[en] Background: This retrospective hospital-based surveillance aimed to assess the epidemiology, causative pathogens trend, and serotypes distribution of pneumococcal meningitis among children aged under 5 years with bacterial meningitis in Southern Vietnam after the introduction of pentavalent vaccine in the Expanded Program on Immunization (EPI). Methods: From 2012 to 2021, cerebrospinal fluid samples were collected from children aged under 5 years with suspected bacterial meningitis at Children's Hospitals 1 and 2 in Ho Chi Minh City. Probable bacterial meningitis (PBM) cases were identified using biochemistry and cytology. Real-time polymerase chain reaction was used to confirm cases of confirmed bacterial meningitis (CBM) caused by Streptococcus pneumoniae, Haemophilus influenzae, or Neisseria meningitidis. Streptococcus pneumoniae serotyping was performed. Results: Of the 2560 PBM cases, 158 (6.2%) were laboratory-confirmed. The CBM proportion decreased during the 10-year study and was associated with age, seasonality, and permanent residence. Streptococcus pneumoniae was the most common pathogen causing bacterial meningitis (86.1%), followed by H influenzae (7.6%) and N meningitidis (6.3%). The case-fatality rate was 8.2% (95% confidence interval, 4.2%-12.2%). Pneumococcal serotypes 6A/B, 19F, 14, and 23F were the most prevalent, and the proportion of pneumococcal meningitis cases caused by the 10-valent pneumococcal conjugate vaccine (PCV) serotypes decreased from 96.2% to 57.1% during the PCV eras. Conclusions: Streptococcus pneumoniae is the most frequent causative agent of bacterial meningitis in children aged under 5 years in Southern Vietnam over the last decade. Policymakers may need to consider introducing PCVs into the EPI to effectively prevent and control bacterial meningitis.
The probable bacterial meningitis sentinel surveillance was supported by a grant from the WHO to the Pasteur Institute in Ho Chi Minh City. This work was supported through funding by the Université Catholique de Louvain Developing countries cooperation - PhD Scholarships.
Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev 2010; 23: 467–92.
Lee JH, Cho HK, Kim KH, et al. Etiology of invasive bacterial infections in immunocompetent children in Korea (1996–2005): a retrospective multicenter study. J Korean Med Sci 2011; 26:174–83.
Mobarak EI. Trend, features and outcome of meningitis in the communicable diseases hospital, Alexandria, Egypt, 1997–2006. J Egypt Public Health Assoc 2012; 87:16–23.
Oordt-Speets AM, Bolijn R, van Hoorn RC, Bhavsar A, Kyaw MH. Global etiology of bacterial meningitis: a systematic review and meta-analysis. PLoS One 2018; 13: e0198772.
Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis 2010; 10:317–28.
Zunt JR, Kassebaum NJ, Blake N, et al. Global, regional, and national burden of meningitis, 1990–2016: a systematic analysis for the Global Burden of Disease study 2016. Lancet Neurol 2018; 17:1061–82.
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019. Lancet 2020; 369:1204–22.
McIntyre PB, O’Brien KL, Greenwood B, van de Beek D. Effect of vaccines on bacterial meningitis worldwide. Lancet 2012; 380:1703–11.
Scarborough M, Thwaites GE. The diagnosis and management of acute bacterial meningitis in resource-poor settings. Lancet Neurol 2008; 7:637–48.
Anh DD, Kilgore PE, Kennedy WA, et al. Haemophilus influenzae type B meningitis among children in Hanoi, Vietnam: epidemiologic patterns and estimates of H. influenzae type B disease burden. Am J Trop Med Hyg 2006; 74:509–15.
Ho Dang Trung N, Le Thi Phuong T, Wolbers M, et al. Aetiologies of central nervous system infection in Viet Nam: a prospective provincial hospital-based descriptive surveillance study. PLoS One 2012; 7:e37825.
Le P, Griffiths UK, Anh DD, Franzini L, Chan W, Swint JM. Cost-effectiveness of Haemophilus influenzae type b vaccine in Vietnam. Vaccine 2015; 33:4639–46.
Nguyen-Huu CD, Bui-Binh-Bao S, Tran KH, et al. Main clinical and laboratory features of children with bacterial meningitis: experience from a tertiary paediatric centre in central Vietnam. Pediatric Health Med Ther 2022; 13:289–95.
Tran TT, Le QT, Tran TN, Nguyen NT, Pedersen FK, Schlumberger M. The etiology of bacterial pneumonia and meningitis in Vietnam. Pediatr Infect Dis J 1998; 17(Suppl 9):S192–4.
World Health Organization. Regional Office for South-East Asia. Surveillance Guide for Vaccine-Preventable Diseases in the WHO South-East Asia Region. World Health Organization. Regional Office for South-East Asia. 2017. Available at: https://apps.who.int/iris/handle/10665/277459.
World Health Organization & Centers for Disease Control and Prevention (U.S.). Laboratory methods for the diagnosis of meningitis caused by neisseria meningitidis, streptococcus pneumoniae, and haemophilus influenzae: WHO manual, 2nd ed. World Health Organization; 2011. Available at: https://apps.who.int/iris/handle/10665/70765
Vuong J, Collard JM, Whaley MJ, et al. Development of real-time PCR methods for the detection of bacterial meningitis pathogens without DNA extraction. PLoS One 2016; 11:e0147765.
Pimenta FC, Roundtree A, Soysal A, et al. Sequential triplex real-time PCR assay for detecting 21 pneumococcal capsular serotypes that account for a high Global Disease Burden. J Clin Microbiol 2013; 51:647–52.
Ouattara M, Tamboura M, Kambiré D, et al. Triplex direct quantitative polymerase chain reaction for the identification of Streptococcus pneumoniae serotypes. J Infect Dis 2021; 224(12 Suppl 2):S204–8.
Paireau J, Chen A, Broutin H, Grenfell B, Basta NE. Seasonal dynamics of bacterial meningitis: a time-series analysis. Lancet Global Heatlh 2016; 4:370–7.
Fitzwater SP, Ramachandran P, Kahn GD, et al. Impact of the introduction of the Haemophilus influenzae type B conjugate vaccine in an urban setting in southern India. Vaccine 2019; 37:1608–13.
David S. Stephens MD. Protecting the herd: the remarkable effectiveness of the bacterial meningitis polysaccharide-protein conjugate vaccines in altering transmission dynamics. Trans Am Clin Climatol Assoc 2011; 122:115–23.
Mohamed YH, Toizumi M, Uematsu M, et al. Prevalence of Streptococcus pneumoniae in conjunctival flora and association with nasopharyngeal carriage among children in a Vietnamese community. Sci Rep 2021; 11:337.
Jayaraman Y, Veeraraghavan B, Girish Kumar CP, et al. Hospital-based sentinel surveillance for bacterial meningitis in under-five children prior to the introduction of the PCV13 in India. Vaccine 2021; 39:3737–44.
Wahl B, O’Brien KL, Greenbaum A, et al. Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000–15. Lancet Glob Health 2018; 6:e744–57.
Du QQ, Shi W, Yu D, hu Yao K. Epidemiology of non-vaccine serotypes of Streptococcus pneumoniae before and after universal administration of pneumococcal conjugate vaccines. Hum Vaccin Immunother 2021; 17:5628–37.
Reyburn R, Tuivaga EJ, Ratu FT, et al. The impact of 10-valent pneumococcal vaccine introduction on invasive disease in Fiji. Lancet Reg Health West Pac 2022; 20: 100352.
