Abstract
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.
Original language | English |
---|---|
Pages (from-to) | 685-711 |
Number of pages | 27 |
Journal | The Lancet Neurology |
Volume | 22 |
Issue number | 8 |
DOIs | |
Publication status | Published - Aug 2023 |
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In: The Lancet Neurology, Vol. 22, No. 8, 08.2023, p. 685-711.
Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Global, regional, and national burden of meningitis and its aetiologies, 1990–2019
T2 - a systematic analysis for the Global Burden of Disease Study 2019
AU - Wunrow, Han Yong
AU - Bender, Rose G.
AU - Vongpradith, Avina
AU - Sirota, Sarah Brooke
AU - Swetschinski, Lucien R.
AU - Novotney, Amanda
AU - Gray, Authia P.
AU - Ikuta, Kevin S.
AU - Sharara, Fablina
AU - Wool, Eve E.
AU - Aali, Amirali
AU - Abd-Elsalam, Sherief
AU - Abdollahi, Ashkan
AU - Abdul Aziz, Jeza Muhamad
AU - Abidi, Hassan
AU - Aboagye, Richard Gyan
AU - Abolhassani, Hassan
AU - Abu-Gharbieh, Eman
AU - Adamu, Lawan Hassan
AU - Adane, Tigist Demssew
AU - Addo, Isaac Yeboah
AU - Adegboye, Oyelola A.
AU - Adekiya, Tayo Alex
AU - Adnan, Mohammad
AU - Adnani, Qorinah Estiningtyas Sakilah
AU - Afzal, Saira
AU - Aghamiri, Shahin
AU - Aghdam, Zahra Babaei
AU - Agodi, Antonella
AU - Ahinkorah, Bright Opoku
AU - Ahmad, Aqeel
AU - Ahmad, Sajjad
AU - Ahmadzade, Mohadese
AU - Ahmed, Ali
AU - Ahmed, Ayman
AU - Ahmed, Jivan Qasim
AU - Ahmed, Meqdad Saleh
AU - Akinosoglou, Karolina
AU - Aklilu, Addis
AU - Akonde, Maxwell
AU - Alahdab, Fares
AU - AL-Ahdal, Tareq Mohammed Ali
AU - Alanezi, Fahad Mashhour
AU - Albelbeisi, Ahmed Hassan
AU - Alemayehu, Tsegaye Begashaw B.
AU - Alene, Kefyalew Addis
AU - Al-Eyadhy, Ayman
AU - Al-Gheethi, Adel Ali Saeed
AU - Ali, Abid
AU - Ali, Beriwan Abdulqadir
AU - Ali, Liaqat
AU - Ali, Syed Shujait
AU - Alimohamadi, Yousef
AU - Alipour, Vahid
AU - Aljunid, Syed Mohamed
AU - Almustanyir, Sami
AU - Al-Raddadi, Rajaa M.
AU - Alvis-Guzman, Nelson
AU - Al-Worafi, Yaser Mohammed
AU - Aly, Hany
AU - Ameyaw, Edward Kwabena
AU - Ancuceanu, Robert
AU - Ansar, Adnan
AU - Ansari, Golnoosh
AU - Anyasodor, Anayochukwu Edward
AU - Arabloo, Jalal
AU - Aravkin, Aleksandr Y.
AU - Areda, Demelash
AU - Artamonov, Anton A.
AU - Arulappan, Judie
AU - Aruleba, Raphael Taiwo
AU - Asaduzzaman, Muhammad
AU - Atalell, Kendalem Asmare
AU - Athari, Seyyed Shamsadin
AU - Atlaw, Daniel
AU - Atout, Maha Moh d.Wahbi
AU - Attia, Sameh
AU - Awoke, Tewachew
AU - Ayalew, Melese Kitu
AU - Ayana, Tegegn Mulatu
AU - Ayele, Alemu Degu
AU - Azadnajafabad, Sina
AU - Azizian, Khalil
AU - Badar, Muhammad
AU - Badiye, Ashish D.
