The epidemiology of Haemophilus influenzae meningitis in children under five years of age in The Gambia, West Africa

Article Abstract:

The annual incidence of Haemophilus influenzae (Hi) meningitis varies around the world; the United States has the highest rate, 45-67 per 100,000, among children under five years old. High rates affect Alaskan natives, Navajo Indians, household contacts and children in day-care centers. In the United States, blacks are at greater risk than whites. Incidence data for countries other than Europe have not been established. In Africa, information on the distribution of the disease is overshadowed by the cerebrospinal meningitis caused by Neisseria meningitides. West African information is limited to that obtained from a single study from Senegal, where the rate was approximately 132 cases per 100,000 in children under one year old. Data were collected from 1985 to 1987 on meningitis cases reported from regional hospitals. The population, in mid-1986, of children under five was 64,311 and under one year old, 10,784. All reported cases were verified, and the index cases and household contacts were followed closely for four weeks. The last visit was made at six months. The controls were selected from a group of healthy children who participated in another study. During this interval, 77 cases of meningitis were reported in children under 5 years old, an incidence of 60 per 100,000 children. Of this group, 64 were less than one year old for a rate of 297 per 100,000 children. The incidence in the less-than-five group parallels the general USA data. The figures for the less-than-one-year group more closely resemble the high-incidence American groups, Alaskan natives and Navajo Indians. The incidence statistics may indeed be low, since facilities for clinical confirmation were not always available. Since the proportions of children under one in developing countries are substantially higher, the number of cases of meningitis is also greater. The case fatality rate (CFR) in The Gambia is 5 to 10 times that of the United States. This disease is a substantial health concern in West Africa, which has unfortunately been overshadowed by malaria and other tropical diseases. The age distribution of cases will enter into decisions to introduce H.Influenza, type B (HIB) vaccine into this area. To provide any benefits, the vaccine must be administered at an early age. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pediatric diseases, Children, Diseases, Gambia, Hemophilus influenzae, Haemophilus influenzae, Hemophilus meningitis

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Clones of serogroup B Neisseria meningitidis causing systemic disease in the Netherlands, 1958-1986

Article Abstract:

Neisseria meningitidis causes epidemic cerebrospinal meningitis, a life-threatening infection that involves inflammation of the membrane covering the brain and spinal cord. N. meningitidis serogroup B diseases are of major concern in Europe and the US, since penicillin-resistant strains are developing and no vaccine is available. Characterization of serotypes and genotypes is difficult since genetic variants of the bacteria seem to appear spontaneously, even during outbreaks. The use of multilocus enzyme electrophoresis (MEE) has demonstrated that identifying surface properties of the cell does not necessarily indicate genotypic similarity. However, MEE can provide the means to follow changes in meningococcal populations as they occur, especially in relation to outbreaks and epidemics. From 1958 to 1986 more than 5,500 strain isolates of meningococcal diseases were collected by the Netherlands Reference Laboratory for Bacterial Meningitis (RBM). This study presents the MEE analysis and variations of 14 enzyme loci, and the genetic relationships of patient isolates in the Netherlands during this period. A total of 278 serogroup B isolates from cases of systemic disease were selected for this study; 28 percent were identified as N. meningitidis serotype 2b. Fifty-three percent could not be classified according to serotype or serosubtype. Genetic relationships and allelic profiles are presented for these isolates. Closely related, but specific clone lineages known as electrophoretic types (ET) 11 and 17 of serotype 2b were characterized from isolates of the epidemic in 1966-1967 and an increased disease wave in 1972. Differences in the male-to-female ratios and ages of patients are described in relation to isolates of some clone lineages. (Consumer Summary produced by Reliance Medical Information, Inc.)

Netherlands, Genetic aspects, Neisseria meningitidis

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Bacterial meningitis in the United States, 1986: report of a multistate surveillance study

Article Abstract:

In 1986, the Centers for Disease Control (CDC) in Atlanta, Georgia, along with six different state and local health departments, conducted a survey of all reported cases of meningitis. Meningitis is an inflammation of the meninges, membranes surrounding the brain and spinal cord. The five most common causes of bacterial meningitis are S. pneumoniae, H. influenzae, Listeria monocytogenes, Neisseria meningitidis and group B streptococcus. The survey monitored the occurrence of these different types of meningitis in 34 million people. The most common bacterial cause of meningitis was H. influenzae, occurring in 45 percent of the study group. Streptococcus pneumoniae was identified in 18 percent of the population and Neisseria meningitidis in 14 percent. The most common cause of bacterial meningitis in children less than one month of age and in the elderly over 60 years of age was group B streptococcus. The overall fatality rate was lowest for H. influenzae (3 percent) and highest for L. monocytogenes (22 percent). These fatality rates are significantly lower than those reported in a study in the early 1970s. However, 32 percent of the H. influenzae isolates were resistant to ampicillin, compared with 24 percent reported in 1981. (Consumer Summary produced by Reliance Medical Information, Inc.)

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