TOPLINE:

Meningitis was responsible for 259,000 deaths globally in 2023, with children younger than 5 years accounting for more than a third of fatalities, new research showed. Although these represented substantial declines since 1990, progress is insufficient toward meeting the World Health Organization (WHO)’s reduction targets for meningitis by 2030.

METHODOLOGY:

• Researchers estimated mortality and morbidity rates for meningitis using data from the GBD 2023 study, which was conducted in 204 countries and territories from 1990 to 2023. Mortality data were obtained from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling; morbidity data were obtained from a systematic review of published studies, surveillance data, cause-specific mortality estimates, claims, and inpatient data.
• Overall, 17 pathogen categories were assessed, including Acinetobacter baumannii, Candida species, coagulase-negative staphylococci, nonpolio enteroviruses, other Streptococcus species, as well as other fungi, bacteria, and viruses.
• Etiology-specific estimates were generated using records of multiple causes of death, hospital discharge data and data linkage, published literature, and microbiological and mortality surveillance data. Risk factors for meningitis-related deaths were assessed.
• The analysis also focused on four WHO-defined vaccine-preventable meningitis pathogens (S pneumoniae, Neisseria meningitidis, Hemophilus influenzae, and group B Streptococcus) to assess progress toward the organization’s global roadmap targets, which include 50% reduction in infections and 70% reduction in deaths by 2030.

TAKEAWAY:

• Overall, 2.5 million incident cases of meningitis and 259,000 all-age deaths due to meningitis occurred globally in 2023, with all-age mortality rates declining by 25% since 2015 and by 63.5% since 1990. Children younger than 5 years had the largest burden, with 86,600 deaths and 953,000 incident cases in 2023. Mortality and incidence rates were similar between men and women.
• The four WHO-defined preventable pathogens of interest contributed to 98,700 deaths and 594,000 incident cases in 2023. Annualized decline rates were 4% for deaths and 2% for incidence between 2015 and 2023, falling short of the 8% and 5% annual reductions, respectively, needed to meet WHO’s 2030 global targets.
• S pneumoniae was the leading cause of global meningitis-specific mortality in 2023, followed by N meningitidis, nonpolio enteroviruses, and other viruses; nonpolio enteroviruses were the leading cause of incident cases of meningitis. Nigeria had the highest rates of both all-age meningitis-specific mortality (30 per 100,000 persons) and incidence (239 per 100,000 persons).
• Globally, low birth weight, a short gestation period, and household air pollution were the major risk factors contributing to meningitis-specific mortality in 2023, with the related mortality rates decreasing by 74%, 72%, and 70.5% since 1990.

IN PRACTICE:

“Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens…and to emerging nonbacterial pathogens,” the investigators wrote. 

The author of an accompanying editorial added that there’s a need for “continued political and financial commitment to improve global access to medical care, effective strategies to combat antimicrobial resistance, and improved therapeutic options. More effort and new vaccines will be needed to accelerate progress to reach the 2030 WHO targets.”

SOURCE:

The study was led by Sarah Brooke Sirota and Rose Grace Bender, Institute for Health Metrics and Evaluation, University of Washington, Seattle. The accompanying editorial was authored by Merijn W. Bijlsma, Emma Children’s Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands. Both articles were published online on March 27 in The Lancet Neurology.

LIMITATIONS:

Limitations included the low availability of meningitis data in low-resource settings, potential inaccuracy of meningitis diagnosis in neonates and infants and potential underestimation of viral meningitis, and the use of a one-cause-per-death approach. Additionally, annual estimates did not account for seasonal and regional outbreak patterns, limiting the ability to assess the efficacy of control measures. 

DISCLOSURES:

The study was funded by the Gates Foundation, the Wellcome Trust, and the UK Department of Health and Social Care. Disclosure information for the study authors is available in the original study publication. The editorialist reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.