AU - Baghcheghi, Nayereh
AU - Bagheri, Mahboube
AU - Bagherieh, Sara
AU - Bahadory, Saeed
AU - Baig, Atif Amin
AU - Barac, Aleksandra
AU - Barati, Shirin
AU - Bardhan, Mainak
AU - Basharat, Zarrin
AU - Bashiri, Azadeh
AU - Basnyat, Buddha
AU - Bassat, Quique
AU - Basu, Saurav
AU - Bayileyegn, Nebiyou Simegnew
AU - Bedi, Neeraj
AU - Behnoush, Amir Hossein
AU - Bekel, Abebe Ayalew
AU - Belete, Melaku Ashagrie
AU - Bello, Olorunjuwon Omolaja
AU - Bhagavathula, Akshaya Srikanth
AU - Bhandari, Dinesh
AU - Bhardwaj, Pankaj
AU - Bhaskar, Sonu
AU - Bhat, Ajay Nagesh
AU - Bijani, Ali
AU - Bineshfar, Niloufar
AU - Boloor, Archith
AU - Bouaoud, Souad
AU - Buonsenso, Danilo
AU - Burkart, Katrin
AU - Cámera, Luis Alberto
AU - Castañeda-Orjuela, Carlos A.
AU - Cernigliaro, Achille
AU - Charan, Jaykaran
AU - Chattu, Vijay Kumar
AU - Ching, Patrick R.
AU - Chopra, Hitesh
AU - Choudhari, Sonali Gajanan
AU - Christopher, Devasahayam J.
AU - Chu, Dinh Toi
AU - Couto, Rosa A.S.
AU - Cruz-Martins, Natália
AU - Dadras, Omid
AU - Dai, Xiaochen
AU - Dandona, Lalit
AU - Dandona, Rakhi
AU - Das, Saswati
AU - Dash, Nihar Ranjan
AU - Dashti, Mohsen
AU - De la Hoz, Fernando Pio
AU - Debela, Sisay Abebe
AU - Dejen, Demeke
AU - Dejene, Hiwot
AU - Demeke, Dessalegn
AU - Demeke, Feleke Mekonnen
AU - Demessa, Berecha Hundessa
AU - Demetriades, Andreas K.
AU - Demissie, Solomon
AU - Dereje, Diriba
AU - Dervišević, Emina
AU - Desai, Hardik Dineshbhai
AU - Dessie, Anteneh Mengist
AU - Desta, Fikreab
AU - Dhama, Kuldeep
AU - Djalalinia, Shirin
AU - Do, Thanh Chi
AU - Dodangeh, Masoud
AU - Dodangeh, Milad
AU - Dominguez, Regina Mae Villanueva
AU - Dongarwar, Deepa
AU - Dsouza, Haneil Larson
AU - Durojaiye, Oyewole Christopher
AU - Dziedzic, Arkadiusz Marian
AU - Ekat, Martin Herbas
AU - Ekholuenetale, Michael
AU - Ekundayo, Temitope Cyrus
AU - El Sayed Zaki, Maysaa
AU - El-Abid, Hassan
AU - Elhadi, Muhammed
AU - El-Hajj, Victor Gabriel
AU - El-Huneidi, Waseem
AU - El-Sakka, Amro A.
AU - Esayas, Hawi Leul
AU - Fagbamigbe, Adeniyi Francis
AU - Falahi, Shahab
AU - Fares, Jawad
AU - Fatehizadeh, Ali
AU - Fatima, Syeda Anum Fatima
AU - Feasey, Nicholas A.
AU - Fekadu, Ginenus
AU - Fetensa, Getahun
AU - Feyissa, Desalegn
AU - Fischer, Florian
AU - Foroutan, Behzad
AU - Gaal, Peter Andras
AU - Gadanya, Muktar A.
AU - Gaipov, Abduzhappar
AU - Ganesan, Balasankar
AU - Gebrehiwot, Mesfin
AU - Gebrekidan, Kahsu Gebrekirstos
AU - Gebremeskel, Teferi Gebru
AU - Gedef, Getachew Muluye
AU - Gela, Yibeltal Yismaw
AU - Gerema, Urge
AU - Gessner, Bradford D.
