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Human Vaccines & Immunotherapeutics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/khvi20
Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005–2012 in Turkey as
bs
as
cs
Mehmet Ceyhan , Nezahat Gürler , Yasemin Ozsurekci , Melike Keser , Ahmet Emre as
as
gs
h
ds
es
fs
Aycan , Venhar Gurbuz , Nuran Salman , Yildiz Camcioglu , Ener Cagri Dinleyici , Sengul hs
i
js
Ozkan , Gulnar Sensoy , Nursen Belet , Emre Alhan , Mustafa Hacimustafaoglu , Solmaz js
ks
ls
ms
ns
Celebi , Hakan Uzun , Ahmet Faik Oner , Zafer Kurugol , Mehmet Ali Tas , Denizmen os
as
as
ps
qs
rs
Aygun , Eda Karadag Oncel , Melda Celik , Olcay Yasa , Fatih Akin & Yavuz Coşkun a
Click for updates
Department of Pediatric Infectious Diseases; Hacettepe University Faculty of Medicine; Ankara, Turkey b
Department of Microbiology and Clinical Microbiology; Istanbul University Faculty of Medicine; Istanbul, Turkey c
Department of Pediatrics; Selcuk University Meram Faculty of Medicine; Konya, Turkey
d
Department of Pediatrics; Istanbul University Faculty of Medicine; Istanbul, Turkey
e
Department of Pediatrics; Istanbul University; Cerrahpasa Faculty of Medicine; Istanbul, Turkey f
Department of Pediatrics; Osmangazi University Faculty of Medicine; Eskisehir, Turkey
g
Microbiology Laboratory; Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital; Ankara, Turkey h
Department of Pediatric Infectious Diseases; Ondokuz Mayis University Faculty of Medicine; Samsun, Turkey i
Department of Pediatrics, Cukurova University Faculty of Medicine; Adana, Turkey
j
Department of Pediatric Infectious Diseases; Uludag University Faculty of Medicine; Bursa, Turkey k
Department of Pediatrics; Duzce University Faculty of Medicine; Duzce, Turkey
l
Department of Pediatrics; Yuzuncu Yil University Faculty of Medicine; Van, Turkeya
m
Department of Pediatric Infectious Diseases; Ege University Faculty of Medicine; Izmir, Turkey n
Department of Pediatrics; Dicle University Faculty of Medicine; Diyarbakir, Turkey
o
Department of Pediatrics; Firat University Faculty of Medicine; Elazig, Turkey
p
Goztepe Research and Training Hospital; Department of Pediatrics; Istanbul, Turkey
q
Department of Pediatrics; Konya Training and Research Hospital; Konya, Turkey
r
Gaziantep University; Faculty of Medicine; Department of Pediatrics; Gaziantep, Turkey
s
Turkish Meningitis Surveillance Team Accepted author version posted online: 01 Nov 2014.Published online: 17 Nov 2014.
To cite this article: Mehmet Ceyhan, Nezahat Gürler, Yasemin Ozsurekci, Melike Keser, Ahmet Emre Aycan, Venhar Gurbuz, Nuran Salman, Yildiz Camcioglu, Ener Cagri Dinleyici, Sengul Ozkan, Gulnar Sensoy, Nursen Belet, Emre Alhan, Mustafa Hacimustafaoglu, Solmaz Celebi, Hakan Uzun, Ahmet Faik Oner, Zafer Kurugol, Mehmet Ali Tas, Denizmen Aygun, Eda Karadag Oncel, Melda Celik, Olcay Yasa, Fatih Akin & Yavuz Coşkun (2014) Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005–2012 in Turkey, Human Vaccines & Immunotherapeutics, 10:9, 2706-2712, DOI: 10.4161/hv.29678
To link to this article: http://dx.doi.org/10.4161/hv.29678
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.
