In 2012, Ghana introduced PCV13 into its childhood immunization program. To monitor the pneumococcus after PCV13 vaccination, we analyzed serotypes, antibiotic resistance, and virulence genes of pneumococcal carriage isolates among children under five years of age. We obtained nasopharyngeal swabs from 513 children from kindergartens and immunization centers in Cape Coast, Ghana. Pneumococcal serotypes were determined by multiplex-PCR and Quellung reaction. Antibiotic resistance and virulence genes prevalence were determined by disc diffusion and PCR respectively. Overall, carriage prevalence was 29.4% and PCV13 coverage was 38.4%. Over 60% of the isolates were non-PCV13 serotypes and serotype 23B was the most prevalent. One isolate showed full resistance to penicillin, while 35% showed intermediate resistance. Resistance to erythromycin and clindamycin remained low, while susceptibility to ceftriaxone, levofloxacin and vancomycin remained high. Penicillin resistance was associated with PCV13 serotypes. Forty-three (28.5%) strains were multidrug-resistant. Virulence genes pavB, pcpA, psrP, pilus-1, and pilus-2 were detected in 100%, 87%, 62.9%, 11.9%, and 6.6% of the strains, respectively. The pilus islets were associated with PCV13 and multidrug-resistant serotypes. PCV13 vaccination had impacted on pneumococcal carriage with a significant increase in non-PCV13 serotypes and lower penicillin resistance. Including PcpA and PsrP in pneumococcal protein-based vaccines could be beneficial to Ghanaian children.

Antibiotic resistance in pneumococci contributes to the high pneumococcal deaths in children. We assessed the molecular characteristics of multidrug-resistant (MDR) pneumococci isolated from healthy vaccinated children under five years of age in Cape Coast, Ghana. A total of 43 MDR isolates were selected from 151 pneumococcal strains obtained from nasopharyngeal carriage. All isolates were previously serotyped by multiplex PCR and Quellung reaction. Susceptibility testing was performed using either the E-test or disk diffusion method. Virulence and antibiotic resistance genes were identified by PCR. Molecular epidemiology was analyzed using multilocus sequence typing (MLST). Vaccine-serotypes 23F and 19F were predominant. The lytA and pavB virulence genes were present in all isolates, whiles 14–86% of the isolates carried pilus-islets 1 and 2, pcpA, and psrP genes. Penicillin, tetracycline, and cotrimoxazole resistance were evident in >90% of the isolates. The ermB, mefA, and tetM genes were detected in (n = 7, 16.3%), (n = 4, 9.3%) and (n = 43, 100%) of the isolates, respectively. However, >60% showed alteration in the pbp2b gene. MLST revealed five novel and six known sequence types (STs). ST156 (Spain^9V-3) and ST802 were identified as international antibiotic-resistant clones. The emergence of international-MDR clones in Ghana requires continuous monitoring of the pneumococcus through a robust surveillance system.

Meningitis is a significant health concern that is associated with high fatality rates, particularly in resource-limited settings such as Ghana, whose northern regions lie within the African Meningitis Belt. Despite the plethora of primary research data on meningitis in Ghana, a systematic review that provides comprehensive information to guide prevention, control, and management efforts is yet to be undertaken. This systematic review, therefore, aimed at bridging this gap by describing the epidemiology of meningitis in Ghana, including its prevalence, aetiology, and antimicrobial resistance. A comprehensive review of electronic databases, including PubMed and Scopus, was conducted between 2nd and 4th December, 2023, following the established PRISMA guidelines. The search encompassed articles published from 1975 to 2023. With no age limitations on study participants, data extraction was performed on peer-reviewed journal articles reporting primary findings. Studies that exclusively reported on meningitis in animal models, in vitro or in vivo were excluded. Studies with a sample size of less than ten were excluded from the analysis. A meta-analysis was carried out to determine the pooled estimate of meningitis prevalence in the country. There were 71,205 suspected meningitis cases analysed during the study period, with 3865 confirmed, and a pooled (overall) prevalence of 18.13%. Specifically, the cases that occurred during non-outbreak and outbreak periods had a pooled prevalence of 16.22% and 23.91%, respectively. The case fatality rates ranged from 20% to 47% between 1998 and 2015 and from 0.82% to 28.6% between 2016 and 2021. The three northern regions – Upper East (30.8%–54.35%), Northern (16.3%–46.4%), and Upper West (17.96%–38.8%) – had relatively high meningitis prevalence, while the Greater Accra and Ashanti Regions had prevalence ranging between 0.8% and 3.29%. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae were the predominant isolates, accounting for 0.48%–77.7%, 2.5%–69.5%, and 0.90%–3.40% of the cases, respectively. All bacterial isolates from meningitis cases were susceptible to ceftriaxone. The most common Neisseria meningitidis serogroups were W135, A, Y, and X, while Serotype 1 dominated among the Streptococcus pneumoniae serotypes. There is a disparity in the distribution of meningitis in Ghana, with the highest prevalence occurring in the northern parts of the country. There seems to have been a reduction in the case fatality rate over the years, probably due to interventions such as vaccinations. Ceftriaxone continues to be a suitable treatment option for meningitis. There should be continuous surveillance of meningitis aetiological agents — especially serotyping of the common pathogens — to help guide national vaccination policies and programmes.

