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

• Main Authors: Wunrow, Han Yong, Bender, Rose G, Meningitis Antimicrobial Resistance Collaborators, GBD 2019, Vongpradith, Avina, Sirota, Sarah Brooke, Swetschinski, Lucien R, Novotney, Amanda, Gray, Authia P, Ikuta, Kevin S, Sharara, Fablina, Wool, Eve E, Aali, Amirali, Abd-Elsalam, Sherief, Abdollahi, Ashkan, Aziz, Jeza Muhamad Abdul, Abidi, Hassan, Aboagye, Richard Gyan, Abolhassani, Hassan, Abu-Gharbieh, Eman, Adamu, Lawan Hassan, Adane, Tigist Demssew, Addo, Isaac Yeboah, Adegboye, Oyelola A, Adekiya, Tayo Alex, Adnan, Mohammad, Adnani, Qorinah Estiningtyas Sakilah, Afzal, Saira, Aghamiri, Shahin, Aghdam, Zahra Babaei, Agodi, Antonella, Ahinkorah, Bright Opoku, Ahmad, Aqeel, Ahmad, Sajjad, Ahmadzade, Mohadese, Ahmed, Ali, Ahmed, Ayman, Ahmed, Jivan Qasim, Ahmed, Meqdad Saleh, Akinosoglou, Karolina, Aklilu, Addis, Akonde, Maxwell, Alahdab, Fares, AL-Ahdal, Tareq Mohammed Ali, Alanezi, Fahad Mashhour, Albelbeisi, Ahmed Hassan, Alemayehu, Tsegaye Begashaw B, Alene, Kefyalew Addis, Al-Eyadhy, Ayman, Al-Gheethi, Adel Ali Saeed, Ali, Abid, Ali, Beriwan Abdulqadir
• Format: Article
• Language: English
• Subjects: aetiology; global burden of disease; meningitis

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 ove