{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T23:34:49Z","timestamp":1783985689332,"version":"3.55.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2024,9,25]],"date-time":"2024-09-25T00:00:00Z","timestamp":1727222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1208882"],"award-info":[{"award-number":["OPP1208882"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Bacterial meningitis is a major cause of death, with an approximate case fatality rate of 37% across all age groups in South Africa. This study aimed to describe the demographic and pathogen characteristics of incident meningitis in children aged &lt;1 year in South Africa from 2014 through 2018, during a period when <jats:italic>Haemophilus influenzae type b<\/jats:italic> vaccine and pneumococcal conjugate vaccines (PCV) were both included in the expanded program on immunization (EPI).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a cohort study of routine laboratory data in the National Health Laboratory Service Corporate Data Warehouse, which covers approximately 80% of the South African population. We defined a case of laboratory-confirmed bacterial meningitis as any person aged &lt;1 year with meningitis diagnosed by culture and identification of a pathogen documented as being a common cause of meningitis in CSF. The cause-specific incidence risks were calculated by dividing the number of positive specimens in each age group and year by the corresponding mid-year population for children under 1 year old and those in the post-neonatal period (\u2265 28 days to 365 days old). For children under 28 days old, the annual numbers of registered livebirths were used. We used Poisson regression to compare the incidence of meningitis by year.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We identified 3575 (1.5%) cases of culture-confirmed bacterial meningitis from the 232,016 cerebrospinal fluid (CSF) specimens tested from 2014\u20132018. The highest number of cases were recorded in children aged &lt;28 days (1873, 52.4%), male children (1800, 50.4%) as well as in the Gauteng Province (2014, 56.3%). <jats:italic>Acinetobacter baumannii<\/jats:italic> (14.9%), <jats:italic>followed<\/jats:italic> by <jats:italic>Klebsiella pneumoniae<\/jats:italic> (13.5%), <jats:italic>and<\/jats:italic> group B streptococcus (GBS) (10.7%), were the most common pathogens detected. Overall, <jats:italic>A<\/jats:italic>. <jats:italic>baumannii<\/jats:italic> had the highest incidence risk, occurring at 9.8 per 100,000 persons in children aged &lt;1 year in 2018. Among neonates, <jats:italic>A<\/jats:italic>. <jats:italic>baumannii<\/jats:italic> peaked at 14.9 per 100,000 livebirths in 2018, while <jats:italic>Streptococcus pneumoniae<\/jats:italic> was most common in the post-neonatal period (\u2265 28 days to 365 days old), peaking at 9.8 per 100,000 persons in 2014. There was an increase in the annual incidence of most pathogens over the study period.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>There was an increasing trend in the annual incidence of bacterial meningitis in infants caused by most pathogens, particularly <jats:italic>A<\/jats:italic>. <jats:italic>baumannii<\/jats:italic>, <jats:italic>K<\/jats:italic>. <jats:italic>pneumoniae<\/jats:italic> and GBS. In addition to increased uptake of vaccination, prevention measures to reduce nosocomial and mother-to-child transmission of bacteria could include antenatal screening for GBS in pregnant women, rigorous hygiene in the hospital environment as well as rational antibiotic use.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0310528","type":"journal-article","created":{"date-parts":[[2024,9,25]],"date-time":"2024-09-25T19:26:38Z","timestamp":1727292398000},"page":"e0310528","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Demographic and pathogen characteristics of incident bacterial meningitis in infants in South Africa: A cohort study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7175-6409","authenticated-orcid":true,"given":"Yannick Nkiambi","family":"Kiakuvue","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumaya","family":"Mall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7869-9462","authenticated-orcid":true,"given":"Nelesh","family":"Govender","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne von","family":"Gottberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudzani","family":"Mashau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Meiring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0376-2302","authenticated-orcid":true,"given":"Cheryl","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,9,25]]},"reference":[{"issue":"7634","key":"pone.0310528.ref001","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1136\/bmj.39409.673657.AE","article-title":"Viral meningitis.","volume":"336","author":"SAE Logan","year":"2008","journal-title":"Bmj"},{"issue":"5","key":"pone.0310528.ref002","first-page":"314","article-title":"Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention.","volume":"96","author":"HR Mount","year":"2017","journal-title":"Am Fam Physician."},{"issue":"4","key":"pone.0310528.ref003","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/S0891-5520(20)30369-X","article-title":"Bacterial meningitis in neonates and children.","volume":"4","author":"X S\u00e1ez-Llorens","year":"1990","journal-title":"Infect Dis Clin North Am."