Downloaded by [McMaster University] at 11:27 06 February 2015
This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
RESEARCH PAPER Human Vaccines & Immunotherapeutics 10:9, 2706--2712; September 2014; © 2014 Taylor & Francis Group, LLC
Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005–2012 in Turkey A multicenter prospective surveillance study Mehmet Ceyhan1,y, Nezahat G€ urler2,y, Yasemin Ozsurekci1,y,*, Melike Keser3,y, Ahmet Emre Aycan1,y, Venhar Gurbuz1,y, 4,y Nuran Salman , Yildiz Camcioglu5,y, Ener Cagri Dinleyici6,y, Sengul Ozkan7,y, Gulnar Sensoy8, Nursen Belet8,y, Emre Alhan9, Mustafa Hacimustafaoglu10,y, Solmaz Celebi10,y, Hakan Uzun11,y, Ahmet Faik Oner12,y, Zafer Kurugol13,y, Mehmet Ali Tas14,y, Denizmen Aygun15,y, Eda Karadag Oncel1,y, Melda Celik1,y, Olcay Yasa16,y, Fatih Akin17,y, and Yavuz Co¸s kun18,y
Downloaded by [McMaster University] at 11:27 06 February 2015
1
Department of Pediatric Infectious Diseases; Hacettepe University Faculty of Medicine; Ankara, Turkey; 2Department of Microbiology and Clinical Microbiology; Istanbul University Faculty of Medicine; Istanbul, Turkey; 3Department of Pediatrics; Selcuk University Meram Faculty of Medicine; Konya, Turkey; 4Department of Pediatrics; Istanbul University Faculty of Medicine; Istanbul, Turkey; 5Department of Pediatrics; Istanbul University; Cerrahpasa Faculty of Medicine; Istanbul, Turkey; 6Department of Pediatrics; Osmangazi University Faculty of Medicine; Eskisehir, Turkey; 7Microbiology Laboratory; Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital; Ankara, Turkey; 8Department of Pediatric Infectious Diseases; Ondokuz Mayis University Faculty of Medicine; Samsun, Turkey; 9Department of Pediatrics, Cukurova University Faculty of Medicine; Adana, Turkey; 10Department of Pediatric Infectious Diseases; Uludag University Faculty of Medicine; Bursa, Turkey; 11Department of Pediatrics; Duzce University Faculty of Medicine; Duzce, Turkey; 12Department of Pediatrics; Yuzuncu Yil University Faculty of Medicine; Van, Turkeya; 13Department of Pediatric Infectious Diseases; Ege University Faculty of Medicine; Izmir, Turkey; 14Department of Pediatrics; Dicle University Faculty of Medicine; Diyarbakir, Turkey; 15Department of Pediatrics; Firat University Faculty of Medicine; Elazig, Turkey; 16Goztepe Research and Training Hospital; Department of Pediatrics; Istanbul, Turkey; 17Department of Pediatrics; Konya Training and Research Hospital; Konya, Turkey; 18 Gaziantep University; Faculty of Medicine; Department of Pediatrics; Gaziantep, Turkey y
Turkish Meningitis Surveillance Team
Keywords: Meningitis, Turkey, etiologic agents, N. meningitidis, S. pneumoniae, Hib, epidemiology, surveillance
Successful vaccination policies for protection from bacterial meningitis are dependent on determination of the etiology of bacterial meningitis. Cerebrospinal fluid (CSF) samples were obtained prospectively from children from 1 month to 18 years of age hospitalized with suspected meningitis, in order to determine the etiology of meningitis in Turkey. DNA evidence of Neisseria meningitidis (N. meningitidis), Streptococcus pneumoniae (S. pneumoniae), and Hemophilus influenzae type b (Hib) was detected using multiplex polymerase chain reaction (PCR). In total, 1452 CSF samples were evaluated and bacterial etiology was determined in 645 (44.4%) cases between 2005 and 2012; N. meningitidis was detected in 333 (51.6%), S. pneumoniae in 195 (30.2%), and Hib in 117 (18.1%) of the PCR positive samples. Of the 333 N. meningitidis positive samples 127 (38.1%) were identified as serogroup W-135, 87 (26.1%) serogroup B, 28 (8.4%) serogroup A and 3 (0.9%) serogroup Y; 88 (26.4%) were non-groupable. As vaccines against the most frequent bacterial isolates in this study are available and licensed, these results highlight the need for broad based protection against meningococcal disease in Turkey.
