Pneumococcal meningitis among hospitalised children after introduction of pneumococcal conjugate vaccine in India: a sentinel hospital surveillance (2019-2022).
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Chethrapilly Purushothaman Girish Kumar, Rajkumar Prabu, Kangusamy Boopathi, Gupta Swati, George Leyanna Susan, Varghese Rosemol, Varadarajan Poovazhagi, Sundaram Balasubramanian, Sathenahalli Veeraraja Basavanthappa, Sreenivasan Priya, Guduru Vijay Kumar, Malik Shikha, Vyas Bhadresh R, Turbadkar Dilip, Sharma Milap, Saini Ghanshyam, Mehta Nirbhay, Baghel Bhagat, Chaudhary Anil Kumar, Bhat Nowneet Kumar, Singh Narender Pal, Singh Kuldeep, Parmar Aparna, Guglani Vishal, Sharma Rakesh, Srivastava Anubha, Garg Amit, Tiwari Anil Kumar, Raza Adil, Kumar Ashok, Nath Reema, Sharma Ajanta, Ghosh Purbasha, Datta Kalpana, Samanta Sandip, Sarkar Arunabha, Radhakrishnan Devasena, Bai Sulochana Putli, Jagannatha Bhavana, Rajahamsan Jyothi, Vadlamanu Usha Rani, Kumar Amber, Randive Mrudul, Chand Jaryal Subhash, Mehta Krunal, Mutha Anita, Majumdar Devjyothi, Kumar Manoj, Kumar Vinod, Kaur Harleen, Batra Prerna, Kumar Prawin, Mittal Kundan, Gupta Varsha, Sood Mangla, Bora Prapti, Dutta Bornali Sarmah, Sarkar Mihir, Bose Somesuvra, Srinivasan Pavithra, Rajan Benisha, Neeravi Ayyanraj, Varun Chakrakodi N, Chakraborty Anurupa, Gupta Manohar Lal, Radera Shruti, Deb Alok Kumar, Kanungo Suman, Mukhopadhyay Asish Kumar, Belludi Ashwin, Malhotra Bharti, Jain Amita, Nanduri Srinivas Acharya, Velusamy Srinivasan, Luvsansharav Ulzii Orshikh, McGee Lesley, Verani Jennifer R, Jayaraman Yuvaraj, Veeraraghavan Balaji, Murhekar Manoj, Gupta Nivedita, ICMR Meningitis Surveillance Group
Аннотация
METHODS: Children (1-59 months) who were hospitalised with suspected meningitis at 32 hospitals across 19 states of India were enrolled in this hospital-based surveillance from 2019 to 2022. Clinical and demographic data were collected. Cerebrospinal fluid (CSF) samples were tested for Streptococcus pneumoniae using real-time PCR. Serotypes were identified using real-time PCR in TaqMan Array Cards. Cases were categorised based on PCV implementation in their district of residence on their admission date as pre-PCV (before rollout of PCV10-SII/PCV13), early-PCV (<1 year since rollout), or post-PCV (≥1 year since rollout) group.
FINDINGS: Among 12,971 children enrolled, 303 (2.3%) had pneumococcal meningitis; 65.3% were between 1 and 11 months of age, and 60.1% were males. Among 260 children with outcome data, 93.1% recovered, while 6.9% died during hospitalisation. The proportion of children with pneumococcal meningitis decreased from 3.5% pre-PCV to 1.8% during both early- and post-PCV periods. Among serotyped pneumococcal meningitis, the proportion of PCV10-SII serotypes was 41.4% in pre-PCV, 33.3% early-PCV, and 25.9% post-PCV periods. The most common PCV10-SII serotypes were 5, 14, and 6B whereas non-PCV10-SII serotypes were 18C/18B, 8, and 10F.
INTERPRETATION: Decline in the proportion of PCV10-SII serotype among paediatric pneumococcal meningitis patients represents preliminary signals of PCV impact in India. These findings provide programmatically relevant evidence to inform ongoing evaluation of PCV implementation. Continued surveillance is essential to monitor serotype distribution and pneumococcal meningitis patterns over time.
FUNDING: Gates Foundation (OPP1188408) and the United Nations Development Programme (00101970).