Neisseria meningitidis Serogroup W Meningitis Epidemic in Togo, 2016.

BACKGROUND: During 2014, 4 regions in Togo within the African meningitis belt implemented vaccination campaigns with meningococcal serogroup A conjugate vaccine (MACV). From January to July 2016, Togo experienced its first major Neisseria meningitidis serogroup W (NmW) outbreak. We describe the epidemiology, response, and management of the outbreak. METHODS: Suspected, probable, and confirmed cases were identified using World Health Organization case definitions. Through case-based surveillance, epidemiologic and laboratory data were collected for each case. Cerebrospinal fluid specimens were analyzed by polymerase chain reaction, culture, or latex agglutination. Vaccination campaigns were conducted in affected districts. RESULTS: From January 11 to July 5, 2016, 1995 suspected meningitis cases were reported, with 128 deaths. Among them, 479 (24.0%) were confirmed by laboratory testing, and 94 (4.7%) and 1422 (71.3%) remained as probable and suspected cases, respectively. Seven epidemic districts had cumulative attack rates greater than 100 per 100 000 population. Of the confirmed cases, 91.5% were NmW; 39 of 40 available NmW isolates were sequence type-11/clonal complex-11. CONCLUSIONS: This outbreak demonstrates that, although high coverage with MACV has reduced serogroup A outbreaks, large meningococcal meningitis outbreaks due to other serogroups may continue to occur; effective multivalent meningococcal conjugate vaccines could improve meningococcal disease prevention within meningitis belt populations.

Etiology of Pediatric Bacterial Meningitis Pre- and Post-PCV13 Introduction Among Children Under 5 Years Old in Lomé, Togo.

BACKGROUND: Pediatric bacterial meningitis (PBM) causes severe morbidity and mortality within Togo. Thus, as a member of the World Health Organization coordinated Invasive Bacterial Vaccine Preventable Diseases network, Togo conducts surveillance targeting Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae, at a sentinel hospital within the capital city, Lomé, in the southernmost Maritime region. METHODS: Cerebrospinal fluid was collected from children <5 years with suspected PBM admitted to the Sylvanus Olympio Teaching Hospital. Phenotypic detection of pneumococcus, meningococcus, and H. influenzae was confirmed through microbiological techniques. Samples were shipped to the Regional Reference Laboratory to corroborate results by species-specific polymerase chain reaction. RESULTS: Overall, 3644 suspected PBM cases were reported, and 98 cases (2.7%: 98/3644) were confirmed bacterial meningitis. Pneumococcus was responsible for most infections (67.3%: 66/98), followed by H. influenzae (23.5%: 23/98) and meningococcus (9.2%: 9/98). The number of pneumococcal meningitis cases decreased by 88.1% (52/59) postvaccine introduction with 59 cases from July 2010 to June 2014 and 7 cases from July 2014 to June 2016. However, 5 cases caused by nonvaccine serotypes were observed. Fewer PBM cases caused by vaccine serotypes were observed in infants <1 year compared to children 2-5 years. CONCLUSIONS: Routine surveillance showed that PCV13 vaccination is effective in preventing pneumococcal meningitis among children <5 years of age in the Maritime region. This complements the MenAfriVac vaccination against meningococcal serogroup A to prevent meningitis outbreaks in the northern region of Togo. Continued surveillance is vital for estimating the prevalence of PBM, determining vaccine impact, and anticipating epidemics in Togo.

Incomplete immunization among children aged 12-23 months in Togo: a multilevel analysis of individual and contextual factors.

BACKGROUND: Inadequate immunization coverage remains a public health problem in Africa. In Togo, only 62% of children under one year of age were fully immunized in 2013. This study aimed to estimate the immunization coverage among children aged 12-23 months, and to identify factors associated with incomplete immunization status in Togo. METHODS: A cross-sectional survey was conducted in the six health regions of Togo. Children aged 12 to 23 months who were living with one of their parents or guardians from selected households were recruited for the study. Data was collected using a pre-tested questionnaire through face-to-face interviews. Multilevel logistic regression analyses were performed to assess factors associated with incomplete immunization coverage. RESULTS: A total of 1261 households were included. Respondents were predominantly women (91.9%) and 22.8% had secondary or higher education level. Immunization cards were available for 85.3% of children. Complete immunization coverage was 72.3%, 95% confidence interval (CI): [69.7-74.8]). After controlling for both individual and contextual level variables, children whose mothers attended secondary school or above were 33% (adjusted Odds Ratio (aOR) = 0.67, CI [0.47-0.94]) less likely to have an incomplete immunization coverage compared to those with no education. The likelihood of incomplete immunization in children decreased with the increase in household's income (aOR = 0.73, 95% CI [0.58-0.93]), children who did not have an immunization card (aOR = 13.41, 95% CI [9.19-19.57]) and those whose parents did not know that children immunization was free of charge (aOR = 1.82, 95% CI [1.00-3.30]) were more likely to have an incomplete immunization. Finally, children whose parents had to walk half an hour to one hour to reach a healthcare center were 57% (aOR = 1.57, 95% CI [1.15-2.13]) more likely to have an incomplete immunization coverage than those whose parents had to walk less than half an hour. CONCLUSION: The goal of 90% coverage at the national level has not been achieved in 2017. Innovative strategies such as using electronic cards and strengthening sensitization activities must be initiated in order to attain a complete immunization coverage in Togo.

Sensitivity, Specificity, and Public-Health Utility of Clinical Case Definitions Based on the Signs and Symptoms of Cholera in Africa.

During 2014, Africa reported more than half of the global suspected cholera cases. Based on the data collected from seven countries in the African Cholera Surveillance Network (Africhol), we assessed the sensitivity, specificity, and positive and negative predictive values of clinical cholera case definitions, including that recommended by the World Health Organization (WHO) using culture confirmation as the gold standard. The study was designed to assess results in real-world field situations in settings with recent cholera outbreaks or endemicity. From June 2011 to July 2015, a total of 5,084 persons with suspected cholera were tested for Vibrio cholerae in seven different countries of which 35.7% had culture confirmation. For all countries combined, the WHO case definition had a sensitivity = 92.7%, specificity = 8.1%, positive predictive value = 36.1%, and negative predictive value = 66.6%. Adding dehydration, vomiting, or rice water stools to the case definition could increase the specificity without a substantial decrease in sensitivity. Future studies could further refine our findings primarily by using more sensitive methods for cholera confirmation.

Epidemiologic Investigations into Outbreaks of Rift Valley Fever in Humans, South Africa, 2008-2011.

Rift Valley fever (RVF) is an emerging zoonosis posing a public health threat to humans in Africa. During sporadic RVF outbreaks in 2008-2009 and widespread epidemics in 2010-2011, 302 laboratory-confirmed human infections, including 25 deaths (case-fatality rate, 8%) were identified. Incidence peaked in late summer to early autumn each year, which coincided with incidence rate patterns in livestock. Most case-patients were adults (median age 43 years), men (262; 87%), who worked in farming, animal health or meat-related industries (83%). Most case-patients reported direct contact with animal tissues, blood, or other body fluids before onset of illness (89%); mosquitoes likely played a limited role in transmission of disease to humans. Close partnership with animal health and agriculture sectors allowed early recognition of human cases and appropriate preventive health messaging.