Global, regional, and national burden of meningitis and its aetiologies, 1990–2019
Published July 20, 2023, in The Lancet Neurology (opens in a new window)
In 2019, there were an estimated 236,000 deaths due to meningitis globally.
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.
Citation
GBD 2019 Meningitis Antimicrobial Resistance Collaborators. Global, regional, and national burden of meningitis and its aetiologies, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology. 19 July 2023. doi: 10.1016/S1474-4422(23)00195-3.
Authors
- Han Wunrow,
- Rose Bender,
- Hmwe Hmwe Kyu,
- Mohsen Naghavi,
- Christopher J.L. Murray,
- Simon Hay,
- Avina Vongpradith,
- Sarah Sirota,
- Lucien Swetschinski,
- Amanda Novotney,
- Authia Gray,
- Kevin Ikuta,
- Eve Wool,
- Aleksandr Aravkin,
- Katrin Burkart,
- Xiaochen Dai,
- Lalit Dandona,
- Rakhi Dandona,
- Regina-Mae Dominguez,
- Mohammed Hassen,
- Stephen Lim,
- Tomislav Mestrovic,
- Ali Mokdad,
- Hasan Nassereldine,
- Bobby Reiner,
- Theo Vos,
- Dereje Yohannis Yada,
- Peng Zheng
Datasets
All our datasets are housed in our data catalog, the Global Health Data Exchange (GHDx). Visit the GHDx to download data from this article.