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The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012

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ABSTRACT

Introduction: Meningitis is a major cause of mortality in southern Africa. We aimed to describe the aetiologies and frequencies of laboratory-confirmed fungal and bacterial meningitis among adults in a South African province with an 11% HIV prevalence, over 4 years.

Methods: We conducted a retrospective, observational study of secondary laboratory data, extracted on all cerebrospinal fluid (CSF) specimens submitted to public-sector laboratories in Gauteng province from 2009 through 2012. We calculated cause-specific incidence rates in the general and HIV-infected populations and used Poisson regression to determine if trends were significant.

Results: We identified 11,891 (10.7%) incident cases of meningitis from 110,885 CSF specimens. Cryptococcal meningitis, tuberculous meningitis and pneumococcal meningitis accounted for 62.3% (n = 7,406), 24.6% (n = 2,928) and 10.1% (n = 1,197) of cases over the four-year period. The overall incidence (cases per 100,000 persons) of cryptococcal meningitis declined by 23% from 24.4 in 2009 to 18.7 in 2012 (p <0.001) and decreased by 19% among HIV-infected persons from 178.2 to 144.7 (p <0.001). Tuberculous meningitis decreased by 40% from 11.3 in 2009 to 6.8 in 2012 (p <0.001) and decreased by 36% among HIV-infected persons from 54.4 to 34.9 (p <0.001). Pneumococcal meningitis decreased by 41% from 4.2 in 2009 to 2.5 in 2012 (p <0.001) and decreased by 38% among HIV-infected persons from 28.0 to 17.5 (p <0.001). Among cases of other bacterial meningitis (248/11,891, 2.1%), Neisseria meningitidis (n = 93), Escherichia coli (n = 72) and Haemophilus influenzae (n = 20) were the most common organisms identified.

Conclusions: In this high HIV-prevalence province, cryptococcal meningitis was the leading cause of laboratory-confirmed meningitis among adults. Over a 4-year period, there was a significant decrease in incidence of cryptococcal, tuberculous and pneumococcal meningitis. This coincided with expansion of the national antiretroviral treatment programme, enhanced tuberculosis control programme and routine childhood immunisation with pneumococcal conjugate vaccines.

No MeSH data available.


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Population incidence of cryptococcal, tuberculous and pneumococcal meningitis among adults in Gauteng province, South Africa, showing key treatment interventions, 2009–2012 (n = 11,531).PCV-7 = seven-valent pneumococcal conjugate vaccine introduction. PCV-13 = thirteen-valent pneumococcal conjugate vaccine introduction. GeneXpert = GeneXpert MTB/Rif assay introduction. CrAg screening = introduction of cryptococcal antigen screening and treatment intervention.
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pone.0163036.g004: Population incidence of cryptococcal, tuberculous and pneumococcal meningitis among adults in Gauteng province, South Africa, showing key treatment interventions, 2009–2012 (n = 11,531).PCV-7 = seven-valent pneumococcal conjugate vaccine introduction. PCV-13 = thirteen-valent pneumococcal conjugate vaccine introduction. GeneXpert = GeneXpert MTB/Rif assay introduction. CrAg screening = introduction of cryptococcal antigen screening and treatment intervention.

Mentions: Significant reductions in the incidence of the three major aetiologies of meningitis were observed from 2009 through 2012 (Fig 4). The incidence of cryptococcal meningitis per 100,000 adults decreased by 23% from 24.4 cases in 2009 to 18.7 cases in 2012 (p <0.001). The incidence of tuberculous meningitis decreased by 40% from 11.3 cases in 2009 to 6.8 cases in 2012 (p <0.001). The incidence of pneumococcal meningitis decreased by 41% from 4.2 cases in 2009 to 2.5 cases in 2012 (p <0.001).


The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012
Population incidence of cryptococcal, tuberculous and pneumococcal meningitis among adults in Gauteng province, South Africa, showing key treatment interventions, 2009–2012 (n = 11,531).PCV-7 = seven-valent pneumococcal conjugate vaccine introduction. PCV-13 = thirteen-valent pneumococcal conjugate vaccine introduction. GeneXpert = GeneXpert MTB/Rif assay introduction. CrAg screening = introduction of cryptococcal antigen screening and treatment intervention.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036788&req=5

pone.0163036.g004: Population incidence of cryptococcal, tuberculous and pneumococcal meningitis among adults in Gauteng province, South Africa, showing key treatment interventions, 2009–2012 (n = 11,531).PCV-7 = seven-valent pneumococcal conjugate vaccine introduction. PCV-13 = thirteen-valent pneumococcal conjugate vaccine introduction. GeneXpert = GeneXpert MTB/Rif assay introduction. CrAg screening = introduction of cryptococcal antigen screening and treatment intervention.
Mentions: Significant reductions in the incidence of the three major aetiologies of meningitis were observed from 2009 through 2012 (Fig 4). The incidence of cryptococcal meningitis per 100,000 adults decreased by 23% from 24.4 cases in 2009 to 18.7 cases in 2012 (p <0.001). The incidence of tuberculous meningitis decreased by 40% from 11.3 cases in 2009 to 6.8 cases in 2012 (p <0.001). The incidence of pneumococcal meningitis decreased by 41% from 4.2 cases in 2009 to 2.5 cases in 2012 (p <0.001).

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Meningitis is a major cause of mortality in southern Africa. We aimed to describe the aetiologies and frequencies of laboratory-confirmed fungal and bacterial meningitis among adults in a South African province with an 11% HIV prevalence, over 4 years.

Methods: We conducted a retrospective, observational study of secondary laboratory data, extracted on all cerebrospinal fluid (CSF) specimens submitted to public-sector laboratories in Gauteng province from 2009 through 2012. We calculated cause-specific incidence rates in the general and HIV-infected populations and used Poisson regression to determine if trends were significant.

Results: We identified 11,891 (10.7%) incident cases of meningitis from 110,885 CSF specimens. Cryptococcal meningitis, tuberculous meningitis and pneumococcal meningitis accounted for 62.3% (n = 7,406), 24.6% (n = 2,928) and 10.1% (n = 1,197) of cases over the four-year period. The overall incidence (cases per 100,000 persons) of cryptococcal meningitis declined by 23% from 24.4 in 2009 to 18.7 in 2012 (p &lt;0.001) and decreased by 19% among HIV-infected persons from 178.2 to 144.7 (p &lt;0.001). Tuberculous meningitis decreased by 40% from 11.3 in 2009 to 6.8 in 2012 (p &lt;0.001) and decreased by 36% among HIV-infected persons from 54.4 to 34.9 (p &lt;0.001). Pneumococcal meningitis decreased by 41% from 4.2 in 2009 to 2.5 in 2012 (p &lt;0.001) and decreased by 38% among HIV-infected persons from 28.0 to 17.5 (p &lt;0.001). Among cases of other bacterial meningitis (248/11,891, 2.1%), Neisseria meningitidis (n = 93), Escherichia coli (n = 72) and Haemophilus influenzae (n = 20) were the most common organisms identified.

Conclusions: In this high HIV-prevalence province, cryptococcal meningitis was the leading cause of laboratory-confirmed meningitis among adults. Over a 4-year period, there was a significant decrease in incidence of cryptococcal, tuberculous and pneumococcal meningitis. This coincided with expansion of the national antiretroviral treatment programme, enhanced tuberculosis control programme and routine childhood immunisation with pneumococcal conjugate vaccines.

No MeSH data available.


Related in: MedlinePlus