clove and Meningitis--Bacterial

The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Madagascar in 2012. The objective of this study was to determine the impact of PCV10 on bacterial meningitis in hospitalized children <5 years of age.. During 2010-2017, data from the hospital admission logbook were recorded for bacterial meningitis and pneumonia hospitalizations in children <5 years of age. Between April 2011 and December 2017, 3312 cerebrospinal fluid (CSF) samples collected from children who fulfilled the World Health Organization case definition of suspected bacterial meningitis were analyzed at the sentinel site laboratory (SSL) by microscopy, culture, and antigen detection tests. A total of 2065 CSF samples were referred to the regional reference laboratory for real-time polymerase chain reaction (RT-PCR) analysis. 2010-2011 was defined as the prevaccine period, 2012 as vaccine introduction year, and 2013-2017 the postvaccine period. The number of cases, causative agent, and pneumonia hospitalizations were compared before and after PCV10 introduction.. In the prevaccine period, bacterial meningitis and pneumonia hospitalizations accounted for 4.5% and 24.5% of all hospitalizations while there were 2.6% and 19%, respectively, in the postvaccine period (P < .001). In samples tested at the SSL, 154 were positive with 80% Streptococcus pneumoniae and 20% other bacteria. Pneumococcal meningitis diagnosed by RT-PCR declined from 14% in 2012 to 3% in 2017. Also, 14% of children with pneumococcal meningitis died.. Following PCV10 introduction, pneumococcal meningitis, bacterial meningitis, and pneumonia hospitalizations declined. Surveillance should continue to monitor the impact of PCV10.

Topics: Child, Preschool; Female; Hospitalization; Humans; Infant; Infant, Newborn; Madagascar; Male; Meningitis, Bacterial; Pneumococcal Vaccines; Pneumonia, Bacterial; Sentinel Surveillance

Two cases of meningitis caused by Streptococcus suis occurred in Madagascar, 1 in 2015 and 1 in 2016. We report the characterization of the novel sequence type, 834, which carried the mrp+/sly+/epf+ virulence marker and a mutation G→T at position 174, leading to a substitution mutS1 to mutS284.

Topics: Adult; Animals; Female; Genotype; Humans; Madagascar; Male; Meat; Meningitis, Bacterial; Middle Aged; Streptococcal Infections; Streptococcus suis; Swine; Young Adult; Zoonoses

The Haemophilus influenzae b is one of the main germs causing bacterial meningitis in children in countries where the vaccine anti-Haemophilus influenzae b is not widely used. In Madagascar, no epidemiological study on this germ has been carried out. The objective of this research is to assess the role of Haemophilus influenzae meningitis in Antananarivo and to determine its epidemiological aspects and evolution. A multicentric study coordinated by the Institut Pasteur de Madagascar included all children less than 15 years old with infectious syndromes associated to a syndrome of meningial irritation and/or convulsion and/or coma. These children were admitted in the pediatric service of the three main hospitals in Antananarivo from June 1998 and June 2000. A lumbar puncture was performed on each child; the cerebrospinal fluid was set aside for cytobacterial and biochemical controls completed with an antimicrobial sensitivity testing and a soluble antigens research. Out of 160 case studies, the Haemophilus influenzae b arrives at the second place among the agents causing bacterial meningitis in children. This type of bacteria is the source of 32% of meningitis after the Streptococcus pneumoniae (34%). It affects 96% of children less than two years old, with a maximal frequency before the age of one year. The lethality rate is 28.6% and the neurological sequelae were observed in 31.4% of patients. Haemophilus influenzae is sensitive to the third generation cephalosporins but shows high resistance to chloramphenicol (42%), amoxicillin (29%) and gentamicin (22%). The relatively high frequency as well as the high lethality rate caused by the Haemophilus influenzae b meningitis, affecting selectively the children under two years old, bring in the need to introduce the anti-Haemophilus influenzae b vaccine in the national vaccination program in Madagascar. This vaccine has proved to be efficient in many countries where it has been used. Furthermore, in the probabilistic treatment of bacterial meningitis in children, the third generation cephalosporins should be used in the first place.

Topics: Adolescent; Age Distribution; Causality; Child; Child, Preschool; Drug Resistance, Bacterial; Female; Haemophilus influenzae type b; Hospitalization; Humans; Infant; Infant Mortality; Madagascar; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Needs Assessment; Neisseria meningitidis; Population Surveillance; Prospective Studies; Spinal Puncture; Streptococcus pneumoniae; Urban Health; Vaccination

To determine the bacterial causal agents of meningitis and their pattern of resistance, in children more than one month to 14 years of age.. A 2 years, prospective study (June 1998 to June 2000) on bacterial meningitis in children was carried out in the main hospitals in Antananarivo. The enrollment criteria upon admission were fever with symptoms of meningitis and/or convulsions and/or coma. A lumbar puncture was systematically performed in each child. The aspect of the cerebrospinal fluid was described, the level of protein and glucose estimated, soluble antigens measured. Following the examination of a Gram straining, an aliquot of the fluid was cultured on specific medium. Antimicrobial sensitivity testing of isolated pathogens was performed.. Bacterial meningitis was confirmed in 119 children: 95 (80%) and 111 (93%) were less than 12 and 24 months of age, respectively. The sex distribution was 1:1. Three predominant microorganisms were identified: Streptococcus pneumoniae (45%), Haemophilus influenzae b (43%) and Neisseria meningitidis (10%) of which ten of 12 cases were belonging to serogroup B. The other microorganisms isolated were E. coli (2%). S. pneumoniae were found to be sensitive to penicillin G and H. influenzae were found to be sensitive to the third generation cephalosporins. Seven percent of the S. pneumoniae strains were mildly resistant (R + I) to chloramphenicol and between 29 and 50% to aminoglucosides. A moderate resistance against gentamicin and amoxicillin was found in 22-29% of the H. influenzae strains. The mortality rate was high (31%) and among the surviving children 30% presented with neurosensitive disorders.. According to these data we may recommend the inclusion of vaccination against H. influenzae in the children immunization program in Madagascar. The early diagnosis and treatment with appropriate antibiotics, such as third generation of cephalosporins, are other critical measures to be taken in order to reduce the risk of developing severe complications associated to bacterial meningitis.

Topics: Adolescent; Age Distribution; Anti-Bacterial Agents; Cerebrospinal Fluid; Child; Child, Preschool; Drug Resistance, Microbial; Female; Haemophilus influenzae; Hospitalization; Humans; Infant; Madagascar; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Population Surveillance; Prospective Studies; Urban Population; Vaccination

Topics: Acute Disease; Age Distribution; Child, Preschool; Female; Hospitalization; Hospitals, General; Hospitals, Pediatric; Hospitals, University; Humans; Infant; Infant Mortality; Infant, Newborn; Madagascar; Male; Meningitis, Bacterial; Prognosis; Prospective Studies; Risk Factors; Sex Distribution