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1.
Clin Infect Dis ; 69(Suppl 2): S126-S132, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31505634

RESUMO

BACKGROUND: Acute bacterial meningitis remains a major cause of childhood mortality in sub-Saharan Africa. We document findings from hospital-based sentinel surveillance of bacterial meningitis among children <5 years of age in The Gambia, from 2010 to 2016. METHODS: Cerebrospinal fluid (CSF) was collected from children admitted to the Edward Francis Small Teaching Hospital with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae was performed by microbiological culture and/or polymerase chain reaction where possible. Whole genome sequencing was performed on pneumococcal isolates. RESULTS: A total of 438 children were admitted with suspected meningitis during the surveillance period. The median age of the patients was 13 (interquartile range, 3-30) months. Bacterial meningitis was confirmed in 21.4% (69/323) of all CSF samples analyzed. Pneumococcus, meningococcus, and H. influenzae accounted for 52.2%, 31.9%, and 16.0% of confirmed cases, respectively. There was a significant reduction of pneumococcal conjugate vaccine (PCV) serotypes, from 44.4% in 2011 to 0.0% in 2014, 5 years after PCV implementation. The majority of serotyped meningococcus and H. influenzae belonged to meningococcus serogroup W (45.5%) and H. influenzae type b (54.5%), respectively. Meningitis pathogens were more frequently isolated during the dry dusty season of the year. Reduced susceptibility to tetracycline, trimethoprim-sulfamethoxazole, and chloramphenicol was observed. No resistance to penicillin was found. CONCLUSIONS: The proportion of meningitis cases due to pneumococcus declined in the post-PCV era. However, the persistence of vaccine-preventable meningitis in children aged <5 years is a major concern and demonstrates the need for sustained high-quality surveillance.


Assuntos
Hospitalização/estatística & dados numéricos , Meningite Pneumocócica/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Vigilância de Evento Sentinela , Doença Aguda/epidemiologia , Pré-Escolar , Feminino , Gâmbia/epidemiologia , Haemophilus influenzae tipo b/classificação , Humanos , Lactente , Recém-Nascido , Masculino , Meningite Meningocócica/epidemiologia , Meningite Pneumocócica/líquido cefalorraquidiano , Meningite Pneumocócica/prevenção & controle , Neisseria meningitidis/classificação , Sorogrupo , Streptococcus pneumoniae/classificação , Vacinas Conjugadas/administração & dosagem , Sequenciamento Completo do Genoma
2.
Vaccine ; 36(47): 7179-7184, 2018 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-29544688

RESUMO

INTRODUCTION: Rotavirus vaccines protect against the leading cause of severe childhood diarrhoea, and have been introduced in many low-income African countries. The Gambia introducedRotateq® (RV5) into their national immunization program in 2013. We revieweddata from an active rotavirus sentinel surveillancesitefor early evidence of vaccine impact. METHODS: We compared rotavirus prevalence in diarrhoeal stool in children< 5 years of age admittedat the Edward Francis Small Teaching Hospital sentinel surveillance site before (2013) andafterRV5 introduction (2015-2016) in the Gambia. The rotavirus-percent positive was separately compared for all diarrhoealhospitalizations and for hospitalizations with severe symptoms. Rotavirus prevalence was compared annually for the pre-vaccine year of 2013 with post-vaccine years of 2015 and 2016 using chi-square or Fisher's exact tests and the p-value to establish significant relationship was set at p < 0.05. All analyses were completed in SAS 9.3 (SAS Analytics, North Carolina). RESULTS: Rotavirus prevalence among all diarrhoeahospitalizations decreased from 22% in 2013 to 11% in 2015 (p = 0.04), while remaining unchanged in 2016 (18%, p = 0.56). For hospitalizations that were clinically severe and/or treated with intravenous fluids (mean of 46 per year), the rotavirus prevalence decreased from 33% in 2013 to 8% in 2015 (p = 0.04), and to 15% in 2016 (p = 0.08). The children with age <1 year accounted for 45% the population infected with rotavirus in both pre and post rotavirus vaccination periods. CONCLUSIONS: Rotavirus vaccine introduction in the Gambia could be among factors resulting in decreased diarrhea hospitalizations among children at the Edward Francis Small Teaching Hospital, particularly those with severe disease. These results support the continuation of rotavirus vaccine and additional monitoring of rotavirus hospitalization trends in the country.


Assuntos
Diarreia/prevenção & controle , Gastroenterite/prevenção & controle , Hospitalização/estatística & dados numéricos , Programas de Imunização , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/uso terapêutico , Pré-Escolar , Diarreia/epidemiologia , Diarreia/virologia , Fezes/virologia , Gastroenterite/epidemiologia , Gastroenterite/virologia , Hospitalização/tendências , Humanos , Lactente , Soluções de Nutrição Parenteral , Prevalência , Infecções por Rotavirus/epidemiologia , Vigilância de Evento Sentinela , Vacinação , Vacinas Atenuadas/uso terapêutico
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