Patterns of meningococcal infection in Sudan with emergence of Neisseria meningitidis serogroup W135.

This study was conducted during the 2004-2006 epidemic of meningitis in Sudan to follow-up the frequency of disease outbreak or endemic waves and to evaluate the new quadrivalent vaccine for actual application. Samples were collected from Darfur, El Gedaref, Kassala and Khartoum States and transported to the National Health Central Laboratory in Khartoum. Of 196 patients with clinical symptoms and signs of meningitis, conventional culture identified Neisseria meningitidis in 37 (189%), confirmed by polymerase chain reaction. N. meningitidis type A was identified in 29 (78.4%) patients, type C in 3 (8.1%) and N. meningitidis W135 in 5 (15.5%). The serotyping and molecular diagnosis patterns of N. meningitidis showed the emergence of the new strain, W135, in 5 (15.5%). The patients from the borders of Sudan, 3 from the West Darfur, and 1 each from El Gedaref and Kassala. These could be related to the movement of pilgrims through the borders to Saudi Arabia in the Hajj season. Serious consideration may be needed for quadrivalent vaccination to prevent seasonal and Hajj season outbreaks.

Patterns of meningococcal infection in Sudan with emergence of Neisseria meningitidis serogroup W135

This study was conducted during the 2004-2006 epidemic of meningitis in Sudan to follow-up the frequency of disease outbreak or endemic waves and to evaluate the new quadrivalent vaccine for actual application. Samples were collected from Darfur, El Gedaref, Kassala and Khartoum States and transported to the National Health Central Laboratory in Khartoum. Of 196 patients with clinical symptoms and signs of meningitis, conventional culture identified Neisseria meningitidis in 37 [18.9%], confirmed by polymerase chain reaction. N. meningitidis type A was identified in 29 [78.4%] patients, type C in 3 [8.1%] and N. meningitidis W135 in 5 [15.5%]. The serotyping and molecular diagnosis patterns of N. meningitidis showed the emergence of the new strain,W 135, in patients from the borders of Sudan, 3 from the West Darfur, and 1 each from El Gedaref and Kassala. These could be related to the movement of pilgrims through the borders to Saudi Arabia in the Hajj season. Serious consideration may be needed for quadrivalent vaccination to prevent seasonal and Hajj season outbreaks

Laboratory-based surveillance for patients with acute meningitis in Sudan, 2004-2005.

To determine the burden of bacterial meningitis and characterize its epidemiology, a laboratory-based surveillance was established in five hospitals in Sudan. Hospital personnel were trained in basic surveillance and bacteriology techniques. Positive cerebrospinal fluid (CSF) cultures were confirmed at Sudan National Laboratories and U.S. Naval Medical Research Unit No. 3. Additionally, 126 frozen CSF samples from culture-negative meningitis cases were tested by polymerase chain reaction (PCR). Of 1,830 suspected meningitis cases enrolled, 75% were less than 5 years old and 63% were males. Of these, 149 (8%) were culture-confirmed, including 121 (81%) Neisseria meningitidis; 18 (12%) Streptococcus pneumoniae, and 10 (7%) Haemophilus influenzae. Of 440 turbid specimens, 132 (30%) were culture-positive. Of the 126 samples from culture-negative meningitis cases that were tested, only 18 (14%) were classified as turbid on gross examination, yet 63 (50%) were positive by PCR. This study suggests that PCR may be useful to more accurately define the burden of disease in epidemic setting. Maintaining laboratory-based surveillance allows evidence-based decision-making and helps monitor the impact of new vaccines introduction.