Trends in Neisseria meningitidis Serogroups Amongst Suspected Cerebrospinal Meningitis Patients in the Meningitis Belt of Ghana- A Five-Year Retrospective Study

Abstract

Background: Neisseria meningitidis is classified based on its surface polysaccharide capsule’s antigenicity into thirteen (13) serogroups. More than 90% of the globally invasive meningococcal infections were caused by serogroups, A, B and C. Serogroup A was the major cause of meningococcal meningitis epidemics in the African meningitis belt prior 2010 when a monovalent meningococcal A conjugate vaccine (MenAfriVac) was introduced in the region. Purpose: This paper aimed to examine a five-year trend of Neisseria meningitidis serogroups in the meningitis belt of Ghana. Methodology: PCR confirmed laboratory results of all suspected cases of cerebrospinal meningitis (CSM) from 2016 to 2020 were obtained from the Tamale Public Health Laboratory and the data were subjected to trend analysis using SPSS Results: Out of the 395 confirmed Neisseria meningitidis cases, 71.4% and 24.6% were serogroups Wand X, respectively. Serogroups; B, C and the NG accounted for 0.5%, 0.5% and 3%, respectively. There is a significant upward trend of serogroup X (p=0.01) and downward trend of the serogroup W (p=0.01) and serogroup C (p=0.05). The serogroups B and C are also showing a downward trend, and the NG serogroups are in the upward trajectory. However, the serogroups; B, and NG yearly are insignificant (with p-values; 0.78, and 0.21, respectively). Conclusion: There has been the emergence of serogroup X, a non-vaccine type Neisseria meningitidis serogroup, as the predominant Neisseria meningitidis serogroup, and is on the upward trajectory since 2016 in the wake of a declining serogroup W after the introduction of the meningococcal polysaccharide ACW vaccine following the outbreak of serogroup W in the Upper West region in 2016. Keywords: Neisseria meningitidis, Serogroups, Real-Time Polymerase Chain Reaction (rt-PCR), Meningitis Belt, Meningococcal, Tamale Public Health Laboratory, Cerebrospinal meningitis (CSM).