},{"issue":"9375","key":"pone.0310528.ref004","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.1016\/S0140-6736(03)13693-8","article-title":"Bacterial meningitis in children","volume":"361","author":"X S\u00e1ez-Llorens","year":"2003","journal-title":"Lancet"},{"issue":"6","key":"pone.0310528.ref005","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1111\/j.1365-3156.2011.02750.x","article-title":"Systematic review: Neonatal meningitis in the developing world","volume":"16","author":"JS Furyk","year":"2011","journal-title":"Tropical Medicine and International Health"},{"key":"pone.0310528.ref006","article-title":"Global, regional, and national burden of meningitis and its aetiologies, 1990\u20132019: a systematic analysis for the","author":"F Bill","year":"2019","journal-title":"Global Burden of Disease Study 2019"},{"issue":"12","key":"pone.0310528.ref007","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/S1474-4422(18)30387-9","article-title":"Global, regional, and national burden of meningitis, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"17","author":"JR Zunt","year":"2018","journal-title":"Lancet Neurol"},{"issue":"OCT","key":"pone.0310528.ref008","first-page":"1","article-title":"Neurological complications in young infants with acute bacterial meningitis.","volume":"9","author":"MH Hsu","year":"2018","journal-title":"Front Neurol"},{"issue":"2","key":"pone.0310528.ref009","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/apa.14942","article-title":"Neurological sequelae remain frequent after bacterial meningitis in children","volume":"109","author":"MB Svendsen","year":"2020","journal-title":"Acta Paediatr"},{"issue":"6","key":"pone.0310528.ref010","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2165\/11593340-000000000-00000","article-title":"Acute bacterial meningitis in infants and children: Epidemiology and management.","volume":"13","author":"S Agrawal","year":"2011","journal-title":"Pediatric Drugs"},{"issue":"6","key":"pone.0310528.ref011","doi-asserted-by":"crossref","first-page":"510","DOI":"10.3325\/cmj.2013.54.510","article-title":"Estimating global and regional morbidity from acute bacterial meningitis in children: Assessment of the evidence.","volume":"54","author":"I Luk\u0161i\u0107","year":"2013","journal-title":"Croat Med J."},{"issue":"8","key":"pone.0310528.ref012","doi-asserted-by":"crossref","first-page":"e1170","DOI":"10.1016\/S2214-109X(22)00246-7","article-title":"Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014\u201319: a cross-sectional study","volume":"10","author":"RC Mashau","year":"2022","journal-title":"Lancet Glob Health"},{"issue":"6","key":"pone.0310528.ref013","first-page":"1","article-title":"Global etiology of bacterial meningitis: A systematic review and meta-analysis.","volume":"13","author":"AM Oordt-Speets","year":"2018","journal-title":"PLoS One"},{"issue":"3","key":"pone.0310528.ref014","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1128\/CMR.00070-09","article-title":"Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis","volume":"23","author":"MC Brouwer","year":"2010","journal-title":"Clin Microbiol Rev"},{"issue":"1","key":"pone.0310528.ref015","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/10158782.2013.11441513","article-title":"Guidelines for the management of acute meningitis in children and adults in South Africa","volume":"28","author":"TH Boyles","year":"2013","journal-title":"Southern African Journal of Epidemiology and Infection"},{"issue":"SUPPL.3","key":"pone.0310528.ref016","doi-asserted-by":"crossref","first-page":"C21","DOI":"10.1016\/j.vaccine.2012.05.055","article-title":"Introduction of pneumococcal conjugate vaccine into the public immunization program in South Africa: Translating research into policy","volume":"30","author":"SA Madhi","year":"2012","journal-title":"Vaccine"},{"issue":"38","key":"pone.0310528.ref017","doi-asserted-by":"crossref","first-page":"4200","DOI":"10.1016\/j.vaccine.2013.04.077","article-title":"Epidemiology of invasive pneumococcal disease in the pre-conjugate vaccine era: South Africa, 2003\u20132008.","volume":"31","author":"A von Gottberg","year":"2013","journal-title":"Vaccine"},{"key":"pone.0310528.ref018","first-page":"87","article-title":"Communicable diseases surveillance and outbreak investigation in South Africa 10.","author":"V Quan","year":"2005"},{"issue":"6","key":"pone.0310528.ref019","first-page":"252","article-title":"Bacterial meningitis in the era of paediatric vaccination against the encapsulated pathogens.","volume":"28","author":"A. von Gottberg","year":"2010","journal-title":"Continuing Medical Education"},{"issue":"3","key":"pone.0310528.ref020","first-page":"82","article-title":"Recommendations for the use of meningococcal vaccines in South Africa.","volume":"32","author":"S Meiring","year":"2017","journal-title":"S Afr J Infect Dis"},{"key":"pone.0310528.ref021","first-page":"1","author":"S. A S","year":"2018","journal-title":"Stats SA Mid-year population estimates 2017"},{"key":"pone.0310528.ref022","unstructured":"YNational Health Laboratory Service [Internet]. [cited 2019 Oct 17]. Available from: http:\/\/www.nhls.ac.za\/"},{"key":"pone.0310528.ref023","unstructured":"STATS SA [Internet]. Available from: