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The Epidemiology of Haemophilus influenzae Type b Meningitis in Burkina Faso

Yaro, Seydou MD*; Lourd, Mathilde MPH; Naccro, B MD; Njanpop-Lafourcade, Berthe-Marie PhD; Hien, Alain PharmD; Ouedraogo, Macaire S. MD; Traore, Yves PhD§; Schouls, Leo M. PhD; du Châtelet, Isabelle Parent MD; Gessner, Bradford D. MDfor the Clinical Groupfor the Laboratory Group

The Pediatric Infectious Disease Journal: May 2006 - Volume 25 - Issue 5 - p 415-419
doi: 10.1097/01.inf.0000217371.38080.8a
Original Studies

Background: Haemophilus influenzae type b (Hib) disease burden studies are important to conduct in African countries that plan to introduce vaccine so that vaccine impact can be documented.

Methods: We implemented population-based meningitis surveillance in 3 districts of Burkina Faso for 12 months each during 2002–2003 and 2004–2005 using polymerase chain reaction, culture and antigen detection.

Results: Lumbar puncture was performed on 1686 patients and 112 had Hib identified. Persons <1, <5, 5–14 and 15+ years of age had annual Hib meningitis incidences of 97, 34, 2.1 and 0.55 per 100,000, respectively; overall case fatality proportion was 25%. During the historic meningitis epidemic season months of December through April, the proportion of purulent cerebrospinal fluid among children aged <5 years that yielded Hib was 27% compared with 30% during other months. Twenty-five of 98 persons with information available were treated with only one or 2 doses of oily chloramphenicol. Among children age <5 years with Hib meningitis, 28% were pretreated with antimalarials and antimalarial pretreatment was associated with delay in hospitalization.

Conclusions: In Burkina Faso, Hib meningitis incidence and case fatality proportion are high and thus vaccine could have a substantial impact. While awaiting well-implemented routine infant Hib vaccination, empiric case management for pediatric meningitis in sub-Saharan Africa must recognize that Hib is likely even during the epidemic season. In malaria-endemic areas, pediatric Hib meningitis case management may be adversely affected by the similar presentation of these 2 diseases.

From *Centre Muraz, Bobo-Dioulasso, Burkina Faso; the †Association pour l'Aide à la Médecine Préventive, Paris, France; the ‡Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso; §Université de Ouagadougou, Ouagadougou, Burkina Faso; and the ∥Laboratory for Vaccine-Preventable Diseases, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.

Accepted for publication January 18, 2006.

The Clinical Group: Adrien Sawadogo, Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso; Pascal Korgho, Flore Ouedraogo, and Francine Ouedraogo, Direction Régionale de la Santé, Ministère de la Santé, Bobo-Dioulasso, Burkina Faso. The Laboratory Group: Sanou Oumarou, Association pour l'Aide à la Médecine Préventive, Paris, France; Dominique Niamba, Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso; Ali Drabo, Centre Muraz, Bobo-Dioulasso, Burkina Faso; Lansina Sangare, Université de Ouagadougou, Ouagadougou, Burkina Faso; and Francis Hien, Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso.

Financial support for this study provided by Sanofi-Pasteur, Institut Pasteur, and the Bill and Melinda Gates Foundation.

Address for correspondence: Bradford D. Gessner, MD, Association Pour l'Aide à la Médecine Préventive, Institut Pasteur, 28 rue du Docteur Roux, 75015, Paris, France; E-mail

© 2006 Lippincott Williams & Wilkins, Inc.