AU - Getachew, Motuma Erena
AU - Ghadiri, Keyghobad
AU - Ghaffari, Kazem
AU - Ghamari, Seyyed Hadi
AU - Ghanbari, Reza
AU - Ghazy, Ramy Mohamed Mohmaed
AU - Ghozali, Ghozali
AU - Gizaw, Admasu Belay AB
AU - Glushkova, Ekaterina Vladimirovna
AU - Goldust, Mohamad
AU - Golechha, Mahaveer
AU - Guadie, Habtamu Alganeh
AU - Guled, Rashid Abdi
AU - Gupta, Mohak
AU - Gupta, Sapna
AU - Gupta, Veer Bala
AU - Gupta, Vijai Kumar
AU - Gupta, Vivek Kumar
AU - Hadi, Najah R.
AU - Haj-Mirzaian, Arvin
AU - Haller, Sebastian
AU - Hamidi, Samer
AU - Haque, Shafiul
AU - Harapan, Harapan
AU - Hasaballah, Ahmed I.
AU - Hasan, Ikramul
AU - Hasani, Hamidreza
AU - Hasanian, Mohammad
AU - Hassankhani, Hadi
AU - Hassen, Mohammed Bheser
AU - Hayat, Khezar
AU - Heidari, Mohammad
AU - Heidari-Foroozan, Mahsa
AU - Heidari-Soureshjani, Reza
AU - Hezam, Kamal
AU - Holla, Ramesh
AU - Horita, Nobuyuki
AU - Hossain, Md Mahbub
AU - Hosseini, Mohammad Salar
AU - Hosseinzadeh, Mehdi
AU - Hostiuc, Sorin
AU - Hussain, Salman
AU - Hussein, Nawfal R.
AU - Ibitoye, Segun Emmanuel
AU - Ilesanmi, Olayinka Stephen
AU - Ilic, Irena M.
AU - Ilic, Milena D.
AU - Imam, Mohammad Tarique
AU - Iregbu, Kenneth Chukwuemeka
AU - Ismail, Nahlah Elkudssiah
AU - Iwu, Chidozie C.D.
AU - Jaja, Chinwe
AU - Jakovljevic, Mihajlo
AU - Jamshidi, Elham
AU - Javadi Mamaghani, Amirreza
AU - Javidnia, Javad
AU - Jokar, Mohammad
AU - Jomehzadeh, Nabi
AU - Joseph, Nitin
AU - Zaman, Sojib Bin
AU - Shrestha, S.
AU - Sajedi, Seyed Aidin
AU - GBD 2019 Meningitis Antimicrobial Resistance Collaborators
N1 - Funding Information: This study was funded by the Bill & Melinda Gates Foundation. S Afzal acknowledges the Institutional support of King Edward Medical University in completing the research work, meeting the deadlines, and providing learning and knowledge resources. A Ahmad acknowledges the Shaqra University for supporting this work. S M Aljunid acknowledges the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and Department of Community Medicine, School of Medicine, International Medical University, Malaysia, for the approval and support to participate in this research project. M M W Atout thanks Philadelphia University, Amman, Jordan. A Fatehizadeh acknowledges support from the Department of Environmental Health Engineering of Isfahan University of Medical Sciences, Isfahan, Iran. N A Feasey is funded by a NIHR Global Health Professorship. P A Gaal acknowledges support from the National Research, Development and Innovation Office of Hungary under grant RRF-2.3.1-21-2022-00006 (Data-driven Health Division of Health Security National Laboratory). V K Gupta acknowledges funding support from National Health and Medical Research Council, Australia. S Hussain acknowledges support from Operational Programme Research, Development and Education Project, Postdoc2MUNI (No.CZ.02.2.69/0.0/0.0/18_053/0016952). M T Imam is supported via funding from Prince Sattam Bin Abdulaziz University (project number PSAU/2023/R/1444). N E Ismail acknowledges institutional support from AIMST University, Malaysia. M Jakovljevic acknowledges co-financing through Grant OI 175 014 of the Ministry of Science, Technological Development and Innovation of the Republic of Serbia. N Joseph acknowledges the Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India for their support and encouragement in this research study. H Kandel is supported by the Kornhauser Research Fellowship at the University of Sydney. I Landires reports support from Sistema Nacional de Investigación, which is supported by Panama's Secretaría Nacional de Ciencia, Tecnología e Innovación. G Lopes was supported by national funds through the Fundação para a Ciência e Tecnologia under the Scientific Employment Stimulus–Individual Call (CEECIND/01768/2021). Z A Memish acknowledges support from the Division of infectious Diseases, Kyung Hee University, Korea. L Monasta received support from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. A Mousavi Khaneghah received support from the Department of Technology of Chemistry, Azerbaijan State Oil and Industry University, Baku, Azerbaijan. V