The Epidemiology of Meningitis among Children in Nigeria in the Post-Vaccination Era Pubblico

Abstract

The Epidemiology of Meningococcal MeningitisMeningitis in Nigerian Children in the Post-Vaccination Era

By Ayomide Sokale

 

 Background: Nigeria is one of twenty-six countries that lie in the meningitis belt of Sub-Saharan Africa which is an area that has the highest rate of meningitis in the world. Between the beginning of a national epidemic in December 2016 and the official end of the outbreak on June 23rd, 2017, Nigeria reported a total of 14,513 cases of meningitis with 1,166 deaths and a case fatality rate of 8%. Of the reported suspected cases only an approximate 7% of cases were laboratory tested, of which approximately 46.2% of these cases were confirmed positive for bacterial meningitis. The bacteria Neisseria meningitidesmeningitides serogroup C was the most dominant disease-causing strain, accounting for approximately 75.4% of positive cases.

Objective: To examine the epidemiology of meningococcal meningitismeningitis in children (aged 0 to 18 years) in Nigeria, in the post-vaccination era, after MenAfriVac vaccination (2011) and the MenACWY conjugate vaccine (2017).

Methods: National Routine surveillance data for suspected cases of meningococcal meningitismeningitis was collected for the years of 2017 and 2018 (n=13,585). All statistical analyses were performed using SAS version 9.4. Counts and proportions were given in place of an estimated prevalence or cumulative incidence.

Results: Out of the entire cohort of 13,585 children approximately 4174 children (30.7%) were within the age group of 5 to 9 years, and 4571 children (33.6%) were within the age group of 10 to 14 years. Of the total cases approximately 60% (n=7986) were male. Finally of the approximately 6% of cases for whom CSF samples were taken 61.5% (n=401) tested positive for N.meningitidismeningitidis serotype C.

Conclusions/ Implications: Meningitis is more prevalent in children in Nigeria than in adults. Nigeria mostly experienced outbreaks of meningococcal meningitismeningitis attributed to N.meningitidismeningitidis serotype A. However the results of this research indicate that among the laboratory-tested cases within the study period, the majority of cases (61.5%) were caused by N.meningitidismeningitidis serogroup C. The results of this study indicate that this emerging strain is more prevalent in children than in adults and may have implications for future vaccine research as well as future policies.

Table of Contents

Table of Contents

Chapter I: Introduction .............................................................................................................................. 1

Introduction and Rationale .................................................................................................................... 1

Problem Statement .................................................................................................................................. 3

Purpose Statement .................................................................................................................................. 4

Research Question and Hypotheses....................................................................................................... 4

Definition of Terms ................................................................................................................................. 4

Chapter II: Literature Review ................................................................................................................... 6

The History of Neisseria Meningitides and Meningitis ........................................................................ 6

The Microbiology and Pathobiology of Neisseria Meningitides .......................................................... 7

The Epidemiology of Meningitis throughout the World ..................................................................... 8

The Epidemiology of Meningitis in Africa (The Meningitis Belt) ...................................................... 9

The Epidemiology of Meningitis in Nigeria ........................................................................................ 10

CHAPTER III: Manuscript ..................................................................................................................... 14

The Epidemiology of Meningitis in Nigerian Children .......................................................................... 15

In the Post-Vaccination Era .................................................................................................................... 15

Contribution of the Student ................................................................................................................. 16

Abstract .................................................................................................................................................. 17

Introduction ........................................................................................................................................... 18

Background ........................................................................................................................................... 19

Materials and Methods ......................................................................................................................... 21

Results .................................................................................................................................................... 27

Characteristics of Suspected Meningitis Cases, 2017-2018 ........................................................... 27

Characteristics of Suspected Meningitis Cases, 2017 .................................................................... 29

Characteristics of Suspected Meningitis Cases, 2018 .................................................................... 30

Discussion .............................................................................................................................................. 34

Limitations ............................................................................................................................................. 37

Conclusion ............................................................................................................................................. 38

Acknowledgments ................................................................................................................................. 38

Tables and Figures ................................................................................................................................ 38

References .............................................................................................................................................. 47

Chapter IV: Public Health Implications ...................................................................................................... 50

References ................................................................................................................................................... 51

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Parola chiave	Neisseria meningitidis serotype C children meningitis immunization Nigeria Neisseria meningitidis serotype A Neisseria meningitidis WHO
Committee Chair / Thesis Advisor	Omer, Saad, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) International governmental organization (e.g., Agency for International Development, etc.)

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