Epidemic forecast and preparedness for explosive-cerebrospinal meningitis outbreak in Nigeria using the preventive vaccination strategy

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Abstract

Background

Within the African meningitis belt, yearly outbreaks of cerebrospinal meningitis (CSM), with incidence rates of 10–100 cases per 100 000 population, are typically punctuated by explosive epidemics occurring every 8–12 years, with incidence rates that can exceed 1000 cases per 100 000 population. From 1928 to 2018, Nigeria recorded the highest number (21%) of cases in the region. The reactive vaccination strategy, a protocol with major drawbacks, has been the vaccination method utilised in Nigeria.

Aim

This review highlights the need for governments within the African meningitis belt to start preparations against the next explosive CSM epidemic expected to occur between 2024 and 2028 using the preventive vaccination strategy.

Methods

We performed a literature search on the Google Scholar search engine using relevant search strings and included studies and reports between 1905 and 2022 that met set criteria.

Results

Neisseria meningitidis serogroups A, B, C, W135, X, and Y; Haemophilus influenzae serotypes a, b, c, e, and f; and Streptococcus pneumoniae serotypes 1, 4, 5, 6, 9, 19, 19F, and 20 were implicated as aetiologies. However, the reactive vaccination strategy was only used against N. meningitidis A or C, H. influenzae b, and pneumococcal conjugate vaccine. Between 2011 and 2017, a polysaccharide vaccine (ACW or ACYW) active against serogroups A, C, W and Y was used within the African meningitis belt for the first time. Varying genotypes of N. meningitidis, H. influenzae and S. pneumoniae were identified.

Conclusion

Our results revealed a very high success rate for the preventive vaccination strategy.

What this study adds

In order to ensure reductions in the morbidity and mortality associated with invasive CSM, the Federal Ministry of Health, Nigeria, should leverage existing knowledge of the circulating serogroups, serotypes, and genotypes of the primary bacterial aetiologies and commence the implementation of the preventive vaccination strategy.

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Most cited references 104

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Multilocus sequence typing: a portable approach to the identification of clones within populations of pathogenic microorganisms.

M. C. J. Maiden, J. Bygraves, E Feil … (1998)

Traditional and molecular typing schemes for the characterization of pathogenic microorganisms are poorly portable because they index variation that is difficult to compare among laboratories. To overcome these problems, we propose multilocus sequence typing (MLST), which exploits the unambiguous nature and electronic portability of nucleotide sequence data for the characterization of microorganisms. To evaluate MLST, we determined the sequences of approximately 470-bp fragments from 11 housekeeping genes in a reference set of 107 isolates of Neisseria meningitidis from invasive disease and healthy carriers. For each locus, alleles were assigned arbitrary numbers and dendrograms were constructed from the pairwise differences in multilocus allelic profiles by cluster analysis. The strain associations obtained were consistent with clonal groupings previously determined by multilocus enzyme electrophoresis. A subset of six gene fragments was chosen that retained the resolution and congruence achieved by using all 11 loci. Most isolates from hyper-virulent lineages of serogroups A, B, and C meningococci were identical for all loci or differed from the majority type at only a single locus. MLST using six loci therefore reliably identified the major meningococcal lineages associated with invasive disease. MLST can be applied to almost all bacterial species and other haploid organisms, including those that are difficult to cultivate. The overwhelming advantage of MLST over other molecular typing methods is that sequence data are truly portable between laboratories, permitting one expanding global database per species to be placed on a World-Wide Web site, thus enabling exchange of molecular typing data for global epidemiology via the Internet.

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Multilocus sequence typing: A portable approach to the identification of clones within populations of pathogenic microorganisms

J. Russell, E Feil, J. Bygraves … (1998)

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Clinical features and prognostic factors in adults with bacterial meningitis.

