Impact of Pneumococcal Conjugate Vaccine 13 and Haemophilus Influenzae type b Vaccine: Database analysis of the Sentinel Surveillance Site of the Pediatric Bacterial Meningitis - Cameroon, 2003-2017

  • Vaccine preventable diseases
  • Public health surveillance
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Background:
Pediatric bacterial meningitis (PBM) is a preventable cause of childhood morbidity and mortality. For Cameroon in 1999, the most common causes of PBM percentage-wise were Streptococcus pneumoniae (S. pneumoniae), and Haemophilus influenzae type b (Hib). However, data are limited on the change of PBM burden and causes since introduction in infant immunization schedule of Hib vaccine in 2009 and Pneumococcal Conjugated Vaccine 13 (PCV) in 2011. We evaluated the impact of these vaccines on PBM in Yaounde.

Methods:
We collected data of children aged 0-60 months before and after the introduction of each vaccine for 2003-2017 in the Yaounde sentinel site for PBM surveillance. We analyzed socio-demographic characteristics, prevalence, case-fatality rate (CFR) for S. Pneumonia and Hib. Pasteur Center of Cameroon confirmed cases with positive cerebrospinal fluid culture. We used Fisher exact test for comparison of data for pre-vaccine and post-vaccine periods.

Results:
Overall, 374 PBM were confirmed out of 1087 samples collected. S. Pneumonia accounted for 19% (206) and Hib 9% (101) of PBM. Meningitis CFR was 9% (29/307). CFR among children of 0-11 month’s was 1% (1/101) for Hib and 14% (28/206) for S. Pneumonia. Hib PBM decreased from pre-vaccine period (2003-2008) to post-vaccine period (2009-2017): 24% (83/351) vs 2% (18/736) (p=0.043). S. Pneumonia PBM decreased from pre-vaccine (2003-2010) period to post-vaccine period (2011-2017): 30% (137/455) vs 11% (69/632) (p = 0.005). Among post-vaccine positive cases, Hib was found in 22% (18) and S neumonia in 27% (69). Hib PBM, serotype-2 was recovered in 86% (6/7) and S Pneumonia, serotypes 15B, 5, 6A / B in 21% (3/14) were identified.

Conclusions:
PBM attributable to S pneumonia and Hib decreased after the introduction of the respective vaccines. Correlating PBM incidence reduction with vaccination coverage data is recommended and could further support continuous pediatric immunization to further decrease and prevent future outbreaks.

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