The incidence, aetiology, and characteristics of bacterial meningitis in young children in South Africa, 2014-2018: a 5-year retrospective review

Abstract

Introduction: Bacterial meningitis in children is an important public health concern both globally and in South Africa. To date, there are a paucity of nationally representative data examining the incidence as well as associated characteristics of bacterial meningitis (excluding tuberculosis(TB)) on the African continent. Further, literature suggests that there has been little attention to the most common pathogens (Acinetobacter baumannii, Klebsiella pneumoniae, group B streptococcus (GBS), Escherichia coli, Staphylococcus aureus, Enterococcus faecium), as well as the demographic characteristics of children with incident meningitis. Therefore, this study aimed to describe the incidence and the aetiology of bacterial meningitis and to compare these characteristics of children under 1-year-old who tested positive for the two most common pathogens related to their infection.

Methods: To address these gaps in the literature, secondary data from the National Health Laboratory Service (NHLS)Central Data Warehouse (CDW) was analysed to examine the incidence, the aetiology and to compare the characteristics of children who tested positive to the 2 most common pathogens identified during the period. A sample of 2,647 cases of laboratory-confirmed meningitis was used and described by the frequency(n) and percentage (%) tables for the aetiology while Poisson and binary logistic regression methods were employed respectively to calculate the incidence and to compare the characteristics of children who tested positive to the 2 most common pathogens isolated.

Results: The study suggests an increase in the number of cases (358 cases in 2014 to 723 cases in 2018) as well as the annual incidence of most pathogens over the study period. Demographic variables associated with incidence included age (being under the age of 28 days), being male and living in Gauteng . The highest incidence was calculated among neonates (A. baumannii: 168.9 per 100 000 persons) while the lowest was calculated in the postneonatal period (Enterococcus faecalis 1.01 per 100 000 persons.). A. baumannii (19.42%) followed by K. pneumonia (17.76%), GBS (14.51%) were the most common pathogens detected. Regarding the age group, A. baumannii (23.91%), K. pneumonia (19.42%) GBS (19.28%) were the most commonly identified organisms among the neonates while K. pneumonia (15.75%), S aureus (14.25%), A. baumannii (14%) were the most commonly organisms isolated in the postneonatale period.

Conclusion: Over the 5-year study period, after the introduction of the Hib vaccine and PCV, there was still an increasing trend in the annual incidence of most pathogens and a change in the leading pathogens with the emergence of pathogens such as A. baumannii, K. pneumonia, GBS. In addition to increased uptake of vaccination against common pathogens, prophylactic measures could include prevention of nosocomial and mother to child transmissible pathogens. Among others, these could include antenatal screening for GBS in pregnant women, rigorous hygiene methods for the healthcare giver and cleaning, disinfection, and sterilization of the hospital environment as well as rationalize antibiotic use.