Background 
Bacterial meningitis (BM) still causes many deaths and long-term sequelae, especially in low income countries. Angola, a Sub-Saharan country, launched Haemophilus influenzae type b in 2006 and 13-valent pneumococcal conjugate vaccine in 2013. Before vaccine introduction Luanda Children´s Hospital (HPDB) treated approximately 800 patients with probable BM yearly.
Methods 
HPDB is a teaching hospital which attends 300 new patients U15 daily. Spinal tap (ST) was performed for children presenting with altered consciousness, prostration, convulsions, meningism, bulging fontanelle and neonatal sepsis. Cerebrospinal fluid (CSF) leukocyte count, glucose and protein were measured routinely. Gram-stain and culture were performed if CSF leukocytes were >10/μl, or glucose <25 mg/dL, and for all neonates CSF. This prospective surveillance study collected data of all STs in HPDB during one year (21.10.2016 – 20.10.2017).
Results 
STs were performed on 2472 children of whom 1370 (55%) were male. Probable BM was diagnosed in 343 children, of whom 155 (45%) aged ≤30 days. Bacteria were detected in 226 CSF samples, causative agents being Streptococcus pneumoniae (n=33), Klebsiella sp. (n=23), Streptococcus agalactiae (n=16), Escherichia coli (n=15), Staphylococcus aureus (n=13) Neisseria meningitidis (n=11), Haemophilus influenzae (n=8), other Gram-positive (n=54), and Gram-negative (n=53) bacteria. At discharge, the other diseases diagnosed were malaria (31% of 1838), neonatal sepsis (26%), convulsions/epilepsy (7.9%), encephalitis/viral meningitis (2.9%), and tuberculous meningitis (1.8%).
Conclusions 
Of all children presenting at HPDB, 2% had ST performed and of them, 14% were diagnosed with probable BM. Almost half of those were neonates. After introduction of conjugate vaccines in Angola, the number of BM in HPDB has lowered about 60%. Still, pneumococcus, meningococcus, and Haemophilus remain important causes of BM. 
This study was funded by Sanofi Pasteur

SPINAL TAPS VS. BACTERIAL MENINGITIS IN THE LUANDA CHILDREN´S HOSPITAL, ANGOLA