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

Joseph Raymond Zunt, Nicholas J. Kassebaum, Natacha Blake, Linda Glennie, Claire Wright, Emma Nichols, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Abdu A. Adamu, Mina G. Adib, Alireza Ahmadi, Muktar Beshir Ahmed, Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, Nadia Akseer, Rajaa M. Al-Raddadi, Fares Alahdab, Kefyalew Addis AleneSyed Mohamed Aljunid, Mohammad A. AlMazroa, Khalid Altirkawi, Nelson Alvis-Guzman, Megbaru Debalkie Animut, Mina Anjomshoa, Mustafa Geleto Ansha, Rana Jawad Asghar, Euripide F.G.A. Avokpaho, Ashish Awasthi, Hamid Badali, Aleksandra Barac, Till Winfried Bärnighausen, Quique Bassat, Neeraj Bedi, Abate Bekele Belachew, Krittika Bhattacharyya, Zulfiqar A. Bhutta, Ali Bijani, Zahid A. Butt, Félix Carvalho, Carlos A. Castañeda-Orjuela, Abdulaal Chitheer, Jee Young J. Choi, Devasahayam J. Christopher, Anh Kim Dang, Ahmad Daryani, Gebre Teklemariam Demoz, Shirin Djalalinia, Huyen Phuc Do, Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken, Maysaa El Sayed Zaki, Iqbal RF Elyazar, Hamed Fakhim, Eduarda Fernandes, Florian Fischer, Takeshi Fukumoto, Morsaleh Ganji, Abadi Kahsu Gebre, Afewerki Gebremeskel, Bradford D. Gessner, Sameer Vali Gopalani, Yuming Guo, Rahul Gupta, Gessessew Bugssa Hailu, Arvin Haj-Mirzaian, Samer Hamidi, Simon I. Hay, Andualem Henok, Seyed Sina Naghibi Irvani, Ravi Prakash Jha, Mikk JÜRISSON, Amaha Kahsay, Manoochehr Karami, André Karch, Amir Kasaeian, Getachew Mullu Kassa, Tesfaye Dessale Dessale Kassa, Adane Teshome Kefale, Yousef Saleh Khader, Ibrahim A. Khalil, Ejaz Ahmad Khan, Young Ho Khang, Jagdish Khubchandani, Ruth W. Kimokoti, Adnan Kisa, Faris Hasan Lami, Miriam Levi, Shanshan Li, Clement T. Loy, Marek Majdan, Azeem Majeed, Lorenzo Giovanni Mantovani, Francisco Rogerlândio Martins-Melo, Colm Mcalinden, Varshil Mehta, Addisu Melese, Ziad A. Memish, Desalegn Tadese Mengistu, Getnet Mengistu, Tomislav Mestrovic, Haftay Berhane Mezgebe, Bartosz Miazgowski, Branko Milosevic, Ali H. Mokdad, Lorenzo Monasta, Ghobad Moradi, Paula Moraga, Seyyed Meysam Mousavi, Ulrich Otto Mueller, Srinivas Murthy, Ghulam Mustafa, Aliya Naheed, Gurudatta Naik, Charles Richard James Newton, Yirga Legesse Nirayo, Molly R. Nixon, Richard Ofori-Asenso, Felix Akpojene Ogbo, Andrew T. Olagunju, Tinuke O. Olagunju, Bolajoko Olubukunola Olusanya, Justin R. Ortiz, Mayowa Ojo Owolabi, Shanti Patel, Gabriel D. Pinilla-Monsalve, Maarten J. Postma, Mostafa Qorbani, Alireza Rafiei, Vafa Rahimi-Movaghar, Robert C. Reiner, Andre M.N. Renzaho, Mohammad Sadegh Rezai, Kedir Teji Roba, Luca Ronfani, Gholamreza Roshandel, Ali Rostami, Hosein Safari, Saeed Safari, Saeid Safiri, Rajesh Sagar, Abdallah M. Samy, Milena M. Santric Milicevic, Benn Sartorius, Shahabeddin Sarvi, Monika Sawhney, Sonia Saxena, Azadeh Shafieesabet, Masood Ali Shaikh, Mehdi Sharif, Mika Shigematsu, Si Si, Eirini Skiadaresi, Mari Smith, Ranjani Somayaji, Mu'awiyyah Babale Sufiyan, Nega Yimer Tawye, Mohamad Hani Temsah, Miguel Tortajada-Girbés, Bach Xuan Tran, Khanh Bao Tran, Kingsley Nnanna Ukwaja, Irfan Ullah, Isidora S. Vujcic, Fasil Shiferaw Wagnew, Yasir Waheed, Kidu Gidey Weldegwergs, Andrea Sylvia Winkler, Charles Shey Wiysonge, Alison B. Wiyeh, Grant M.A. Wyper, Ebrahim M. Yimer, Naohiro Yonemoto, Zoubida Zaidi, Zerihun Menlkalew Zenebe, Valery L. Feigin, Theo Vos, Christopher J.L. Murray

Research output: Contribution to journalArticlepeer-review

74 Scopus citations

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.
Original languageEnglish (US)
Pages (from-to)1061-1082
Number of pages22
JournalThe Lancet Neurology
Volume17
Issue number12
DOIs
StatePublished - Dec 1 2018
Externally publishedYes

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