Global, regional, and national burden of meningitis, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

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Abstract

BACKGROUND: Acute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes. METHODS: The Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2016 study estimated meningitis burden due to one of four types of cause: pneumococcal, meningococcal, Haemophilus influenzae type b, and a residual category of other causes. Cause-specific mortality estimates were generated via cause of death ensemble modelling of vital registration and verbal autopsy data that were subject to standardised data processing algorithms. Deaths were multiplied by the GBD standard life expectancy at age of death to estimate years of life lost, the mortality component of disability-adjusted life-years (DALYs). A systematic analysis of relevant publications and hospital and claims data was used to estimate meningitis incidence via a Bayesian meta-regression tool. Meningitis deaths and cases were split between causes with meta-regressions of aetiological proportions of mortality and incidence, respectively. Probabilities of long-term impairment by cause of meningitis were applied to survivors and used to estimate years of life lived with disability (YLDs). We assessed the relationship between burden metrics and Socio-demographic Index (SDI), a composite measure of development based on fertility, income, and education. FINDINGS: Global meningitis deaths decreased by 21·0% from 1990 to 2016, from 403 012 (95% uncertainty interval [UI] 319 426-458 514) to 318 400 (265 218-408 705). Incident cases globally increased from 2·50 million (95% UI 2·19-2·91) in 1990 to 2·82 million (2·46-3·31) in 2016. Meningitis mortality and incidence were closely related to SDI. The highest mortality rates and incidence rates were found in the peri-Sahelian countries that comprise the African meningitis belt, with six of the ten countries with the largest number of cases and deaths being located within this region. Haemophilus influenzae type b was the most common cause of incident meningitis in 1990, at 780 070 cases (95% UI 613 585-978 219) globally, but decreased the most (-49·1%) to become the least common cause in 2016, with 397 297 cases (291 076-533 662). Meningococcus was the leading cause of meningitis mortality in 1990 (192 833 deaths [95% UI 153 358-221 503] globally), whereas other meningitis was the leading cause for both deaths (136 423 [112 682-178 022]) and incident cases (1·25 million [1·06-1·49]) in 2016. Pneumococcus caused the largest number of YLDs (634 458 [444 787-839 749]) in 2016, owing to its more severe long-term effects on survivors. Globally in 2016, 1·48 million (1·04-1·96) YLDs were due to meningitis compared with 21·87 million (18·20-28·28) DALYs, indicating that the contribution of mortality to meningitis burden is far greater than the contribution of disabling outcomes. INTERPRETATION: Meningitis burden remains high and progress lags substantially behind that of other vaccine-preventable diseases. Particular attention should be given to developing vaccines with broader coverage against the causes of meningitis, making these vaccines affordable in the most affected countries, improving vaccine uptake, improving access to low-cost diagnostics and therapeutics, and improving support for disabled survivors. Substantial uncertainty remains around pathogenic causes and risk factors for meningitis. Ongoing, active cause-specific surveillance of meningitis is crucial to continue and to improve monitoring of meningitis burdens and trends throughout the world. FUNDING: Bill & Melinda Gates Foundation.

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The record

Venue

The Lancet Neurology

Topic

Bacterial Infections and Vaccines

Field

Immunology and Microbiology

Canadian institutions

—

Funders

Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-BicoccaResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesHealth Research Council of New ZealandMerck Sharp and DohmeDebre Markos UniversityKurdistan University Of Medical SciencesPomorski Uniwersytet Medyczny W SzczecinieGolestan University of Medical SciencesMedical Research CouncilDebre Tabor UniversityTartu ÜlikoolTechnische Universität MünchenUniversitair Medisch Centrum GroningenAhvaz Jundishapur University of Medical SciencesAstellas PharmaUniversiti Kebangsaan MalaysiaYork UniversityMazandaran University of Medical SciencesCochrane South AfricaEuropean CommissionAstraZenecaMinistério da Educação e CiênciaIslamic Azad UniversityMinisterio de Educación, Cultura y DeporteBanaras Hindu UniversityUniversitat de ValènciaSeoul National UniversityMonash UniversityMinistério da EducaçãoKuwait UniversityWestern Sydney UniversityMinistry of Education, Science and TechnologyBundesministerium für Bildung und ForschungMinisterio de Economía y CompetitividadAlborz University of Medical SciencesAin Shams UniversityInternational Centre for Diarrhoeal Disease Research, BangladeshRijksuniversiteit GroningenMinistarstvo Prosvete, Nauke i Tehnološkog RazvojaUniversity of AucklandCancer Society of New ZealandSouth African Medical Research CouncilNational Research FoundationShahid Beheshti University of Medical SciencesGlaxoSmithKlineImperial College LondonMeningitis Research FoundationAlexander von Humboldt-StiftungSanofi PasteurJordan University of Science and TechnologyMcMaster UniversityUniversity of OxfordMaragheh University of Medical SciencesHamadan University of Medical SciencesNovavaxUrmia University of Medical SciencesUniversitetet i OsloJohns Hopkins UniversityUNICEFAhmadu Bello UniversityWellcome TrustUrmia UniversityBall State UniversityAlfaisal UniversitySimmons CollegeFundação para a Ciência e a TecnologiaPfizerUniversità degli Studi di MilanoUniversità degli Studi di FirenzeBill and Melinda Gates FoundationWest Virginia UniversityTulane UniversityMaurice Wilkins Centre for Molecular BiodiscoveryDepartment of Science and Technology, Ministry of Science and Technology, IndiaSanofi

Keywords

MedicineMeningitisIncidence (geometry)Disease burdenLife expectancyCase fatality rateBurden of diseaseCause of deathPediatricsDemographyEpidemiologyDiseasePopulationEnvironmental healthInternal medicine

Has abstract in OpenAlex

yes

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