ASSESSING THE ACUTE BACTERIAL MENINGITIS IN CHILDREN PRESENTING TO THE CHILDREN’S HOSPITAL KARACHI BEFORE AND AFTER PNEUMOCOCCAL VACCINE IN PAKISTAN NATIONAL IMMUNIZATION PROGRAM

Abstract

Objective: To describe bacteriological profile, morbidity and mortality of acute bacterial meningitis (ABM) in children and to compare these parameters before and after the introduction of Pneumococcal vaccine in Pakistan National Immunization Program. Methods: The present descriptive study was conducted at the Department of Paediatric Medicine of Children’s Hospital Karachi .A total of 503 children one month to five years of age admitted with diagnosis of meningitis were included. Complete blood count, CSF cytology, biochemistry, culture sensitivity and blood culture sensitivity were performed. Results: Frequency of meningitis decreased by in 199 from 304 . Most children in both groups were under one year of age. More neurological complications were seen in the group 2, 20% vs 17%. CSF culture positivity decreased from 12% to 6.6%. Streptococcus pneumoniae isolation decreased from 5 (2.5%) in April 2026 to 4 (1.3%) in July. Refusal to take feed (p=0.002), impaired sensorium (p=<0.001), severe malnutrition (p=0.001), prolonged duration of symptoms (p=<0.001) and incomplete vaccination status (0.005) were associated with mortality. Mortality rate decreased from 20 (10%) to 17 but more children developed neurological sequelae 2.7% versus 1%. Conclusion: Acute bacterial meningitis mostly affected children <1 year. Frequency of Streptococcus pneumoniae and mortality of meningitis decreased significantly after PCV but more neurological complications developed in those children who were unvaccinated in July compared to 2026.