Global, regional, and national burden of meningitis and its aetiologies, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Meningitis Antimicrobial Resistance Collaborators, Han Yong Wunrow, Rose G. Bender, Avina Vongpradith, Sarah Brooke Sirota, Lucien R. Swetschinski, Amanda Novotney, Authia P. Gray, Kevin S. Ikuta, Fablina Sharara, Eve E. Wool, Amirali Aali, Sherief Abd-Elsalam, Ashkan Abdollahi, Jeza Muhamad Abdul Aziz, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Eman Abu-Gharbieh, Lawan Hassan AdamuTigist Demssew Adane, Isaac Yeboah Addo, Oyelola A. Adegboye, Tayo Alex Adekiya, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Saira Afzal, Shahin Aghamiri, Zahra Babaei Aghdam, Antonella Agodi, Bright Opoku Ahinkorah, Aqeel Ahmad, Sajjad Ahmad, Mohadese Ahmadzade, Ali Ahmed, Ayman Ahmed, Jivan Qasim Ahmed, Meqdad Saleh Ahmed, Karolina Akinosoglou, Addis Aklilu, Maxwell Akonde, Fares Alahdab, Tareq Mohammed Ali AL-Ahdal, Fahad Mashhour Alanezi, Ahmed Hassan Albelbeisi, Tsegaye Begashaw B. Alemayehu, Kefyalew Addis Alene, Ayman Al-Eyadhy, Adel Ali Saeed Al-Gheethi, Abid Ali, Beriwan Abdulqadir Ali, Liaqat Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Sami Almustanyir, Rajaa M. Al-Raddadi, Nelson Alvis-Guzman, Yaser Mohammed Al-Worafi, Hany Aly, Edward Kwabena Ameyaw, Robert Ancuceanu, Adnan Ansar, Golnoosh Ansari, Anayochukwu Edward Anyasodor, Jalal Arabloo, Aleksandr Y. Aravkin, Demelash Areda, Anton A. Artamonov, Judie Arulappan, Raphael Taiwo Aruleba, Muhammad Asaduzzaman, Kendalem Asmare Atalell, Seyyed Shamsadin Athari, Daniel Atlaw, Maha Moh d.Wahbi Atout, Sameh Attia, Tewachew Awoke, Melese Kitu Ayalew, Tegegn Mulatu Ayana, Alemu Degu Ayele, Sina Azadnajafabad, Khalil Azizian, Muhammad Badar, Ashish D. Badiye, Nayereh Baghcheghi, Mahboube Bagheri, Sara Bagherieh, Saeed Bahadory, Atif Amin Baig, Aleksandra Barac, Shirin Barati, Mainak Bardhan, Zarrin Basharat, Azadeh Bashiri, Buddha Basnyat, Quique Bassat, Saurav Basu, Nebiyou Simegnew Bayileyegn, Neeraj Bedi, Amir Hossein Behnoush, Abebe Ayalew Bekel, Melaku Ashagrie Belete, Olorunjuwon Omolaja Bello, Akshaya Srikanth Bhagavathula, Dinesh Bhandari, Pankaj Bhardwaj, Sonu Bhaskar, Ajay Nagesh Bhat, Ali Bijani, Niloufar Bineshfar, Archith Boloor, Souad Bouaoud, Danilo Buonsenso, Katrin Burkart, Luis Alberto Cámera, Carlos A. Castañeda-Orjuela, Achille Cernigliaro, Jaykaran Charan, Vijay Kumar Chattu, Patrick R. Ching, Hitesh Chopra, Sonali Gajanan Choudhari, Devasahayam J. Christopher, Dinh Toi Chu, Rosa A.S. Couto, Natália Cruz-Martins, Omid Dadras, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Saswati Das, Nihar Ranjan Dash, Mohsen Dashti, Fernando Pio De la Hoz, Sisay Abebe Debela, Demeke Dejen, Hiwot Dejene, Dessalegn Demeke, Feleke Mekonnen Demeke, Berecha Hundessa Demessa, Andreas K. Demetriades, Solomon Demissie, Diriba Dereje, Emina Dervišević, Hardik Dineshbhai Desai, Anteneh Mengist Dessie, Fikreab Desta, Kuldeep Dhama, Shirin Djalalinia, Thanh Chi Do, Masoud Dodangeh, Milad Dodangeh, Regina Mae Villanueva Dominguez, Deepa Dongarwar, Haneil Larson Dsouza, Oyewole Christopher Durojaiye, Arkadiusz Marian Dziedzic, Martin Herbas Ekat, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Maysaa El Sayed Zaki, Hassan El-Abid, Muhammed Elhadi, Victor Gabriel El-Hajj, Waseem El-Huneidi, Amro A. El-Sakka, Hawi Leul Esayas, Adeniyi Francis Fagbamigbe, Shahab Falahi, Jawad Fares, Ali Fatehizadeh, Syeda Anum Fatima Fatima, Nicholas A. Feasey, Ginenus Fekadu, Getahun Fetensa, Desalegn Feyissa, Florian Fischer, Behzad Foroutan, Peter Andras Gaal, Muktar A. Gadanya, Abduzhappar Gaipov, Balasankar Ganesan, Mesfin Gebrehiwot, Kahsu Gebrekirstos Gebrekidan, Teferi Gebru Gebremeskel, Getachew Muluye Gedef, Yibeltal Yismaw Gela, Urge Gerema, Bradford D. Gessner, Motuma Erena Getachew, Keyghobad Ghadiri, Kazem Ghaffari, Seyyed Hadi Ghamari, Reza Ghanbari, Ramy Mohamed Mohmaed Ghazy, Ghozali Ghozali, Admasu Belay AB Gizaw, Ekaterina Vladimirovna Glushkova, Mohamad Goldust, Mahaveer Golechha, Habtamu Alganeh Guadie, Rashid Abdi Guled, Mohak Gupta, Sapna Gupta, Veer Bala Gupta, Vijai Kumar Gupta, Vivek Kumar Gupta, Najah R. Hadi, Arvin Haj-Mirzaian, Sebastian Haller, Samer Hamidi, Shafiul Haque, Harapan Harapan, Ahmed I. Hasaballah, Ikramul Hasan, Hamidreza Hasani, Mohammad Hasanian, Hadi Hassankhani, Mohammed Bheser Hassen, Khezar Hayat, Mohammad Heidari, Mahsa Heidari-Foroozan, Reza Heidari-Soureshjani, Kamal Hezam, Ramesh Holla, Nobuyuki Horita, Md Mahbub Hossain, Mohammad Salar Hosseini, Mehdi Hosseinzadeh, Sorin Hostiuc, Salman Hussain, Nawfal R. Hussein, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Irena M. Ilic, Milena D. Ilic, Mohammad Tarique Imam, Kenneth Chukwuemeka Iregbu, Nahlah Elkudssiah Ismail, Chidozie C.D. Iwu, Chinwe Jaja, Mihajlo Jakovljevic, Elham Jamshidi, Amirreza Javadi Mamaghani, Javad Javidnia, Mohammad Jokar, Nabi Jomehzadeh, Nitin Joseph, Mohammad Ali Moni

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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 languageEnglish
Pages (from-to)685-711
Number of pages27
JournalThe Lancet Neurology
Volume22
Issue number8
DOIs
Publication statusPublished - Aug 2023

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