http:\/\/www.statssa.gov.za\/"},{"issue":"5","key":"pone.0310528.ref024","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.ajic.2008.03.002","article-title":"CDC\/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting.","volume":"36","author":"TC Horan","year":"2008","journal-title":"Am J Infect Control"},{"issue":"10","key":"pone.0310528.ref025","article-title":"Statistical classification of South African seasonal divisions on the basis of daily temperature data","volume":"116","author":"AJ van der Walt","year":"2020","journal-title":"S Afr J Sci"},{"issue":"July","key":"pone.0310528.ref026","first-page":"1","article-title":"Statistical release- Mid-year population estimates.","volume":"P0302","author":"StasSA","year":"2012","journal-title":"Africa"},{"issue":"9","key":"pone.0310528.ref027","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1371\/journal.pone.0163036","article-title":"The epidemiology of meningitis among adults in a south African province with a high HIV prevalence, 2009\u20132012.","volume":"11","author":"E Britz","year":"2016","journal-title":"PLoS One"},{"key":"pone.0310528.ref028","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.ijid.2021.06.025","article-title":"Epidemiology and Trends of Infective Meningitis in Neonates and Infants Less than 3 Months Old in Hong Kong.","volume":"111","author":"CH Wong","year":"2021","journal-title":"International Journal of Infectious Diseases"},{"issue":"3","key":"pone.0310528.ref029","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1017\/S095026881500179X","article-title":"Impact of the 13-valent pneumococcal conjugate vaccine on the incidence of pneumococcal meningitis in children","volume":"144","author":"AG Chapoutot","year":"2016","journal-title":"Epidemiol Infect"},{"issue":"38","key":"pone.0310528.ref030","doi-asserted-by":"crossref","first-page":"5724","DOI":"10.1016\/j.vaccine.2019.04.090","article-title":"Can pneumococcal meningitis surveillance be used to assess the impact of pneumococcal conjugate vaccine on total invasive pneumococcal disease? A case-study from South Africa, 2005\u20132016","volume":"37","author":"J. Kleynhans","year":"2019","journal-title":"Vaccine"},{"key":"pone.0310528.ref031","article-title":"Declining Incidence of I nvasive Meningococcal Disease in South Africa","author":"S. Meiring","year":"2018","journal-title":"Clinical Infectious Diseases"},{"issue":"10","key":"pone.0310528.ref032","doi-asserted-by":"crossref","first-page":"811","DOI":"10.2471\/BLT.06.030361","article-title":"Impact of conjugate Haemophilus influenzae type b (Hib) vaccine introduction in South Africa.","volume":"84","author":"A von Gottberg","year":"2006","journal-title":"Bull World Health Organ"},{"key":"pone.0310528.ref033","article-title":"Expanded programme on immunisation (EPI) national coverage survey report.","author":"PC Makamba-Mutevedzi","year":"2020"},{"key":"pone.0310528.ref034","first-page":"173","author":"PT Heath","year":"2003","journal-title":"Neonatal meningitis."},{"issue":"4","key":"pone.0310528.ref035","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.jhin.2016.08.022","article-title":"Burden, spectrum, and impact of healthcare-associated infection at a South African children\u2019s hospital","volume":"94","author":"A Dramowski","year":"2016","journal-title":"Journal of Hospital Infection"},{"issue":"5","key":"pone.0310528.ref036","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.apjtb.2017.01.019","article-title":"Nosocomial infections: Epidemiology, prevention, control and surveillance.","volume":"7","author":"HA Khan","year":"2017","journal-title":"Asian Pac J Trop Biomed"},{"issue":"SUPPL. 1","key":"pone.0310528.ref037","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/INF.0b013e3181958769","article-title":"Pathogens associated with sepsis in newborns and young infants in developing countries","volume":"28","author":"AKM Zaidi","year":"2009","journal-title":"Pediatric Infectious Disease Journal"},{"issue":"02","key":"pone.0310528.ref038","article-title":"Acute bacterial meningitis among children under 5 years of age in Oman: a retrospective study during 2000\u20132005","volume":"2","author":"N Dash","year":"2008","journal-title":"The Journal of Infection in Developing Countries"},{"key":"pone.0310528.ref039","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/2052-3211-6-4","article-title":"Antimicrobial sensitivity patterns of cerebrospinal fluid (CSF) isolates in Namibia: implications for empirical antibiotic treatment of meningitis.","volume":"6","author":"A Mengistu","year":"2013","journal-title":"J Pharm Policy Pract"},{"issue":"2","key":"pone.0310528.ref040","doi-asserted-by":"crossref","first-page":"273","DOI":"10.3201\/eid1302.051553","article-title":"Meningococcal disease in South Africa, 1999\u20132002","volume":"13","author":"GB Coulson","year":"2007","journal-title":"Emerg Infect Dis"},{"key":"pone.0310528.ref041","author":"W. Stevens","journal-title":"NHLS Data Strategy"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310528","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,25]],"date-time":"2024-09-25T19:26:55Z","timestamp":1727292415000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310528"}},"subtitle":[],"editor":[{"given":"D. William","family":"Cameron","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,9,25]]},"references-count":41,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0310528","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,25]]}}}