Poster Mehmet Ceyhan, MD Faculty of number The Changing Epidemiology of Bacterial Meningitis During 2015-2017 in : Department of Pediatric Infectious Diseases, , Turkey 682 A Hospital Based Prospective Surveillance Study. Email: [email protected] Mehmet Ceyhan, MD1, Yasemin Ozsurekci, MD1, Cihangül Bayhan, MD1, Nezahat Gurler, MD2, Enes Sali, MD3, Melike Keser Emiroglu, MD4, Fatma Nur Öz, MD5, Yıldız Camcioglu, MD6, Nuran Salman, MD7, Zafer Kurugol, MD8, Havva Ozlem Altay Akisoglu, MD9, Nilden Tuygun, MD10, Nursen Belet, MD11, Emel Ulusoy, MD12, Ener Cagri Dinleyici, MD13, Hasan Tezer, MD14, Aslınur Parlakay, MD15, Adem Karbuz, MD16, Fesih Aktar, MD17, Mustafa Hacimustafaoglu, MD18, Sevgen Tanır Basaranoglu, MD1, Kubra Aykac, MD1, Emine Kocabas, MD19, Ozlem Ozgur Gundeslioglu, MD19, Nevin Hatipoglu, MD20, Sadık Sami Hatipoglu, MD20, Gülnar Şensoy, MD21, Eda Karadag Oncel, MD22, Mehmet Ali Solmaz, MD23, Soner Sertan Kara, MD24, Solmaz Çelebi, MD18, Ümit Çelik, MD25, Özge Metin, M.D.26, Şefika Bozdemir, MD27, Ilker Devrim, MD28, Ahu Kara, MD28 and Murat Sütçü, M.D.29 (1)Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey, (2)Department of Microbiology and Clinical Microbiology, Istanbul Medical Faculty, Istanbul, Turkey, (3)Department of Pediatric Infectious Diseases, Sanliurfa Training and Research Hospital, Şanlıurfa, Turkey, (4)Department of Pediatric Infectious Diseases, Selcuk University Faculty of Medicine, Konya, Turkey, (5)Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey, (6)Department of Immunology-Allergy and Infectious Diseases, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey, (7)Department of Pediatric Infectious Diseases, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey, (8)Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir, Turkey, (9)Department of Microbiology, Dr. Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey, (10)Department of Pediatrics, Dr. Sami Ulus Maternity and Children's Training and Research Hospital, ankara, Turkey, (11)Department of Pediatric Infectious Diseases, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey, (12)Department of Pediatric Emergency Care, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey, (13)Department of Pediatric Intensive Care and Infectious Disease Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey, (14)Department of Pediatric Infectious Diseases, Gazi Univeristy Faculty of Medicine, Ankara, Turkey, (15)Department of Pediatric Infectious Diseases, Ankara Hematology Oncology Children's Training and Research Hospital, Ankara, Turkey, (16)Department of Pediatric Infectious Diseases, Okmeydani Training and Research Hospital, Istanbul, Turkey, (17)Department of Pediatrics, University Faculty of Medicine, Diyarbakir, Turkey, (18)Department of Pediatric Infectious Diseases, Uludag University Faculty of Medicine, Bursa, Turkey, (19)Department of Pediatric Infectious Diseases, Cukurova University Faculty of Medicine, Adana, Turkey, (20)Department of Pediatric Infectious Diseases, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey, (21)Department of Pediatric Infectious Diseases, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey, (22)Department of Pediatric Infectious Diseases, İzmir Tepecik Training and Research Hospital, İzmir, Turkey, (23)Department of Pediatrics, Van Training and Research Hospital, Van, Turkey, (24)Department of Pediatric Infectious Diseases, Erzurum Training and Research Hospital, Erzurum, Turkey, (25)Department of Pediatric Infectious Diseases, Adana Numune Training and Research Hospital, Adana, Turkey, (26)Department of Pediatric Infectious Diseases, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey, (27)Department of Pediatric Infectious Diseases, Kayseri Training and Research Hospital, Kayseri, Turkey, (28)Department of Pediatric Infectious Disease, Dr. Behcet Uz Children's Hospital, Izmir, Turkey, (29)Department of Pediatric Infectious Diseases, Konya Training and Research Hospital, Konya, Turkey

BACKGROUND Table 1. Distribution of causative agents of bacterial meningitis in Turkey during 2005-2017 Figure 1. Distribution of causative agents of bacterial meningitis in Turkey during 2005-2017

