A systematic review and meta-analysis of meningococcal disease burden in India
In India, while vaccination remains a pivotal tool in infectious disease prevention, meningococcal vaccines are specifically recommended for high-risk groups or during outbreaks, not for routine immunization due to reported low numbers. Understanding the epidemiology is crucial for health priorities and interventions, and meningococcal meningitis has manifested in India across diverse situations, from sporadic cases to extensive epidemics affecting all age groups. Despite individual studies, no quantitative data pooling has been conducted to determine the overall prevalence and fatality in India.
This systematic review and meta-analysis offer insights into the disease's presence in both epidemic and endemic conditions. The prevalence of meningococcal meningitis is reported at 12.1% in epidemics and 0.76% in endemic situations, with a fatality rate of 12.8% in epidemic settings. Notably, N. meningitis contributes to 3.2% of acute bacterial meningitis cases in endemic settings. This study underscores the endemic and epidemic nature of meningococcal disease in India, emphasizing the urgency for continuous monitoring and immunization efforts, particularly given the high fatality rates and prevalence of Serogroup A.
Abstract
Objective:
To perform a systematic review and meta-analysis of meningococcal disease burden in India.
Methods:
We searched publications on meningococcal disease in India between 1996 and 2020 using PubMed and Google Scholar. Prevalence (proportion) of Meningococcal meningitis and Case-fatality ratio (CFR) were pooled using a random effects model. Other outcomes were pooled qualitatively.
Results:
The prevalence of Meningococcal meningitis in epidemic and endemic conditions was 12.1% (95% CI: 5.2-21.4) and 0.76% (95% CI: 0.3-1.4), respectively, with a CFR of 12.8% (95% CI: 6.8-20.4) in epidemic settings; N. meningitis caused 3.2% (95% CI: 1.6-5.3) of Acute Bacterial Meningitis (ABM) cases in endemic settings. The disease appeared in infants, adolescents, and adults with Serogroup A prevalence. Treatment and prophylaxis were limited to antibiotics despite increased resistance.
Conclusion:
The study reveals the epidemic and endemic presence of the disease in India with high fatality and serogroup A prevalence. Further monitoring and immunization are required to prevent outbreaks.
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