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Incidence and aetiology of bacterial meningitis among children aged 1-59 months in South Asia: systematic review and meta-analysis.
Ali, Mohsin; Chang, Brian A; Johnson, Kipp W; Morris, Shaun K.
Afiliación
  • Ali M; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA.
  • Chang BA; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA.
  • Johnson KW; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA; Institute for Next Generation Healthcare, Icahn Institute for Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA.
  • Morris SK; Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada; Centre for Global Child Health, Hospital for Sick Children Research Institute, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada. Electronic address: shaun.morris@sickkids.ca.
Vaccine ; 36(39): 5846-5857, 2018 09 18.
Article en En | MEDLINE | ID: mdl-30145101
BACKGROUND: Bacterial meningitis is a significant cause of morbidity and mortality worldwide among children aged 1-59 months. We aimed to describe its burden in South Asia, focusing on vaccine-preventable aetiologies. METHODS: We searched five databases for studies published from January 1, 1990, to April 25, 2017. We estimated incidence and aetiology-specific proportions using random-effects meta-analysis. In secondary analyses, we described vaccine impact and pneumococcal meningitis serotypes. RESULTS: We included 48 articles cumulatively reporting 20,707 cases from 1987 to 2013. Mean annual incidence was 105 (95% confidence interval [CI], 53-173) cases per 100,000 children. 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%). These meta-analyses had substantial between-study heterogeneity (I2 > 78%, P < 0.0001). Among studies reporting only confirmed cases, these three bacteria caused a median of 78% cases (IQR, 50-87%). Hib meningitis incidence declined by 72-83% at sentinel hospitals in Pakistan and Bangladesh, respectively, within two years of implementing nationwide vaccination. On average, PCV10 covered 49% (95% CI, 39-58%), PCV13 covered 51% (95% CI, 40-61%), and PPSV23 covered 74% (95% CI, 67-80%) of pneumococcal meningitis serotypes. Lower PCV10 and PCV13 serotype coverage in Bangladesh was associated with higher prevalence of serotype 2, compared to India and Pakistan. CONCLUSIONS: 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vacunas Bacterianas / Meningitis Bacterianas Tipo de estudio: Incidence_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Child, preschool / Female / Humans / Infant / Male / Newborn País/Región como asunto: Asia Idioma: En Revista: Vaccine Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Países Bajos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vacunas Bacterianas / Meningitis Bacterianas Tipo de estudio: Incidence_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Child, preschool / Female / Humans / Infant / Male / Newborn País/Región como asunto: Asia Idioma: En Revista: Vaccine Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Países Bajos