Epidemiology and Clinical Outcomes of Bacterial Meningitis in Children and Adults in Low- and Middle-Income Countries

Abstract

Purpose of review: Despite the availability of effective vaccines against the three primary pathogens (Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis) that cause bacterial meningitis, this condition remains a significant cause of morbidity, neurologic sequelae, and mortality among children and adults living in low-income and middle-income countries.

Recent findings: Bacterial meningitis represents a significant public health challenge for national and global health systems. Since vaccine-preventable meningitis remains highly prevalent in low-income and middle-income countries, the World Health Organization (WHO) recently developed a global roadmap to defeating meningitis by 2030 and ameliorating its associated neurological sequelae.

Summary: There is a need for a global approach to surveillance and prevention of bacterial meningitis. Increasing vaccination coverage with conjugate vaccines against pneumococcus and meningococcus with optimal immunization schedules are high-value healthcare interventions. Additionally, overcoming diagnostic challenges and the early institution of empirical antibiotic therapy and, when feasible, adjunctive steroid therapy constitutes the pillars of reducing the disease burden of bacterial meningitis in resource-limited settings.

Keywords: Adults; Bacterial meningitis; Children; Haemophilus influenzae b; Low- and middle-income countries; Neisseria meningitidis; Streptococcus pneumoniae.

Fig. 1

Incidence rates of bacterial meningitis in the tropics and subtropics *Figure adapted and modified from 2. Source: WHO GIS Centre for Health. **Most low-income and lower-middle-income countries are geographically located in the tropics (between the Tropic of Capricorn [23°27′ degrees south of the equator] and the Tropic of Cancer [23°27’ degrees north of the equator]) and the subtropics