Poster Presentation Lancefield International Symposium for Streptococci and Streptococcal Diseases 2025

  Impact of Pneumococcal conjugate vaccine (PCV10) on meningitis in Nepalese children.     (#112)

Bhishma Pokhrel 1 , Meeru Gurung 1 , Ruby Basi 1 , Sanjeev Bijukchhe 1 2 , Puja Amatya 1 , Rusy Shrestha 1 , Michael J Carter 2 , Stephen Thorson 1 , Sarah Kelly 2 , Merryn Voysey 2 , Maria Knoll 3 , Dominic Kelly 2 4 , David Murdoch 5 , Andrew Pollard 2 4 , Shrijana Shrestha 1
  1. Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
  2. Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
  3. International Vaccine Access Centre, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
  5. Department of Pathology and Biomedical Sciences, University of Otago, Christchurch, New Zealand

Introduction:

Pneumococcus is a leading cause of invasive bacterial diseases (IBD), such as meningitis, in children. We evaluated the effect of routine infant immunization with PCV10, introduced in 2015, on meningitis cases among children hospitalized at Patan Hospital, Nepal.

Methodology:

Children aged 30 days to 14 years admitted between 2005 and 2023 with suspected IBD at Patan Hospital were included. CSF specimens from suspected meningitis cases were cultured, and samples with >5 white cells/cm³ were tested for S. pneumoniae using the BINAX test. Pneumococcal serotyping was performed using the Quellung method. Bacterial meningitis was defined as >100 white cells/cm³ or detection of any bacterial pathogen in CSF among cases diagnosed with meningitis at hospital discharge.

Results:

Between 2005 and 2023, 5614 CSF specimens were collected, with 58 tested positive for S. pneumoniae. Among these, 19 were culture-positive, all from the pre-vaccine period. The rest were diagnosed by BINAX. The most common serotypes were 1, 23F, 9V, and 12A.

CSF was collected from 3684 children pre-vaccine (2005–2015) and from1930 children post-vaccine (2016–2023). Of these, 734/3684 (20%) and 300/1930 (15.5%), respectively, had meningitis as discharge diagnosis (p<0.001).

Detection of CSF white cells >100/cm³ decreased from 334/3684 (9.0%) pre-vaccine to 113/1930 (5.8%) post-vaccine (p<0.001). S. pneumoniae was detected in 43/734 (5.8%) meningitis cases pre-vaccine compared with 15/300 (5.0%) post-vaccine (p=0.586).

Conclusion:

Despite a significant decline in overall bacterial meningitis, pneumococcal meningitis reduction is not significant. We could not exclude socioeconomic/health trends.