South Asia has relatively high incidence of bacterial meningitis among children aged 1-59 months

Objectives:
What is the incidence of bacterial meningitis among children aged 1-59 months in South Asia, focusing on vaccine-preventable aetiologies?  

Study design:
This review article included 48 articles cumulatively reporting 20,707 cases of bacterial meningitis from 1987 to 2013.

Results and conclusions:
The investigators found meta-analyses showed mean annual incidence of bacterial meningitis was 105 [95% CI = 53-173, I2 > 78%, p  0.0001] cases per 100,000 children.

The investigators found on average, Haemophilus influenzae type b (Hib) accounted for 13% [95% CI = 8-19%] of cases, pneumococcus for 10% [95% CI = 6-15%] and meningococcus for 1% [95% CI = 0-2%].
Among studies reporting only confirmed cases, these three bacteria caused a median of 78% cases [IQR = 50-87%].

The investigators found Haemophilus influenzae type b (Hib) meningitis incidence declined by 72-83% at sentinel hospitals in Pakistan and Bangladesh, respectively, within two years of implementing nationwide vaccination.

The investigators found on average, pneumococcal conjugate vaccine 10 (PCV10) covered 49% [95% CI = 39-58%], 13-valent pneumococcal protein-conjugate vaccine (PCV13) covered 51% [95% CI = 40-61%] and 3-valent pneumococcal polysaccharide vaccine (PPSV23) covered 74% [95% CI = 67-80%] of pneumococcal meningitis serotypes.

The investigators found lower PCV10 and PCV13 serotype coverage in Bangladesh was associated with higher prevalence of serotype 2, compared to India and Pakistan.

The investigators concluded South Asia has relatively high incidence of bacterial meningitis among children aged 1-59 months, with vaccine-preventable bacteria causing a substantial proportion. These estimates are likely underestimates due to multiple epidemiological and microbiological factors. Further research on vaccine impact and distribution of pneumococcal serotypes will inform vaccine policymaking and implementation.

Original title:
Incidence and aetiology of bacterial meningitis among children aged 1-59 months in South Asia: systematic review and meta-analysis by Ali M, Chang BA1, […], Morris SK.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30145101

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