Nuñez-Samudio acknowledges support from the Sistema Nacional de Investigación, which is supported by Panama's Secretaría Nacional de Ciencia, Tecnología e Innovación. J Perdigão is supported by Fundação para a Ciência e Tecnologia through Estímulo Individual ao Emprego Científico (CEECIND/00394/2017) and UID/DTP/04138/2019 and, by Associação para o Desenvolvimento do Ensino e Investigação da Microbiologia. M Pinheiro thanks the Fundação para a Ciência e Tecnologia for funding through program DL 57/2016-Norma transitória. Z Z Piracha acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. I Qattea acknowledges support from the Cleveland Clinic Foundation and Nassau University Medical Center. E M M Redwan acknowledges support from King Abdulaziz University, Jeddah, and King Abdulaziz City for Science & Technology, Saudi Arabia, Science & Technology Development Fund, and US-Egypt Science & Technology joint Fund, The Academy of Scientific Research & Technology, Egypt. A Riad acknowledges support from the NPO “Systemic Risk Institute” number LX22NPO5101, funded by European Union - Next Generation EU (Ministry of Education, Youth and Sports, NPO: EXCELES). U Saeed acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. A M Samy acknowledges support from Ain Shams University and the Egyptian Fulbright Mission Program. P A Shah acknowledges support from Bangalore Medical College and Research Institute and the Rajiv Gandhi University of Health Sciences, Karnataka, India. A Sheikh acknowledges support from Health Data Research UK. P H Shetty acknowledges the Department of Forensic Medicine and Toxicology, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, India. L M L R Silva was supported by the project code CENTRO-04-3559-FSE-000162, Fundo Social Europeu. M R Tovani-Palone acknowledges the Saveetha Institute of Medical and Technical Sciences for supporting this study. P Turner acknowledges institutional and personal salary support from the Wellcome core grant to the Mahidol Oxford Tropical Medicine Research Unit, Thailand (grant number 220211). B Unnikrishnan acknowledges support from Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. S B Zaman acknowledges receiving a scholarship from the Australian Government Research Training Program in support of his academic career. A Zumla acknowledges support from the EU European & Developing Countries Clinical Trials Partnership-funded Pan-African Network for Rapid Research, Response, Relief and Preparedness for infectious diseases epidemics (PANDORA-ID-NET) and the UK National Institutes for Health Research Senior Investigator award. Funding Information: This study was funded by the Bill & Melinda Gates Foundation. S Afzal acknowledges the Institutional support of King Edward Medical University in completing the research work, meeting the deadlines, and providing learning and knowledge resources. A Ahmad acknowledges the Shaqra University for supporting this work. S M Aljunid acknowledges the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and Department of Community Medicine, School of Medicine, International Medical University, Malaysia, for the approval and support to participate in this research project. M M W Atout thanks Philadelphia University, Amman, Jordan. A Fatehizadeh acknowledges support from the Department of Environmental Health Engineering of Isfahan University of Medical Sciences, Isfahan, Iran. N A Feasey is funded by a NIHR Global Health Professorship. P A Gaal acknowledges support from the National Research, Development and Innovation Office of Hungary under grant RRF-2.3.1-21-2022-00006 (Data-driven Health Division of Health Security National Laboratory). V K Gupta acknowledges funding support from National Health and Medical Research Council, Australia. S Hussain acknowledges support from Operational Programme Research, Development and Education Project, Postdoc2MUNI (No.CZ.02.2.69/0.0/0.0/18_053/0016952). M T Imam is supported via funding from Prince Sattam Bin Abdulaziz University (project number PSAU/2023/R/1444). N E Ismail acknowledges institutional support from AIMST University, Malaysia. M