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15 July 2005

Volume 192, Number 2
The Journal of Infectious Diseases 2005;192:192–199
© 2005 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2005/19202-0002$15.00
DOI: 10.1086/431151
MAJOR ARTICLE

An Outbreak of Serotype 1 Streptococcus pneumoniae Meningitis in Northern Ghana with Features That Are Characteristic of Neisseria meningitidis Meningitis Epidemics

Julia Leimkugel,1

Abudulai Adams Forgor,2

Sébastien Gagneux,1,a

Valentin Pflüger,1

Christian Flierl,1

Elizabeth Awine,2

Martin Naegeli,1

Jean‐Pierre Dangy,1

Tom Smith,1

Abraham Hodgson,2 and

Gerd Pluschke1

1Swiss Tropical Institute, Basel, Switzerland; 2Navrongo Health Research Centre, Ministry of Health, Navrongo, Ghana

Background.The Kassena‐Nankana District (KND) of northern Ghana lies in the African meningitis belt, where epidemics of bacterial meningitis have been reoccurring every 8–12 years. These epidemics are generally caused by Neisseria meningitidis, an organism that is considered to be uniquely capable of causing meningitis epidemics.

Methods.We recruited all patients with suspected meningitis in the KND between 1998 and 2003. Cerebrospinal fluid samples were collected and analyzed by standard microbiological techniques. Bacterial isolates were subjected to serotyping, multilocus sequence typing (MLST), and antibiotic‐resistance testing.

Results.A continual increase in the incidence of pneumococcal meningitis was observed from 2000 to 2003. This outbreak exhibited strong seasonality, a broad host age range, and clonal dominance, all of which are characteristic of meningococcal meningitis epidemics in the African meningitis belt. The case‐fatality rate for pneumococcal meningitis was 44.4%; the majority of pneumococcal isolates were antibiotic sensitive and expressed the serotype 1 capsule. MLST revealed that these isolates belonged to a clonal complex dominated by sequence type (ST) 217 and its 2 single‐locus variants, ST303 and ST612.

Conclusions.The S. pneumoniae ST217 clonal complex represents a hypervirulent lineage with a high propensity to cause meningitis, and our results suggest that this lineage might have the potential to cause an epidemic. Serotype 1 is not included in the currently licensed pediatric heptavalent pneumococcal vaccine. Mass vaccination with a less complex conjugate vaccine that targets hypervirulent serotypes should, therefore, be considered.

Received 2 November 2004; accepted 16 February 2005; electronically published 10 June 2005.

Reprints or correspondence: Dr. Gerd Pluschke, Dept. of Molecular Immunology, Swiss Tropical Institute, Socinstr. 57, Basel 4002, Switzerland ().

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  • Financial support: Meningitis Research Foundation (grant 03/01).

  • Present affiliation: Division of Infectious Diseases and Geographic Medicine, Stanford University Medical Center, Stanford, California.

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