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An Outbreak of Serotype 1 Streptococcus pneumoniae Meningitis in Northern Ghana with Features That Are Characteristic of Neisseria meningitidis Meningitis Epidemics

Leimkugel, Julia ; Adams Forgor, Abudulai ; Gagneux, Sébastien ; Pflüger, Valentin ; Flierl, Christian ; Awine, Elizabeth ; Naegeli, Martin ; Dangy, Jean-Pierre ; Smith, Tom ; Hodgson, Abraham ; Pluschke, Gerd

In: The Journal of Infectious Diseases, 2005, vol. 192, no. 2, p. 192-199

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    Title
    • An Outbreak of Serotype 1 Streptococcus pneumoniae Meningitis in Northern Ghana with Features That Are Characteristic of Neisseria meningitidis Meningitis Epidemics
    Author
    • Leimkugel, Julia. Swiss Tropical Institute, Basel, Switzerland
    • Adams Forgor, Abudulai. Navrongo Health Research Centre, Ministry of Health, Navrongo, Ghana
    • Gagneux, Sébastien. Swiss Tropical Institute, Basel, Switzerland
    • Pflüger, Valentin. Swiss Tropical Institute, Basel, Switzerland
    • Flierl, Christian. Swiss Tropical Institute, Basel, Switzerland
    • Awine, Elizabeth. Navrongo Health Research Centre, Ministry of Health, Navrongo, Ghana
    • Naegeli, Martin. Swiss Tropical Institute, Basel, Switzerland
    • Dangy, Jean-Pierre. Swiss Tropical Institute, Basel, Switzerland
    • Smith, Tom. Swiss Tropical Institute, Basel, Switzerland
    • Hodgson, Abraham. Navrongo Health Research Centre, Ministry of Health, Navrongo, Ghana
    • Pluschke, Gerd. Swiss Tropical Institute, Basel, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • The Journal of Infectious Diseases, 2005, vol. 192, no. 2, p. 192-199. The University of Chicago Press
    Other Version
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:303774
    Summary
    BackgroundThe Kassena-Nankana District (KND) of northern Ghana lies in the African meningitis belt, where epidemics of bacterial meningitis have been reoccurring every 8-12 years. These epidemics are generally caused by Neisseria meningitidis an organism that is considered to be uniquely capable of causing meningitis epidemics MethodsWe recruited all patients with suspected meningitis in the KND between 1998 and 2003. Cerebrospinal fluid samples were collected and analyzed by standard microbiological techniques. Bacterial isolates were subjected to serotyping, multilocus sequence typing (MLST), and antibiotic-resistance testing ResultsA continual increase in the incidence of pneumococcal meningitis was observed from 2000 to 2003. This outbreak exhibited strong seasonality, a broad host age range, and clonal dominance, all of which are characteristic of meningococcal meningitis epidemics in the African meningitis belt. The case-fatality rate for pneumococcal meningitis was 44.4%; the majority of pneumococcal isolates were antibiotic sensitive and expressed the serotype 1 capsule. MLST revealed that these isolates belonged to a clonal complex dominated by sequence type (ST) 217 and its 2 single-locus variants, ST303 and ST612 ConclusionsThe S. pneumoniae ST217 clonal complex represents a hypervirulent lineage with a high propensity to cause meningitis, and our results suggest that this lineage might have the potential to cause an epidemic. Serotype 1 is not included in the currently licensed pediatric heptavalent pneumococcal vaccine. Mass vaccination with a less complex conjugate vaccine that targets hypervirulent serotypes should, therefore, be considered