Jakovljevic acknowledges co-financing through Grant OI 175 014 of the Ministry of Science, Technological Development and Innovation of the Republic of Serbia. N Joseph acknowledges the Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India for their support and encouragement in this research study. H Kandel is supported by the Kornhauser Research Fellowship at the University of Sydney. I Landires reports support from Sistema Nacional de Investigación, which is supported by Panama's Secretaría Nacional de Ciencia, Tecnología e Innovación. G Lopes was supported by national funds through the Fundação para a Ciência e Tecnologia under the Scientific Employment Stimulus–Individual Call (CEECIND/01768/2021). Z A Memish acknowledges support from the Division of infectious Diseases, Kyung Hee University, Korea. L Monasta received support from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. A Mousavi Khaneghah received support from the Department of Technology of Chemistry, Azerbaijan State Oil and Industry University, Baku, Azerbaijan. V Nuñez-Samudio acknowledges support from the Sistema Nacional de Investigación, which is supported by Panama's Secretaría Nacional de Ciencia, Tecnología e Innovación. J Perdigão is supported by Fundação para a Ciência e Tecnologia through Estímulo Individual ao Emprego Científico (CEECIND/00394/2017) and UID/DTP/04138/2019 and, by Associação para o Desenvolvimento do Ensino e Investigação da Microbiologia. M Pinheiro thanks the Fundação para a Ciência e Tecnologia for funding through program DL 57/2016-Norma transitória. Z Z Piracha acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. I Qattea acknowledges support from the Cleveland Clinic Foundation and Nassau University Medical Center. E M M Redwan acknowledges support from King Abdulaziz University, Jeddah, and King Abdulaziz City for Science & Technology, Saudi Arabia, Science & Technology Development Fund, and US-Egypt Science & Technology joint Fund, The Academy of Scientific Research & Technology, Egypt. A Riad acknowledges support from the NPO “Systemic Risk Institute” number LX22NPO5101, funded by European Union - Next Generation EU (Ministry of Education, Youth and Sports, NPO: EXCELES). U Saeed acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. A M Samy acknowledges support from Ain Shams University and the Egyptian Fulbright Mission Program. P A Shah acknowledges support from Bangalore Medical College and Research Institute and the Rajiv Gandhi University of Health Sciences, Karnataka, India. A Sheikh acknowledges support from Health Data Research UK. P H Shetty acknowledges the Department of Forensic Medicine and Toxicology, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, India. L M L R Silva was supported by the project code CENTRO-04-3559-FSE-000162, Fundo Social Europeu. M R Tovani-Palone acknowledges the Saveetha Institute of Medical and Technical Sciences for supporting this study. P Turner acknowledges institutional and personal salary support from the Wellcome core grant to the Mahidol Oxford Tropical Medicine Research Unit, Thailand (grant number 220211). B Unnikrishnan acknowledges support from Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. S B Zaman acknowledges receiving a scholarship from the Australian Government Research Training Program in support of his academic career. A Zumla acknowledges support from the EU European & Developing Countries Clinical Trials Partnership-funded Pan-African Network for Rapid Research, Response, Relief and Preparedness for infectious diseases epidemics (PANDORA-ID-NET) and the UK National Institutes for Health Research Senior Investigator award. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Publisher Copyright: © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2023/8
Y1 - 2023/8
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85165009783&partnerID=8YFLogxK
U2 - 10.1016/S1474-4422(23)00195-3
DO - 10.1016/S1474-4422(23)00195-3
M3 - Article
C2 - 37479374
AN - SCOPUS:85165009783
SN - 1474-4422
VL - 22
SP - 685
EP - 711
JO - The Lancet Neurology
JF - The Lancet Neurology
IS - 8
ER -