By IDSE News Staff
Meningitis contributes to higher child mortality rates than estimated by the WHO, according to a new study by the CHAMPS network and led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by "la Caixa" Foundation.
In addition, the findings indicate a shift in the landscape of pathogens associated with meningitis, with an increase of pathogens like Klebsiella pneumoniae and Acinetobacter baumannii, alongside a decline in Streptococcus pneumoniae and Haemophilus influenzae type B (Hib) due to vaccination efforts. This shift, the authors point out, "challenges the foundations of current empirical antibiotic guidelines."
CHAMPS' findings suggest that meningitis contributes to higher child mortality rates (7%) than the WHO's estimate of 5.1%. Critically, many of these cases had not been recognized as meningitis before death, highlighting the need for faster diagnosis and treatment to prevent fatalities. Less than one-fourth of all confirmed meningitis cases had undergone a lumbar puncture; better diagnostics that are deployed earlier are needed to avoid missing cases of this life-threatening infection, according to Quique Bassat, MD, PhD, an ICREA researcher and the general director at ISGlobal, as well as senior author of the study.
The study shows a high prevalence of drug-resistant bacteria in hospital cases, highlighting the need for earlier suspicion and faster diagnosis with appropriate treatment to reduce mortality, the study found
Meningitis remains a serious condition, especially for young children, with high death rates and lasting neurologic effects in survivors. Vaccines can protect against the most common types of meningitis-causing bacteria, such as Hib, S. pneumoniae and Neisseria meningitidis, but does not help against the other pathogens. Yet, reaching the WHO’s goal to eliminate meningitis by 2030 requires a better understanding of the global impact of this disease and the specific pathogens involved, according to the report.
“Meningitis poses a diagnostic challenge due to its nonspecific symptoms, which often resemble those of other serious illnesses,” Dr. Bassat said. “Identifying the specific pathogens behind meningitis cases would allow us to make a better use of resources and guide the development of new, highly awaited vaccines.”
The study drew on data from the CHAMPS network, which is conducting an in-depth investigation into causes of childhood deaths in seven countries: Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa. Using a technique called MITS (minimally invasive tissue sampling), researchers performed biopsies to obtain samples of key organs or fluids, including cerebrospinal fluid, followed by histopathologic examination, molecular testing for 126 pathogens and microbiological cultures.
The study found that meningitis was a contributing factor in 7% of the 3,857 deaths analyzed. The highest proportions of child deaths due to meningitis were observed in South Africa (16.6%) and Ethiopia (15.6%), followed by Mali and Sierra Leone. Most of these deaths (66%) occurred in newborns, with the remaining cases diagnosed in older infants and young children. "The higher incidence among newborns may be due to the vertical transmission of pathogens infecting their mothers, and the lack of specific strategies to protect them during delivery. Additionally, their underdeveloped immune systems also confer a higher vulnerability,” said Sara Ajanovic, MD, MSc, PhD, an ISGlobal researcher and co-author of the study.
The prevalence of pathogens associated with meningitis deaths in the hospital and in the community varied among regions. However, the most common pathogens were Acinetobacter baumannii and Klebsiella pneumoniae, particularly in deaths occurring in healthcare settings where these multidrug-resistant bacteria are often acquired. Better infection prevention practices in hospitals are sorely needed to reduce these meningitis cases. Worryingly, it also means that without the appropriate antibiotics, the risk for dying from meningitis remains high.
Almost half of meningitis deaths occurred at the community level, likely due to limited access to healthcare. Although vaccines have significantly reduced cases of S. pneumoniae, this bacterium still caused many of the community-acquired cases of meningitis, the epidemiologists said.
Although vaccination has had a positive impact on meningitis cases, Dr. Ajanovic said new vaccines against emerging pathogens like K. pneumoniae are sorely needed.