Introduction Acute bacterial meningitis is one of the most severe infectious diseases, not only causing physical and neurologic sequelae, but also continues to be an important cause of mortality.1,2 Although most disease occurs in infants and young children, high incidence may be observed in healthy older children and adolescents. Despite the continuing development of new antibacterial agents, bacterial meningitis fatality rates remain high, with reported rates between 2% and 30%.3,4 Furthermore, 10–20% of survivors suf-
fer permanent sequel, including epilepsy, mental retardation, or sensorineural deafness.5-7 In infants and children, before the introduction of modern vaccines, 90% of reported cases of acute bacterial meningitis were caused by Hemophilus influenzae type b (Hib), Streptococcus pneumoniae (S. pneumoniae), or Neisseria meningitidis (N. meningitidis).8,9 Hib meningitis primarily affects very young children, most cases occurring in children from 1 mo to 3 y of age.3,9 The introduction of highly effective Hib polysaccharide-protein conjugate vaccines has virtually eliminated invasive Hib disease in
*Correspondence to: Yasemin Ozsurekci; Email: [email protected] Submitted: 02/20/2014; Revised: 06/10/2014; Accepted: 06/21/2014 http://dx.doi.org/10.4161/hv.29678
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most industrialized countries where routine Hib vaccination has been implemented.8,9 In most countries, S. pneumoniae was the next major cause of childhood bacterial meningitis, particularly in those where Hib disease has been eliminated by vaccination.10 In some European and sub-Saharan African countries, it is the second most frequently reported cause of septic meningitis after meningococcal cases.4,10 The ongoing development and introduction into routine immunization schedules of glycoconjugate pneumococcal vaccines has markedly reduced the incidence of disease caused by vaccine serotypes, initially against the seven serotypes in the first vaccine, and now with coverage increasing from 10 or 13 serotypes in recent years. The success of these vaccines means N. meningitidis is now considered to be the leading cause of bacterial meningitis in many regions of the world, causing an estimated 1.2 million cases of bacterial meningitis and sepsis worldwide each year.11,12 There are 12 recognized serogroups of N.meningitidis, but the vast majority of invasive disease is related to six meningococcal serogroups: (Men) A, B, C, W-135, X and Y.13-15 The epidemiology and distribution of these disease-causing serogroups varies widely by geographic region: so while Men A is the most predominant disease-causing serogroup in sub-Saharan Africa and remains an important factor in parts of Asia, it now seldom if ever occurs in Western Europe or North America, where cases of Men A used to occur. In contrast, Men B and Men C dominate in the industrialized countries of North and South America,15,16 while the introduction of routine childhood vaccination with monovalent meningococcal serogroup C conjugate vaccines into Europe and Australia has markedly decreased incidence there. Serogroup W-135 has recently emerged in some parts of the world, primarily in the Middle East and Africa, in some instances causing large epidemics, and has been associated with small outbreaks in Europe due to pilgrims returning from Hajj.17 Men Y has been increasing in relative incidence over recent years in North America, South America and South Africa, and most recently, cases of Men X disease have emerged in sub-Saharan Africa. Men ACWY conjugate vaccines have been available for years but are not widely used. On the other hand, MenC conjugate vaccine has been widely used in Europe and MenA conjugate vaccine in sub-Saharan Africa through mass vaccination campaign and that their impact (MenA and MenC) has been dramatic in reducing meningitis due to the respective serotypes.15,17-19 Since 2002, in accordance with the Saudi Arabian requirements, all Turkish pilgrims to the Hajj in Mecca have received a quadrivalent meningococcal polysaccharide vaccine before travel. However, MenB and MenACWY conjugate vaccines are not yet routinely recommended for infants in Turkey. Hib vaccine was included in the Turkish immunization schedule and was administered as a separate injection in 2006 as DPTCOPVCHib. DTaP-IPV/Hib combined vaccine replaced them in 2008. The seven-valent pneumococcal conjugate vaccine (PCV-7) has been implemented into the Turkish national immunization schedule at ages 2, 4, 6, and 12 mo of age in 2008. This was replaced with the 13-valent vaccine (PCV-13) in 2011.
