Investigation and public health response to a confirmed case of Streptococcus pneumoniae meningitis, Kadjebi District, Oti Region, Ghana, 2023

Introduction: Bacterial meningitis remains a major life-threatening condition that requires prompt detection and response due to its rapid onset and high case fatality rate, which can reach about 70% when untreated. On 23 May 2023, the National Public Health Reference Laboratory confirmed the first Streptococcus pneumoniae meningitis case in Kadjebi District, Oti Region of Ghana, triggering a public health response. We investigated to ascertain the situation, confirm the diagnosis, and implement preventive and control measures. Methods: We conducted a field investigation in Wawaso community between 25 May and 29 May 2023. A suspected case was defined as any person residing in Kadjebi District from 29 April to 19 May 2023 presenting with a sudden onset of fever and neck stiffness or other meningeal signs, while laboratory identification of a bacterial pathogen constituted a confirmed case. Cerebrospinal fluid was collected and tested using latex agglutination and reverse transcription polymerase chain reaction tests. We reviewed health records, interviewed community members, and performed contact tracing. We analyzed data by person, place, and time. Results: We found one confirmed case of S. pneumoniae meningitis in a 9-year-old unvaccinated male pupil from Wawaso. He presented with headache, fever (38.6°C) and later developed neck stiffness and drooping eyelid. He had no recent travel history or known contact with a similar illness before symptom onset and recovered fully with treatment without any neurological sequelae. The case was detected 6 days after symptom onset and reported to the district within 24 hours after meningitis was suspected. Laboratory confirmation was obtained within 5 days, and field investigation commenced 9 days after notification. From the records review, no additional cases were identified as none met the case definition. We also listed 140 contacts and monitored daily for ten days, and none developed symptoms suggestive of meningitis. Conclusion: This is a sporadic case of S. pneumoniae meningitis with no evidence of secondary transmission. Timely case detection was not achieved. We recommend sensitization of clinicians on meningitis surveillance to improve timely detection and reporting.