article · The Lancet Neurology
A systematic analysis using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 assessed the global burden of acute infectious meningitis from 1990 to 2019 across 204 countries and territories. The study modelled meningitis mortality and morbidity, and estimated the proportion of cases and deaths attributable to various pathogens. In 2019, there were an estimated 236,000 deaths and 2.51 million incident cases globally, with the highest burden in children younger than five years. While age-standardised mortality rates decreased significantly over the period, Streptococcus pneumoniae, Neisseria meningitidis, and Klebsiella pneumoniae were the leading causes of meningitis deaths in 2019. The findings highlight substantial progress but also indicate areas for further intervention.
Understanding the global, regional, and national burden of meningitis and its causes is crucial for tracking progress towards global health goals. This research helps identify populations most at risk and the specific pathogens responsible, informing targeted public health interventions, vaccination programmes, and resource allocation to reduce disease incidence and mortality.
The abstract suggests that further reductions in meningitis burden are possible through low-cost multivalent vaccines, increased access to accurate and rapid diagnostic assays, and enhanced surveillance. This indicates opportunities for developing and deploying new or improved vaccines, diagnostic tools for quick pathogen identification, and surveillance technologies. These are applied research areas with potential for near-market products and services, targeting healthcare providers and public health organisations globally.
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BACKGROUND: Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we aimed to assess incident cases and deaths due to acute infectious meningitis by aetiology and age from 1990 to 2019, for 204 countries and territories. METHODS: We modelled meningitis mortality using vital registration, verbal autopsy, sample-based vital registration, and mortality surveillance data. Meningitis morbidity was modelled with a Bayesian compartmental model, using data from the published literature identified by a systematic review, as well as surveillance data, inpatient hospital admissions, health insurance claims, and cause-specific meningitis mortality estimates. For aetiology estimation, data from multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature studies were analysed by use of a network analysis model to estimate the proportion of meningitis deaths and cases attributable to the following aetiologies: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococcus, Escherichia coli, Klebsiella pneumoniae, Listeria monocytogenes, Staphylococcus aureus, viruses, and a residual other pathogen category. FINDINGS: In 2019, there were an estimated 236 000 deaths (95% uncertainty interval [UI] 204 000-277 000) and 2·51 million (2·11-2·99) incident cases due to meningitis globally. The burden was greatest in children younger than 5 years, with 112 000 deaths (87 400-145 000) and 1·28 million incident cases (0·947-1·71) in 2019. Age-standardised mortality rates decreased from 7·5 (6·6-8·4) per 100 000 population in 1990 to 3·3 (2·8-3·9) per 100 000 population in 2019. The highest proportion of total all-age meningitis deaths in 2019 was attributable to S pneumoniae (18·1% [17·1-19·2]), followed by N meningitidis (13·6% [12·7-14·4]) and K pneumoniae (12·2% [10·2-14·3]). Between 1990 and 2019, H influenzae showed the largest reduction in the number of deaths among children younger than 5 years (76·5% [69·5-81·8]), followed by N meningitidis (72·3% [64·4-78·5]) and viruses (58·2% [47·1-67·3]). INTERPRETATION: Substantial progress has been made in reducing meningitis mortality over the past three decades. However, more meningitis-related deaths might be prevented by quickly scaling up immunisation and expanding access to health services. Further reduction in the global meningitis burden should be possible through low-cost multivalent vaccines, increased access to accurate and rapid diagnostic assays, enhanced surveillance, and early treatment. FUNDING: Bill & Melinda Gates Foundation.
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DOI: 10.1016/s1474-4422(23)00195-3
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