www.landesbioscience.com
As knowledge of the local epidemiology is necessary to support policymakers decision on the most appropriate vaccine to be used against bacterial meningitis, since 2005 we have been performing a nationwide hospital-based meningitis surveillance study across several regions of Turkey. We present here the results from 2005 to 2012.
Materials and Methods Study design This multicenter, hospital-based, prospective, epidemiological study was conducted in Turkey between February 2005 and December 2012 among children and adolescents younger than 18 y of age. The study was reviewed and approved by the Hacettepe University Institutional Ethics Committee. This ethical approval was sufficient for the other study sites as well. Patients with suspected meningitis were screened and hospitalized in 12 hospitals located in 7 regions of Turkey [Central Anatolia, Marmara, South East Anatolia, Aegean, East Anatolia, Mediterranean, and Black Sea] which provide healthcare services to approximately 32% of the Turkish population. After patients’ parents/legal guardians had given informed consent, specimens were collected for the diagnosis. Hospital pediatricians identified suspected cases of acute bacterial meningitis based on the following standard criteria: any sign of meningitis (fever [38 C], vomiting [3 episodes in 24 h], headache, signs of meningeal irritation [bulging fontanel, Kernig or Brudzinski signs, or neck stiffness]) in children >1 y of age; fever without any documented source; impaired consciousness (Blantyre Coma Scale
Human Vaccines & Immunotherapeutics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/khvi20
Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005–2012 in Turkey as
bs
as
cs
Mehmet Ceyhan , Nezahat Gürler , Yasemin Ozsurekci , Melike Keser , Ahmet Emre as
as
gs
h
ds
es
fs
Aycan , Venhar Gurbuz , Nuran Salman , Yildiz Camcioglu , Ener Cagri Dinleyici , Sengul hs
i
js
Ozkan , Gulnar Sensoy , Nursen Belet , Emre Alhan , Mustafa Hacimustafaoglu , Solmaz js
ks
ls
ms
ns
Celebi , Hakan Uzun , Ahmet Faik Oner , Zafer Kurugol , Mehmet Ali Tas , Denizmen os
as
as
ps
qs
rs
Aygun , Eda Karadag Oncel , Melda Celik , Olcay Yasa , Fatih Akin & Yavuz Coşkun a
Click for updates
Department of Pediatric Infectious Diseases; Hacettepe University Faculty of Medicine; Ankara, Turkey b
Department of Microbiology and Clinical Microbiology; Istanbul University Faculty of Medicine; Istanbul, Turkey c
Department of Pediatrics; Selcuk University Meram Faculty of Medicine; Konya, Turkey
d
Department of Pediatrics; Istanbul University Faculty of Medicine; Istanbul, Turkey
e
Department of Pediatrics; Istanbul University; Cerrahpasa Faculty of Medicine; Istanbul, Turkey f
Department of Pediatrics; Osmangazi University Faculty of Medicine; Eskisehir, Turkey
g
Microbiology Laboratory; Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital; Ankara, Turkey h
Department of Pediatric Infectious Diseases; Ondokuz Mayis University Faculty of Medicine; Samsun, Turkey i
Department of Pediatrics, Cukurova University Faculty of Medicine; Adana, Turkey
j
Department of Pediatric Infectious Diseases; Uludag University Faculty of Medicine; Bursa, Turkey k
Department of Pediatrics; Duzce University Faculty of Medicine; Duzce, Turkey
l
Department of Pediatrics; Yuzuncu Yil University Faculty of Medicine; Van, Turkeya
m
Department of Pediatric Infectious Diseases; Ege University Faculty of Medicine; Izmir, Turkey n
Department of Pediatrics; Dicle University Faculty of Medicine; Diyarbakir, Turkey
o
Department of Pediatrics; Firat University Faculty of Medicine; Elazig, Turkey
p
Goztepe Research and Training Hospital; Department of Pediatrics; Istanbul, Turkey
q
Department of Pediatrics; Konya Training and Research Hospital; Konya, Turkey
r
Gaziantep University; Faculty of Medicine; Department of Pediatrics; Gaziantep, Turkey
s
Turkish Meningitis Surveillance Team Accepted author version posted online: 01 Nov 2014.Published online: 17 Nov 2014.
