Epidemiology of bacterial meningitis in Niamey, Niger, 1981-96.

In the African meningitis belt the importance of endemic meningitis is not as well recognized as that of epidemics of meningococcal meningitis that occur from time to time. Using retrospective surveillance, we identified a total of 7078 cases of laboratory-diagnosed bacterial meningitis in Niamey, Niger, from 1981 to 1996. The majority (57.7%) were caused by Neisseria meningitidis, followed by Streptococcus pneumoniae (13.2%) and Haemophilus influenzae b (Hib) (9.5%). The mean annual incidence of bacterial meningitis was 101 per 100,000 population (70 per 100,000 during 11 non-epidemic years) and the average annual mortality rate was 17 deaths per 100,000. Over a 7-year period (including one major epidemic year) for which data were available, S. pneumoniae and Hib together caused more meningitis deaths than N. meningitidis. Meningitis cases were more common among males and occurred mostly during the dry season. Serogroup A caused 85.6% of meningococcal meningitis cases during the period investigated; three-quarters of these occurred among children aged < 15 years, and over 40% among under-5-year-olds. Both incidence and mortality rates were highest among infants aged < 1 year. In this age group, Hib was the leading cause of bacterial meningitis, followed by S. pneumoniae. The predominant cause of meningitis in persons aged 1-40 years was N. meningitidis. Use of the available vaccines against meningitis due to N. meningitidis, S. pneumoniae, and Hib could prevent substantial endemic illness and deaths in sub-Saharan Africa, and potentially prevent recurrent meningococcal epidemics.

PIP: The study presented information on the epidemiology of bacterial meningitis in Niamey, Niger from 1981 to 1996 using retrospective surveillance. During the 15-year period, 7078 cases of laboratory-diagnosed bacterial meningitis were identified. 3 years (1984-85, 1985-86, and 1994-95) were considered to be epidemic years, and in these years incidence of bacterial meningitis exceeded 140 cases/100,000 population. The major pathogens were Neisseria meningitidis (57.7%), Streptococcus pneumoniae (13.2%), and Haemophilus influenzae (Hib) (9.5%). Mean annual incidence of bacterial meningitis was 101/100,000 population with an average annual mortality rate of 17 deaths/100,000. Both S. pneumoniae and Hib had caused more meningitis deaths than N. meningitidis, as observed over the 7-year period for which data were available. Meanwhile, N. meningitidis was the major cause of meningitis in persons aged 1-40 years. Meningitis was more common among males than females and was more prevalent during dry seasons. Incidence of meningococcal meningitis was higher (74.3%) in children under 15 years of age, and over 40% of these cases occurred in children below 5 years old. Infants aged less than 1 year had the highest incidence and mortality rates; neonatal (1 month of age) meningitis was identified in 101 cases. The high rate of endemic illness and deaths due to meningitis in sub-Saharan Africa could be prevented through the use of available vaccines such as meningococcal polysaccharide vaccines and Hib conjugate vaccines.

[Ceftriaxone (Rocéphine) in major African infectious pathology. Results at the Niamey Hospital (Niger) ]. / Ceftriaxone en pathologie infectieuse majeure africaine. Résultats obtenus au CHU de Niamey (Niger).

Ceftriaxone is a wide-spectrum-third generation cephalosporin characterized by outstandingly high efficacy as well as pharmokinetic properties making it suitable for administration in a single daily injection. Ceftriaxone has been found to be useful for treatment of the very severe infectious pathology in countries where hygiene and medical superstructures are still rudimentary. Eighteen of 20 patients with purulent meningitis (13 to Neisseria meningitidis A, 3 to Streptoc. pneumoniae, 1 to Listeria and 3 aseptic) recovered (there being 2 deaths at the 36th hour) after a mean 6 days of hospitalization. Despite the very delicate patient condition, recovery was seen in all 11 cases of very grave bronchopneumopathy, generally due to Streptoc, pneumonia. A dose of 2 g/day in 1 or 2 IV injections is sufficient in the adult, 0.50 g in a single dose being injected to infants weighing less than 10 kg, Meningitis required 4 to 7 days treatment (9 days in a case of Listeria) while the treatment period was longer for respiratory infections. Seven patients had been refractory to treatment with beta-lactamines and/or aminosides, and no adverse drug reactions were noted.