Bacterial meningitis in malawian adults, adolescents, and children during the era of antiretroviral scale-up and haemophilus influenzae type B vaccination, 2000-2012

Emma C. Wall, Dean B.Everett, Mavuto Mukaka, Naor Bar-Zeev, Nicholas Feasey, Andreas Jahn, Mike Moore, Joep J.Van Oosterhout, Paul Pensalo, Kenneth Baguimira, Stephen B. Gordon, Elizabeth M. Molyneux, Enitan D. Carrol, Neil French, Malcolm E. Molyneux, Robert S. Heyderman

Research output: Contribution to journalReview articlepeer-review

Abstract

We documented bacterial meningitis trends among adults and children presenting to a large teaching hospital in Malawi during introduction of Haemophilus influenzae type b (Hib) vaccination and the rollout of antiretroviral therapy (ART). Methods. We analyzed data from 51 000 consecutive cerebrospinal fluid (CSF) samples obtained from adults, adolescents, and children with suspected meningitis admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi, between 2000 and 2012. Results. There was a significant decline in the total number of CSF isolates over 12 years (incident rate ratio [IRR], 0.93; 95% CI, .92-.94; P .001). This decline was entirely in children aged 5 years (IRR, 0.87; 95% CI, .85-.88; P .001) and coincided with the introduction of Hib vaccination. The number of adult isolates has remained unchanged (IRR, 0.99; 95% CI, .97-1.0; P = .135) despite rapid scale-up of ART provision. In children aged 5 years, Streptococcus pneumoniae, nontyphoidal salmonellae (NTS), and Hib were the most frequently isolated pathogens, and have declined over this time period. Streptococcus pneumoniae was the most frequently isolated pathogen in older children and adults. Estimated incidence of bacterial meningitis in 2012 was 20 per 100 000 cases in children aged 14 years, 6 per 100 000 adolescents, and 10 per 100 000 adults. Conclusions. Rates of bacterial meningitis have declined in children, but not adults, coinciding with the introduction of Hib vaccination. The highly successful rollout of ART has not yet resulted in a reduction in the incidence in adults where the burden remains high. Long-term surveillance of bacterial meningitis outside of the epidemic "meningitis belt" in Africa is essential.

Original languageEnglish (US)
Pages (from-to)e137-e145
JournalClinical Infectious Diseases
Volume58
Issue number10
DOIs
StatePublished - May 15 2014
Externally publishedYes

Keywords

  • Africa
  • Antiretroviral therapy.
  • HIV
  • Meningitis
  • Vaccination

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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