To cite this article: Mehmet Ceyhan, Nezahat Gürler, Yasemin Ozsurekci, Melike Keser, Ahmet Emre Aycan, Venhar Gurbuz, Nuran Salman, Yildiz Camcioglu, Ener Cagri Dinleyici, Sengul Ozkan, Gulnar Sensoy, Nursen Belet, Emre Alhan, Mustafa Hacimustafaoglu, Solmaz Celebi, Hakan Uzun, Ahmet Faik Oner, Zafer Kurugol, Mehmet Ali Tas, Denizmen Aygun, Eda Karadag Oncel, Melda Celik, Olcay Yasa, Fatih Akin & Yavuz Coşkun (2014) Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005–2012 in Turkey, Human Vaccines & Immunotherapeutics, 10:9, 2706-2712, DOI: 10.4161/hv.29678
To link to this article: http://dx.doi.org/10.4161/hv.29678
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.
Downloaded by [McMaster University] at 11:27 06 February 2015
This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
RESEARCH PAPER Human Vaccines & Immunotherapeutics 10:9, 2706--2712; September 2014; © 2014 Taylor & Francis Group, LLC
Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005–2012 in Turkey A multicenter prospective surveillance study Mehmet Ceyhan1,y, Nezahat G€ urler2,y, Yasemin Ozsurekci1,y,*, Melike Keser3,y, Ahmet Emre Aycan1,y, Venhar Gurbuz1,y, 4,y Nuran Salman , Yildiz Camcioglu5,y, Ener Cagri Dinleyici6,y, Sengul Ozkan7,y, Gulnar Sensoy8, Nursen Belet8,y, Emre Alhan9, Mustafa Hacimustafaoglu10,y, Solmaz Celebi10,y, Hakan Uzun11,y, Ahmet Faik Oner12,y, Zafer Kurugol13,y, Mehmet Ali Tas14,y, Denizmen Aygun15,y, Eda Karadag Oncel1,y, Melda Celik1,y, Olcay Yasa16,y, Fatih Akin17,y, and Yavuz Co¸s kun18,y
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1
Department of Pediatric Infectious Diseases; Hacettepe University Faculty of Medicine; Ankara, Turkey; 2Department of Microbiology and Clinical Microbiology; Istanbul University Faculty of Medicine; Istanbul, Turkey; 3Department of Pediatrics; Selcuk University Meram Faculty of Medicine; Konya, Turkey; 4Department of Pediatrics; Istanbul University Faculty of Medicine; Istanbul, Turkey; 5Department of Pediatrics; Istanbul University; Cerrahpasa Faculty of Medicine; Istanbul, Turkey; 6Department of Pediatrics; Osmangazi University Faculty of Medicine; Eskisehir, Turkey; 7Microbiology Laboratory; Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital; Ankara, Turkey; 8Department of Pediatric Infectious Diseases; Ondokuz Mayis University Faculty of Medicine; Samsun, Turkey; 9Department of Pediatrics, Cukurova University Faculty of Medicine; Adana, Turkey; 10Department of Pediatric Infectious Diseases; Uludag University Faculty of Medicine; Bursa, Turkey; 11Department of Pediatrics; Duzce University Faculty of Medicine; Duzce, Turkey; 12Department of Pediatrics; Yuzuncu Yil University Faculty of Medicine; Van, Turkeya; 13Department of Pediatric Infectious Diseases; Ege University Faculty of Medicine; Izmir, Turkey; 14Department of Pediatrics; Dicle University Faculty of Medicine; Diyarbakir, Turkey; 15Department of Pediatrics; Firat University Faculty of Medicine; Elazig, Turkey; 16Goztepe Research and Training Hospital; Department of Pediatrics; Istanbul, Turkey; 17Department of Pediatrics; Konya Training and Research Hospital; Konya, Turkey; 18 Gaziantep University; Faculty of Medicine; Department of Pediatrics; Gaziantep, Turkey y
Turkish Meningitis Surveillance Team
Keywords: Meningitis, Turkey, etiologic agents, N. meningitidis, S. pneumoniae, Hib, epidemiology, surveillance