Diederik van de Beek, Jan de Gans, Lodewijk Spanjaard … (2004)

We conducted a nationwide study in the Netherlands to determine clinical features and prognostic factors in adults with community-acquired acute bacterial meningitis. From October 1998 to April 2002, all Dutch patients with community-acquired acute bacterial meningitis, confirmed by cerebrospinal fluid cultures, were prospectively evaluated. All patients underwent a neurologic examination on admission and at discharge, and outcomes were classified as unfavorable (defined by a Glasgow Outcome Scale score of 1 to 4 points at discharge) or favorable (a score of 5). Predictors of an unfavorable outcome were identified through logistic-regression analysis. We evaluated 696 episodes of community-acquired acute bacterial meningitis. The most common pathogens were Streptococcus pneumoniae (51 percent of episodes) and Neisseria meningitidis (37 percent). The classic triad of fever, neck stiffness, and a change in mental status was present in only 44 percent of episodes; however, 95 percent had at least two of the four symptoms of headache, fever, neck stiffness, and altered mental status. On admission, 14 percent of patients were comatose and 33 percent had focal neurologic abnormalities. The overall mortality rate was 21 percent. The mortality rate was higher among patients with pneumococcal meningitis than among those with meningococcal meningitis (30 percent vs. 7 percent, P<0.001). The outcome was unfavorable in 34 percent of episodes. Risk factors for an unfavorable outcome were advanced age, presence of otitis or sinusitis, absence of rash, a low score on the Glasgow Coma Scale on admission, tachycardia, a positive blood culture, an elevated erythrocyte sedimentation rate, thrombocytopenia, and a low cerebrospinal fluid white-cell count. In adults presenting with community-acquired acute bacterial meningitis, the sensitivity of the classic triad of fever, neck stiffness, and altered mental status is low, but almost all present with at least two of the four symptoms of headache, fever, neck stiffness, and altered mental status. The mortality associated with bacterial meningitis remains high, and the strongest risk factors for an unfavorable outcome are those that are indicative of systemic compromise, a low level of consciousness, and infection with S. pneumoniae. Copyright 2004 Massachusetts Medical Society.

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Author and article information

Journal

Journal ID (nlm-ta): Afr J Lab Med

Journal ID (iso-abbrev): Afr J Lab Med

Journal ID (publisher-id): AJLM

Title: African Journal of Laboratory Medicine

Publisher: AOSIS

ISSN (Print): 2225-2002

ISSN (Electronic): 2225-2010

Publication date (Electronic): 17 November 2023

Publication date Collection: 2023

Volume: 12

Issue: 1

Electronic Location Identifier: 2086

Affiliations

[1 ]Department of Medical Microbiology, Faculty of Clinical Sciences, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria

[2 ]Medical Microbiology & Parasitology Laboratories, National Hospital, Abuja, Federal Capital Territory, Nigeria

[3 ]Medical Microbiology Laboratory, Department of Medical Laboratory Services, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria

[4 ]Medical Biotechnology Department, National Biotechnology Development Agency, Abuja, Federal Capital Territory, Nigeria

[5 ]Hematology and Blood Transfusion Laboratory Department, National Hospital, Abuja, Federal Capital Territory, Nigeria

[6 ]Nursing Services Department, Diete-Koki Memorial Hospital, Opolo, Yenagoa, Bayelsa State, Nigeria

Author notes

Corresponding author: Iseimokumo Peletiri, kumochris@ 123456hotmail.com

Author information

Iseimokumo C. Peletiri https://orcid.org/0000-0002-1663-7351

Rosemary C. Nwachukwu https://orcid.org/0000-0002-9084-1027

Diweni C. Peletiri https://orcid.org/0000-0001-7894-9409

Esther Q. Onoja https://orcid.org/0000-0002-0214-4898

Charity T. Tulagha https://orcid.org/0000-0002-1130-3299

Ikaprite I. Igbalibo https://orcid.org/0000-0002-4021-9141

Grace M. Ayanbimpe https://orcid.org/0000-0003-1669-2091

Eugene I. Ikeh https://orcid.org/0000-0002-2643-585X

Article

Publisher ID: AJLM-12-2086

DOI: 10.4102/ajlm.v12i1.2086

PMC ID: 10696563

PubMed ID: 38058850

SO-VID: 697b2622-9365-474f-85aa-e65da3175e31

License:

Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

Epidemic forecast and preparedness for explosive-cerebrospinal meningitis outbreak in Nigeria using the preventive vaccination strategy

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Abstract

Background

Aim

Methods

Results

Conclusion

What this study adds

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SciELO South Africa

Most cited references 104

Multilocus sequence typing: a portable approach to the identification of clones within populations of pathogenic microorganisms.

Multilocus sequence typing: A portable approach to the identification of clones within populations of pathogenic microorganisms

Clinical features and prognostic factors in adults with bacterial meningitis.

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