Preventive strategies involving the use of pneumococcal conjugate vaccines (PCVs) are known to drastically reduce pneumococcal disease. However, PCV vaccination has been plagued with serotype replacement by non-PCV serotypes. In this study, we describe the prevalence and molecular characteristics of non-PCV13 serotypes (non-vaccine serotypes, NVTs) from pneumococcal carriage isolates obtained from children < 5 years old in Cape Coast, Ghana, after PCV introduction. The isolates were subjected to antibiotic susceptibility testing and multilocus sequence typing (MLST), and molecular techniques were used to detect the presence of virulence genes. Serotypes 11A, 13, 15B, 23B, and 34 formed the top five of the 93 NVT isolates. As such, 20 (21.5%), 49 (48.4%), and 70 (74.3%) isolates were non-susceptible to penicillin, tetracycline, and cotrimoxazole, respectively. Sixteen (17.2%) multidrug-resistant isolates were identified. However, non-susceptibility to ceftriaxone and erythromycin was low and all isolates were fully susceptible to levofloxacin, linezolid, and vancomycin. Whereas pcpA, pavB, lytA, and psrP genes were detected in nearly all serotypes, pilus islet genes were limited to serotypes 11A, 13, and 23B. MLST for predominant serotype 23B isolates revealed three known and seven novel sequence types (STs). ST172 and novel ST15111 were the most dominant and both STs were related to PMEN clone Columbia^23F-26 (ST338). In conclusion, non-PCV13 serotype 23B was the most prevalent, with characteristics of rapid clonal expansion of ST172 and ST15111, which are related to international clones of the pneumococcus. Continuous monitoring of NVTs in Ghana is, therefore, essential, as they have the potential to cause invasive disease, show high antibiotic resistance, and attenuate the effects of PCV vaccination.

Aim: The research was carried out to ascertain the antimicrobial effect of the plants Omphalocarpum ahia, Homalium letestui, and Coelocaryon oxycarpum, which are used locally to treat some infectious diseases. Place and Duration of Study: Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana and Department of Herbal Medicine, KNUST, Ghana from June to August 2014. Method: The stem barks of the plants were extracted with 70 % methanol and successively partitioned with petroleum ether, ethyl acetate, methanol to obtain three different fractions. The antimicrobial activities of the extracts and fraction against MRSA, S. typhi, E. coli, S. pneumoniae, P. aeruginosa, E. faecalis, and S. aureus were determined using the disk diffusion method and the minimum inhibition concentration by the serial microplate dilution method with 0.2 mg/ml p-iodonitrotetrazolium as growth indicator whereas gentamycin was used as the positive control. Phytochemical tests on the plant materials were done according to standard methods. Result: All the fractions of each plant had activity against some of the bacteria. Ethyl acetate (EA) and hydro-methanolic (CE) extracts of Coelocaryon oxycarpum exhibited activity against all selected bacteria with MIC ranging from 0.625-5 mg/ml for CE and 0.3125-5 mg/ml for EA. Hydro-methanolic (CE) extracts of Omphalocarpum ahia also exhibited antibacterial activity against all the selected bacteria. Conclusion: The current research showed that Omphalocarpum ahia and Coelocaryon oxycarpum have considerable antimicrobial activity against all the strains used in the study. Local knowledge may afford lead materials for the development of novel antimicrobial agents.