 例病例发生在疫苗引入之前，4 例发生在疫苗引入之后。ABM 的总病死率为 29%（49/169），<2 个月年龄组最高，为 37%（10/27）。疑似细菌性脑膜炎的病死率为 8.6%（18/209），临床疑似脑膜炎的病死率为 12.8%（134/1049）。
冈比亚儿童继续遭受与疑似脑膜炎相关的大量发病率和死亡率，尤其是急性细菌性脑膜炎。撒哈拉以南非洲地区如此重病的儿童需要改进的诊断和临床护理。
