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Pneumococcal Meningitis Outbreaks in Africa, 2000-2018: Systematic Literature Review and Meningitis Surveillance
Kat Franklin1, Brenda Kwambana-Adams2, Fernanda C Lessa3
1Oxford University, Oxford, United Kingdom.
Background:
The meningitis belt of sub-Saharan Africa has traditionally experienced large outbreaks of meningitis mainly caused by Neisseria meningitidis. More recently, Streptococcus pneumoniae has been recognized as a cause of meningitis outbreaks in the region. Little is known about the natural history and epidemiology of these outbreaks, and, in contrast to meningococcal meningitis, there is no agreed definition for a pneumococcal meningitis epidemic. The aim of this analysis was to systematically review and understand pneumococcal meningitis outbreaks in Africa between 2000 and 2018.
Methods:
Meningitis outbreaks were identified using a systematic literature review and analyses of meningitis surveillance databases. Potential outbreaks were included in the final analysis if they reported at least 10 laboratory-confirmed meningitis cases above baseline per week with ≥50% of cases confirmed as pneumococcus.
Results:
A total of 10 potential pneumococcal meningitis outbreaks were identified in Africa between 2000 and 2018. Of these, 2 were classified as confirmed, 7 were classified as possible, and 1 was classified as unlikely. Three outbreaks spanned more than 1 year. In general, the outbreaks demonstrated lower peak attack rates than meningococcal meningitis outbreaks and had a predominance of serotype 1. Patients with pneumococcal meningitis tended to be older and had higher case fatality rates than meningococcal meningitis cases. An outbreak definition, which includes a weekly district-level incidence of at least 10 suspected cases per 100 000 population per week, with >10 cumulative confirmed cases of pneumococcus per year, would have identified all 10 potential outbreaks.
Conclusions:
Given the frequency of and high case fatality from pneumococcal meningitis outbreaks, public health recommendations on vaccination strategies and the management of outbreaks are needed. Improved laboratory testing for S. pneumoniae is critical for early outbreak identification.
Insights
Pneumococcal meningitis outbreaks in Africa are frequent and deadly, often affecting older individuals. Early identification and improved vaccination strategies are crucial for public health management of these Streptococcus pneumoniae outbreaks.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Sub-Saharan Africa's meningitis belt faces outbreaks from Neisseria meningitidis and increasingly Streptococcus pneumoniae.
- Limited understanding exists regarding the natural history and epidemiology of pneumococcal meningitis outbreaks.
- A standardized definition for pneumococcal meningitis epidemics is lacking, unlike for meningococcal meningitis.
Purpose of the Study:
- To systematically review and understand pneumococcal meningitis outbreaks in Africa from 2000 to 2018.
- To analyze the characteristics and epidemiology of identified pneumococcal meningitis outbreaks.
- To propose a potential definition for pneumococcal meningitis epidemics.
Main Methods:
- Systematic literature review and analysis of meningitis surveillance databases were employed.
- Outbreaks were included if they reported ≥10 laboratory-confirmed meningitis cases above baseline weekly, with ≥50% confirmed as pneumococcus.
- A proposed outbreak definition was evaluated against identified outbreaks.
Main Results:
- Ten potential pneumococcal meningitis outbreaks were identified in Africa between 2000 and 2018 (2 confirmed, 7 possible, 1 unlikely).
- Outbreaks showed lower peak attack rates than meningococcal meningitis, predominantly serotype 1, affecting older patients with higher case fatality rates.
- A proposed definition (10 suspected cases/100,000/week, >10 cumulative confirmed cases/year) would have identified all 10 potential outbreaks.
Conclusions:
- Pneumococcal meningitis outbreaks are frequent and associated with high case fatality rates.
- Public health recommendations for vaccination and outbreak management are urgently needed.
- Enhanced laboratory testing for Streptococcus pneumoniae is vital for early outbreak detection.
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