Successful vaccination policies for protection from bacterial meningitis are dependent on determination of the etiology of bacterial meningitis. Cerebrospinal fluid (CSF) samples were obtained prospectively from children from 1 month to 18 years of age hospitalized with suspected meningitis, in order to determine the etiology of meningitis in Turkey. DNA evidence of Neisseria meningitidis (N. meningitidis), Streptococcus pneumoniae (S. pneumoniae), and Hemophilus influenzae type b (Hib) was detected using multiplex polymerase chain reaction (PCR). In total, 1452 CSF samples were evaluated and bacterial etiology was determined in 645 (44.4%) cases between 2005 and 2012; N. meningitidis was detected in 333 (51.6%), S. pneumoniae in 195 (30.2%), and Hib in 117 (18.1%) of the PCR positive samples. Of the 333 N. meningitidis positive samples 127 (38.1%) were identified as serogroup W-135, 87 (26.1%) serogroup B, 28 (8.4%) serogroup A and 3 (0.9%) serogroup Y; 88 (26.4%) were non-groupable. As vaccines against the most frequent bacterial isolates in this study are available and licensed, these results highlight the need for broad based protection against meningococcal disease in Turkey.
Introduction Acute bacterial meningitis is one of the most severe infectious diseases, not only causing physical and neurologic sequelae, but also continues to be an important cause of mortality.1,2 Although most disease occurs in infants and young children, high incidence may be observed in healthy older children and adolescents. Despite the continuing development of new antibacterial agents, bacterial meningitis fatality rates remain high, with reported rates between 2% and 30%.3,4 Furthermore, 10–20% of survivors suf-
fer permanent sequel, including epilepsy, mental retardation, or sensorineural deafness.5-7 In infants and children, before the introduction of modern vaccines, 90% of reported cases of acute bacterial meningitis were caused by Hemophilus influenzae type b (Hib), Streptococcus pneumoniae (S. pneumoniae), or Neisseria meningitidis (N. meningitidis).8,9 Hib meningitis primarily affects very young children, most cases occurring in children from 1 mo to 3 y of age.3,9 The introduction of highly effective Hib polysaccharide-protein conjugate vaccines has virtually eliminated invasive Hib disease in
*Correspondence to: Yasemin Ozsurekci; Email: [email protected] Submitted: 02/20/2014; Revised: 06/10/2014; Accepted: 06/21/2014 http://dx.doi.org/10.4161/hv.29678
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most industrialized countries where routine Hib vaccination has been implemented.8,9 In most countries, S. pneumoniae was the next major cause of childhood bacterial meningitis, particularly in those where Hib disease has been eliminated by vaccination.10 In some European and sub-Saharan African countries, it is the second most frequently reported cause of septic meningitis after meningococcal cases.4,10 The ongoing development and introduction into routine immunization schedules of glycoconjugate pneumococcal vaccines has markedly reduced the incidence of disease caused by vaccine serotypes, initially against the seven serotypes in the first vaccine, and now with coverage increasing from 10 or 13 serotypes in recent years. The success of these vaccines means N. meningitidis is now considered to be the leading cause of bacterial meningitis in many regions of the world, causing an estimated 1.2 million cases of bacterial meningitis and sepsis worldwide each year.11,12 There are 12 recognized serogroups of N.meningitidis, but the vast majority of invasive disease is related to six meningococcal serogroups: (Men) A, B, C, W-135, X and Y.13-15 The epidemiology and distribution of these disease-causing serogroups varies widely by geographic