The Changing Landscape of Epidemic Bacterial Meningitis in Africa: New Opportunities for Prevention

Reports of epidemic meningitis in Africa typically lead one to imagine explosive outbreaks of meningococcal meningitis. Discussions of invasive pneumococcal disease generally bring to mind cases of sporadic infection that primarily involve the very young the elderly and the immunocompromised. Reported pneumococcal disease outbreaks mostly have occurred in institutional settings or in closed communities rather than in the general population. Against the background of these presuppositions Leimkugel et al. in this issue of the Journal of Infectious Diseases provide an important description of progressively larger annual epidemics of meningitis caused by Streptococcus pneumoniae that occurred throughout the Kassena- Nankana District of northern Ghana from 2000 to 2003. Disease occurred in a highly seasonal pattern with cases occurring primarily during the dry seasons of each year. The annual outbreaks of S. pneumoniae meningitis occurred concurrently with the annual epidemics of Neisseria meningitidis meningitis that are characteristic of the African meningitis belt in sub-Saharan Africa. One intriguing characteristic of these annual outbreaks was that the majority of cases were caused by a single clonal complex of serotype 1 S. pneumoniae. (excerpt)