Community-acquired Invasive Bacterial Disease in Urban Gambia, 2005-2015: A Hospital-based Surveillance

Saffiatou Darboe* (Corresponding Author), Uduak Okomo, Abdul-Khalie Muhammad, Buntung Ceesay, Mamadou Jallow, Effua Usuf, Sam Tweed, Edem Akpalu, Brenda Kwambana-Adams, Samuel Kariuki, Martin Antonio, Richard S Bradbury, Karen Forrest, Thushan I de Silva, Bolarinde Joseph Lawal, Davis Nwakanma, Ousman Secka, Anna Roca

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
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BACKGROUND: Invasive bacterial diseases cause significant disease and death in sub-Saharan Africa. Several are vaccine preventable, although the impact of new vaccines and vaccine policies on disease patterns in these communities is poorly understood owing to limited surveillance data.

METHODS: We conducted a hospital-based surveillance of invasive bacterial diseases in The Gambia where blood and cerebrospinal fluid (CSF) samples of hospitalized participants were processed. Three surveillance periods were defined in relation to the introduction of pneumococcal conjugate vaccines (PCVs), before (2005- 2009), during (2010-2011) and after (2012-2015) PCV introduction. We determined the prevalences of commonly isolated bacteria and compared them between the different surveillance periods.

RESULTS: A total of 14 715 blood and 1103 CSF samples were collected over 11 years; overall, 1045 clinically significant organisms were isolated from 957 patients (972 organisms [6.6%] from blood and 73 [6.6%] from CSF). The most common blood culture isolates were Streptococcus pneumoniae (24.9%), Staphylococcus aureus (22.0%), Escherichia coli (10.9%), and nontyphoidal Salmonella (10.0%). Between the pre-PCV and post-PCV eras, the prevalence of S. pneumoniae bacteremia dropped across all age groups (from 32.4% to 16.5%; odds ratio, 0.41; 95% confidence interval, .29-.58) while S. aureus increased in prevalence, becoming the most prevalent bacteria (from 16.9% to 27.2%; 1.75; 1.26-2.44). Overall, S. pneumoniae (53.4%), Neisseria meningitidis (13.7%), and Haemophilus influenzae (12.3%) were the predominant isolates from CSF. Antimicrobial resistance to common antibiotics was low.

CONCLUSIONS: Our findings demonstrate that surveillance data on the predominant pathogens associated with invasive disease is necessary to inform vaccine priorities and appropriate management of patients.

Original languageEnglish
Pages (from-to)S105-S113
Number of pages9
JournalClinical Infectious Diseases
Issue numberSupplement_2
Early online date30 Aug 2019
Publication statusPublished - 15 Sept 2019

Bibliographical note

Acknowledgments. The authors thank Ameh James for his comments and suggestions, Kabiro Kanteh and Fatoumata Ceesay for helping retrieve records, and the staff of the Clinical Services Department and Clinical Laboratories.

Financial support. This work was supported by the Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine.

Supplementary Data
Supplementary materials are available at Clinical Infectious Diseases online. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author.


  • bacteremia
  • community-acquired infection
  • invasive bacterial disease
  • meningitis
  • vaccine preventable disease


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