By Marie Rosenthal, MS
The WHO recently published its first global guidelines for meningitis diagnosis, treatment and care, aiming to speed up detection, ensure timely treatment and improve long-term care for patients.
Despite effective treatments and vaccines against some forms of meningitis, the disease remains a significant health threat with an estimated 2.5 million cases reported globally in 2019. This includes 1.6 million cases of bacterial meningitis that resulted in approximately 240,000 deaths (Microorganisms 2021;9[5]:900).
“Bacterial meningitis kills one in six of the people it strikes, and leaves many others with lasting health challenges,” said Tedros Adhanom Ghebreyesus, PhD, MS, the WHO director-general. “Implementing these new guidelines will help save lives, improve long-term care for those affected by meningitis, and strengthen health systems.”
Improving clinical management of meningitis is essential to reducing mortality and morbidity, minimizing long-term complications and disability, and improving quality of life for affected individuals and communities, the WHO said.
The disease burden remains particularly high in low- and middle-income countries and in settings experiencing large epidemics. The highest burden of disease is seen in a region of sub-Saharan Africa, often referred to as the “meningitis belt,” which is at high risk for recurrent epidemics of meningococcal meningitis.
The new guidelines contain evidence-based recommendations for the clinical management of children older than 1 month of age as well as adolescents and adults with acute community-acquired meningitis.
They address all aspects of clinical care including diagnosis, antibiotic therapy, adjunctive treatment, supportive care and management of long-term effects. Given the similarities in clinical presentation, diagnosis and management approaches across different forms of acute community-acquired meningitis, the guidelines address both bacterial and viral causes.
The guidelines provide recommendations for non-epidemic and epidemic settings, the latter superseding previous 2014 WHO guidelines, which covered meningitis outbreak response.
As resource-limited settings bear the highest burden of meningitis, these guidelines have been developed to provide technical guidance suitable for implementation in low- and middle-income countries.
The guidelines are intended for use by healthcare professionals in first- and second-level facilities, including emergency, inpatient and outpatient services. Policymakers, health planners, academic institutions and civil society organizations can also use them to inform capacity-building, education and research efforts, according to the WHO.
The guidelines contribute to the broader Defeating Meningitis by 2030 Global Road Map, adopted by WHO Member States in 2020, which aims to:
- eliminate bacterial meningitis epidemics;
- reduce cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%; and
- reduce disability and improve quality of life after meningitis.
Achieving these goals requires coordinated action across five key areas:
- Diagnosis and treatment: faster detection and optimal clinical management.
- Prevention and epidemic control: developing new affordable vaccines, achieving high immunization coverage, and improving outbreak preparedness and response.
- Disease surveillance: strengthening monitoring systems.
- Care and support for those affected by meningitis: ensuring early recognition and improved access to care and support for aftereffects from meningitis.
- Advocacy and engagement: increasing political commitment and inclusion in country plans, better public understanding of meningitis, and increased awareness of right to prevention, care and after-care services.
With these guidelines, the agency hopes it will provide countries with a critical tool to close gaps in meningitis diagnosis, treatment and care, ensuring that more people receive timely treatment and long-term support.
