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Meta-Analysis
. 2019 Apr 20;9(4):e024343.
doi: 10.1136/bmjopen-2018-024343.

Serogroup-specific meningococcal carriage by age group: a systematic review and meta-analysis

Meagan E Peterson  1 , You Li  1 , Heather Shanks  1 , Rebecca Mile  1 , Harish Nair  2 , Moe H Kyaw  3 ; Meningococcal Carriage Group
Collaborators, Affiliations
Meta-Analysis

Serogroup-specific meningococcal carriage by age group: a systematic review and meta-analysis

Meagan E Peterson et al. BMJ Open. .

Abstract

Objective: Neisseria meningitidis carriage prevalence has known variation across the lifespan, but it is unclear whether carriage varies among meningococcal capsular groups. Therefore, we aimed to characterise group-specific meningococcal carriage by age group and world region from 2007 to 2016.

Design: Systematic review and meta-analysis.

Data sources: MEDLINE, Embase, Global Health Database, WHO Global Health Library, Web of Science, Current Contents Connects, China National Knowledge Infrastructure and Wanfang were systematically searched. Database searches were conducted through July 2018 and Google Scholar forward searches of included studies were conducted through August 2018. References of included studies and relevant conference abstracts were also searched to identify additional articles for inclusion.

Eligibility criteria: Studies were eligible for inclusion if they reported capsular group-specific meningococcal carriage in a healthy population of a specified age group and geographical region. For this review, only studies conducted between 2007 and 2016 were included.

Data extraction and synthesis: Data were independently extracted by two authors into Microsoft Access. Studies were assessed for risk of bias using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Studies eligible for inclusion in quantitative analyses by pre-specified age groups were pooled using random effects meta-analyses. Results are reported by capsular group, age group and WHO region. Where meta-analyses were not appropriate, study results were discussed narratively.

Results: 7511 articles were identified and 65 were eligible for inclusion. Adolescents and young adults were the focus of many studies (n=24), especially in the Americas and Europe. Studies from China and Africa, typically, included data from a wider age range. The overall carriage prevalence varied markedly by age group and region. Based on the available data, 21 studies were included in meta-analyses reporting serogroup carriage for: all ages in Africa, 18-24-year olds in the Americas, and 11-17 and 18-24-year olds in Europe. Capsular groups W, X, Y and 'other' (non-ABCWXY, including non-groupable) were the most prevalent in Africa, and 5-17-year olds had higher carriage prevalence than other age groups. 'Other' serogroups (11.5%, 95% CI 1.6% to 16.1%) were the most common among 18-24-year olds from the Americas. In Europe, 18-24-year old were carriers more frequently than 11-17-year olds, and groups B (5.0%, 95% CI 3.0% to 7.5%), Y (3.9%, 95% CI 1.3% to 7.8%) and 'other' (6.4%, 95% CI 3.1% to 10.8%) were the most commonly carried in the older age group.

Conclusions: Of the age groups included in the analysis, carriage patterns by age were similar across capsular groups within a region but differed between regions. Data gaps remain for age- and capsular group-specific carriage in many regions, especially in the Eastern Mediterranean and South-East Asia. As such, clear and robust conclusions about the variation of capsular group-specific carriage by age group and WHO region were unable to be determined.

Prospero registration number: CRD42017074671.

Keywords: Neisseira meningitidis; carriage; serogroup.

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Conflict of interest statement

Competing interests: MHK is an employee of Sanofi Pasteur. CDB reports grants from Sanofi Pasteur for a study that contributed to the analysis, non-financial support from GSK outside of the submitted work, and grants from Roche outside of the submitted work. SE reports grants and personal fees from GSK, Sanofi Aventis, and Merck; grants from Pfizer, Novartis, DMG, and Valeas; and personal fees from Seqirus outside of the submitted work. FR reports grants paid to a charitable association from Pfizer, GSK, and MSD outside of the submitted work. All other authors have no competing interests to declare. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of included studies.
Figure 2
Figure 2
Meningococcal carriage in the African region across the lifespan (in years) stratified by serogroup. The number of data points included for each age meta-estimate are reported after the age group label. ‘Other’ includes both non-encapsulated and other capsulated (eg, E, Z).
Figure 3
Figure 3
Meningococcal carriage in the region of the Americas in 18–24-year olds stratified by serogroup. The number of data points included for each age meta-estimate are reported after the age group label. ‘Other’ includes both non-encapsulated and other capsulated (eg, E, Z).
Figure 4
Figure 4
Meningococcal carriage in the European region in 11–17-year olds and 18–24-year olds stratified by serogroup. The number of data points included for each age meta-estimate are reported after the age group label. ‘Other’ includes both non-encapsulated and capsulated (eg, E, Z).
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