region: so while Men A is the most predominant disease-causing serogroup in sub-Saharan Africa and remains an important factor in parts of Asia, it now seldom if ever occurs in Western Europe or North America, where cases of Men A used to occur. In contrast, Men B and Men C dominate in the industrialized countries of North and South America,15,16 while the introduction of routine childhood vaccination with monovalent meningococcal serogroup C conjugate vaccines into Europe and Australia has markedly decreased incidence there. Serogroup W-135 has recently emerged in some parts of the world, primarily in the Middle East and Africa, in some instances causing large epidemics, and has been associated with small outbreaks in Europe due to pilgrims returning from Hajj.17 Men Y has been increasing in relative incidence over recent years in North America, South America and South Africa, and most recently, cases of Men X disease have emerged in sub-Saharan Africa. Men ACWY conjugate vaccines have been available for years but are not widely used. On the other hand, MenC conjugate vaccine has been widely used in Europe and MenA conjugate vaccine in sub-Saharan Africa through mass vaccination campaign and that their impact (MenA and MenC) has been dramatic in reducing meningitis due to the respective serotypes.15,17-19 Since 2002, in accordance with the Saudi Arabian requirements, all Turkish pilgrims to the Hajj in Mecca have received a quadrivalent meningococcal polysaccharide vaccine before travel. However, MenB and MenACWY conjugate vaccines are not yet routinely recommended for infants in Turkey. Hib vaccine was included in the Turkish immunization schedule and was administered as a separate injection in 2006 as DPTCOPVCHib. DTaP-IPV/Hib combined vaccine replaced them in 2008. The seven-valent pneumococcal conjugate vaccine (PCV-7) has been implemented into the Turkish national immunization schedule at ages 2, 4, 6, and 12 mo of age in 2008. This was replaced with the 13-valent vaccine (PCV-13) in 2011.
www.landesbioscience.com
As knowledge of the local epidemiology is necessary to support policymakers decision on the most appropriate vaccine to be used against bacterial meningitis, since 2005 we have been performing a nationwide hospital-based meningitis surveillance study across several regions of Turkey. We present here the results from 2005 to 2012.
Materials and Methods Study design This multicenter, hospital-based, prospective, epidemiological study was conducted in Turkey between February 2005 and December 2012 among children and adolescents younger than 18 y of age. The study was reviewed and approved by the Hacettepe University Institutional Ethics Committee. This ethical approval was sufficient for the other study sites as well. Patients with suspected meningitis were screened and hospitalized in 12 hospitals located in 7 regions of Turkey [Central Anatolia, Marmara, South East Anatolia, Aegean, East Anatolia, Mediterranean, and Black Sea] which provide healthcare services to approximately 32% of the Turkish population. After patients’ parents/legal guardians had given informed consent, specimens were collected for the diagnosis. Hospital pediatricians identified suspected cases of acute bacterial meningitis based on the following standard criteria: any sign of meningitis (fever [38 C], vomiting [3 episodes in 24 h], headache, signs of meningeal irritation [bulging fontanel, Kernig or Brudzinski signs, or neck stiffness]) in children >1 y of age; fever without any documented source; impaired consciousness (Blantyre Coma Scale
