Epidemiology of meningitis in children in a Brazilian northeastern state

To describe the epidemiological profile of meningitis in children under the age of five resident in the State of Paraiba between 2007 and 2017. A time series analysis in a descriptive epidemiological study, whose population comprised all the cases confirmed by the Executive Management of Health Surveillance of Paraiba. The obtained sample was analyzed through statistical resources using the SPSS software version 18.0. The age group indicated an increased concentration in children under the age of 1year old, corresponding to a coefficient of incidence of 24.1/10.000 habitants. The criteria of confirmation indicated 44.3% by means of the chemical and cytological examination, 77.6% progressed to hospital discharge and 9.8% to death. Regarding the temporal distribution of the cases, the year 2012 appears with the highest number of confirmed cases 20.06% and 2015 presented the lowest incidence 3.61%, within the period studied. The combat of Meningitis is still characterized as a relevant issue in the State, despite the declining tendency of confirmed cases, the incidence may still be considered as being high due to the vaccine protection that is available.

For the data collection, was requested to the Executive Management of Health Surveillance of the State of Paraiba, by means of an authorization instrument, the liberation of the information contained in the meningitis notification forms recorded in the SINAN. After the liberation by the Ethics and Research Committee, the information was provided and the analysis of the data began. Subsequently, the relevant data was inserted and analyzed by means of statistical resources, using the software Statistical Package for the Social Science (SPSS) version 18.0. The data analysis was conducted using the techniques of descriptive statistics. With the purpose of comparing the existence of the correlation of the data, using Pearson's chi-square test, which considered as being significant the p value < 0.05. These were revealed in tables and were discussed in the light of relevant literature at national and international level.
The research project was registered and approved by the Brazil platform, and legal consent was obtained for the accomplishment of the research, in the light of the ethical principles, under the approval number 3.008.029 and CAAE 02491718.0.0000.5181. Table 1 shows predominance of confirmed meningitis cases between 2011 and 2012 (17,4 and 16,2% respectively), which can be justified by the low vaccination coverage in the years after the implementation of the vaccine. After 2013, there is a significant decrease in the number of cases that could be related to the intensification of the vaccination campaigns and to the progress in the coverage of both the PCV10 and meningococcal vaccines (93,34% and 96,81% respectively). Development, v. 9, n. 9, e570997553, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i9.7553 5 After comparing the percentage of cases that occurred before (2007 -2009) and after (2011 -2017) the implementation of the meningitis vaccine in the country, we notice a decrease in this last period, especially among the age group under 4 years of age. Therefore, routine vaccination must occur according to the NIP regulations aiming at supporting all promotion and prevention programs to this population group.     Therefore, adoption of precautionary strategies, such as vaccination, has been shown to be highly effective. Even when restricted to a few age groups, it becomes an important tool in reducing the cases of the disease.

Results
Finally, it is possible to observe that even in cases in which the etiology is not well defined, the immunization prompted a decrease in the number of cases, reinforcing the need for epidemiological studies to support different public health strategies in the studied population. prevention of diseases, in addition to promoting equity in the access to the to the healthcare services which promotes the universality of the healthcare, respecting the principles of the SUS. There still are some fragilities related to the ESF, however, it can be stated that these services are allies in the reduction of infant mortality, and in the control of infectious and immune predictable diseases, contributing to the child by means of the child healthcare, in which is included the monitoring of the immunization schedules (Facchini et al., 2006).
It should be highlighted that in order to strengthen the surveillance and control procedures in Latin America, must be emphasized the need for improvement of the indicators, the laboratorial capacity in relation to the diagnostic tests; the communication about the epidemiological and laboratorial analysis and the long-term monitoring of the consequences of the disease, as well as the improvement of the surveillance procedures for the delineation of prevention and control strategies (Sáfadi et al., 2017).
The great importance from the epidemiological point of view is estimated, if the immunization programs were more comprehensive, granting immunity to the various subtypes of the disease and a greater agility and efficiency in the diagnostic criteria contributing to a decline of this disease in its totality.

Final Considerations
Based on the results, it was possible to trace the epidemiological profile of the meningitis in the studied population, in addition to verify the temporal distribution of this disease. It was identified that children under five years of age obtained a higher incidence coefficient corresponding to the largest risk group for this disease; the male gender was the most affected and the unspecified meningitis the one that appeared most among the etiologies, this factor suggesting a certain difficulty in relation to the diagnosis of the disease. As a confirmation criteria the chemocytological predominated and in spite of the fact that the majority of cases evolve to hospital discharge, the mortality percentage in the State of choice is still concerning. Therefore, we highlight here that, epidemiological information of this type are relevant to initiate public health measures and to ensure an adequate care to the population.
We stress that children's immunization represents an important progress in terms of public health accomplishments. Therefore, it is possible to infer that the inclusion of the 10valent Pneumococcal conjugate (PCV10) and Monovalent C meningococcal vaccines in the schedule of the NIP has shown to be effective in the currently investigated context, as the meningitis cases declined.
As limitations of this study are highlighted the presence of faults in the register and cases of meningitis in addition to the incompleteness of the notification forms in a correct way, and, consequently compromise the quality of the acquired information, as well as the analysis and future hypothesis which can be suggested. It is suggested, however, implementation of constant strategies and monitoring, so as to ensure better results.