Neisseria meningitidis Streptococcus pneumoniae Haemophilus influenza type b The etiology of bacterial meningitis in Turkey has been changed as in the rest of the world Study period (year) 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014 2015-2016 2017 100,0 after the implementation of conjugated vaccines against Streptococcus pneumonia and Causative bacteria n % n % n % n % n % n % n % 90,4 90,0 Haemophilus influenzae type b (Hib) in Turkish national immunization schedule. A clear Neisseria 82,1 decline was observed in meningitis caused by S.pneumoniae and Hib in Turkey according 138 56,8 108 40,4 41 62,1 46 66,7 85 90,4 36 73,5 23 82,1 meningitidis 80,0 73,5 to our previous studies. As it is important to know the causative microorganisms in 66,7 Serogroup W 59 42,8 19 17,6 23 56,1 26 56,5 36 42,4 5 13,9 2 8,7 70,0 62,1 bacterial meningitis in deciding the strategy to be followed in prevention and empiric 56,8 treatment of bacterial meningitis, we have been performing a nationwide hospital-based Serogroup B 43 31,2 38 35,2 3 7,3 3 6,5 28 32,9 16 44,4 15 65,2 60,0 meningitis surveillance study across several regions of Turkey. Here we present our results 50,0 Serogroup A 1 0,7 9 8,3 15 36,6 3 6,5 3 3,5 1 2,8 2 8,7 40,4 from 2015 to 2017. Serogroup C 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 40,0 PERCENTILE 31,8 30,4 Serogroup Y 3 2,2 0 0,0 0 0,0 0 0,0 2 2,4 1 2,8 1 4,3 30,0 22,6 36,7 24,5 17,9 Serogoup X 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 1 2,8 1 4,3 20,0 9,6 METHODS Nongroupable 32 23,2 42 38,9 0 0,0 14 30,4 16 18,8 12 33,3 2 8,7 10,0 20,6 22,8 6,1 2,9 0,0 2,0 0,0 S. pneumoniae 55 22,6 98 36,7 21 31,8 21 30,4 9 9,6 12 24,5 5 17,9 0,0 This prospective study was conducted in 25 hospitals located 7 regions of Turkey 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014 2015-2016 2017 H. influenza type b (representing 30% of Turkey population) and children aged between 1 month and 18 50 20,6 61 22,8 4 6,1 2 2,9 0 0 1 2,0 0 0,0 YEARS years with suspected meningitis and hospitalized between 1 January 2015 and 31 December 2017 were included. After written parental/legal guardians consent, Total 243 100 267 100,0 66 100 69 100 94 100 49 100 28 100 cerebrospinal fluid samples were collected and bacterial identification was made Figure 2. Distribution of meningococcal serogroups of meningococcal meningitis in Turkey according to the multiplex PCR assay results. The study protocol was approved by the during 2015-2017 and comparison with results belonging to previous years. ethics committee of the Hacettepe University Institutional Ethics Committee as well as Disclosure of potential conflicts of interest CONCLUSION No potential conflicts of interest were disclosed. the other sites of local ethic committees. Funding 70,0 65,2 The epidemiology of meningococcal diseases has been vary Funding for this study was provided by GlaxoSmithKline. 60,0 56,1 56,5 in time with or without any apparent reasons. Hajj is a well References RESULTS known cause for serogroup W epidemics and serogorup W 1.Ceyhan M, Ozsurekci Y, Gurler N, Karadag Oncel E, Camcioglu Y, Salman N, et al. Bacterial agents 50,0 44,4 causing meningitis during 2013-: A multi-center hospital-based prospective 42,8 42,4 was the most common cause of meningitis in Turkey during 38,9 surveillance study. Hum Vaccin Immunother. 2016;12(11):2940-5. 40,0 35,2 36,6 2009-2014 as in other Middle East countries. After the 2.Ceyhan M, Gurler N, Ozsurekci Y, Keser M, Aycan AE, Gurbuz V, et al. Meningitis caused by 32,9 33,3 During the study period 927 children were hospitalized for suspected meningitis and Hib Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005- 31,2 30,4 impact of serogroup W epidemics related to Hajj seen in 2012 in Turkey. A multicenter prospective surveillance study. Hum Vaccin Immunother. 30,0

(n:1), S. pneumonia (n:17) and Neisseria meningitidis (n:59) were detected in 77 samples Percentile 23,2 2010’s was diminished, serogroup B has been the leading 2014;10(9):2706-12. 18,8 (Figure 1, Table 1). During 2015-2016, N. meningitidis serogroup W, B, A, Y, X 3.Gonzalez-Granado LI. Acute bacterial meningitis. Lancet Infect Dis. 2010;10(9):596. 20,0 17,6 frequencies were as 5 (13.9 %), 16 (44.4 %), 1 (2.8 %), 1 (2.8 %), 1 (2.8 %) respectively. cause of childhood meningitis since 2015. In countries 4.Snaebjarnardottir K, Erlendsdottir H, Reynisson IK, Kristinsson K, Halldorsdottir S, Hardardottir H, 13,9 et al. Bacterial meningitis in children in Iceland, 1975-2010: a nationwide epidemiological study. 8,7 affected from Hajj like Turkey, vaccination of children with 10,0 2,2 8,3 7,3 6,5 3,5 There were 12 nongroupable N. meningitidis samples and serogroup C wasn’t detected. Scand J Infect Dis. 2013;45(11):819-24. 2,4 2,8 4,3 In 2017, of meningococcal meningitis serogroup B, W, A, Y and X were identified in 2 (8.7 serogroup B meningococcal vaccine as well as quadrivalent 5.Mace SE. Acute bacterial meningitis. Emerg Med Clin North Am. 2008;26(2):281-317, viii. 0,7 conjugated vaccine seems to be very important. It should be 6.Diomande FV, Djingarey MH, Daugla DM, Novak RT, Kristiansen PA, Collard JM, et al. Public 0,0 %), 15 ( 65.2 %), 2 (8.7 %), 1 ( 4.3 %) and 1 (4.3 %) cases, respectively (Table 1, Figure 2). Health Impact After the Introduction of PsA-TT: The First 4 Years. Clin Infect Dis. 2015;61 Suppl 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014 2015-2016 2017 There were four death in this study period, all of them were caused by N. meningitidis kept in mind that meningococcal epidemiology is dynamic 5:S467-72. and needed to be closely monitored to detect changes in 7. Feigin RD, Cutrer WB. Bacterial meningitis beyond the neonatal period. In: Feigin & Cherry’s Years serogroup B and three of them were under 1 year old. Textbook of Pediatric Infectious Diseases, Feigin RD, Cherry JD, Harrison RE, Kaplan SL, eds. (6th years ed.). Philadelphia: Saunders Elsevier; 2009; 439–471 Serogroup W Serogroup B Serogroup A Serogroup C Serogroup Y Serogoup X Nongroupable