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World Meningitis Day and the World Health Organization’s roadmap to defeat bacterial meningitis in the COVID-19 pandemic era

Open AccessPublished:April 28, 2021DOI:https://doi.org/10.1016/j.ijid.2021.04.070
      World Meningitis Day, which happens every year on April 24th, reminds us that despite the huge threat imposed by the COVID-19 pandemic worldwide, there are many other challenging infectious diseases that should not be neglected. More than 2.5 million cases and 236,000 deaths due to meningitis were reported in 2019 (
      • Global Burden of Disease Collaborative Network
      Global burden of disease study 2019 (GBD 2019) results.
      ), and acute bacterial meningitis is the most common bacterial infection of the central nervous system. The largest burden of meningitis is seen in children up to 5 years old and in low- and middle-income countries, especially in the meningitis belt of sub-Saharan Africa. However, outbreaks of the disease occur in all continents of the world, showing that this is a matter of global public health (
      • Zainel A.
      • Mitchell H.
      • Sadarangani M.
      Bacterial meningitis in children: neurological complications, associated risk factors, and prevention.
      ,
      • Wall E.C.
      • Chan J.M.
      • Gil E.
      • Heyderman R.S.
      Acute bacterial meningitis.
      ).
      The World Health Organization roadmap on defeating meningitis by 2030 tackles the main causes of acute bacterial meningitis, including Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae and Streptococcus agalactiae (group B Streptococcus, GBS), which together are responsible for more than 90% of all acute bacterial meningitis cases. With the goals to eliminate outbreaks and epidemics, reduce the number of cases and deaths, as well as improve quality of life after meningitis, the roadmap is based on 5 pillars: prevention and epidemic control, diagnosis and treatment, disease surveillance, support and care for people affected by meningitis, and advocacy and engagement (
      • WHO
      Defeating bacterial meningitis by 2030.
      ).
      Vaccination is a key aspect of the World Health Organization’s roadmap. Introduction and expansion of vaccination against meningococcus, pneumococcus and H. influenzae has drastically reduced meningitis-related cases (
      • Rodgers E.
      • Bentley S.D.
      • Borrow R.
      • Bratcher H.B.
      • Brisse S.
      • Brueggemann A.B.
      • et al.
      The global meningitis genome partnership.
      ,
      • Zainel A.
      • Mitchell H.
      • Sadarangani M.
      Bacterial meningitis in children: neurological complications, associated risk factors, and prevention.
      ,
      • Wall E.C.
      • Chan J.M.
      • Gil E.
      • Heyderman R.S.
      Acute bacterial meningitis.
      ). Nearly 50% and 70% of countries worldwide currently have high coverage (≥80%) for pneumococcal and H. influenzae vaccines, respectively (
      • International Vaccine Access Center (IVAC)
      Johns Hopkins Bloomberg School of Public Health. VIEW-hub.
      ). However, the case fatality rate of meningitis has remained the same, and most of these vaccines confer protection to only a portion of serogroups or serotypes that can be found within these bacterial species, raising concerns about the emergence of non-vaccine variants (
      • Zainel A.
      • Mitchell H.
      • Sadarangani M.
      Bacterial meningitis in children: neurological complications, associated risk factors, and prevention.
      ,
      • Wall E.C.
      • Chan J.M.
      • Gil E.
      • Heyderman R.S.
      Acute bacterial meningitis.
      ). In addition, antimicrobial resistance is an emerging and concerning aspect in most, if not all, of the 4 major meningitis-related pathogens (
      • WHO
      Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics.
      ,
      • CDC
      Antibiotic resistance threats in the United States, 2019.
      ).
      As the COVID-19 pandemic has shown, improving prevention, diagnosis and surveillance of a global public health threat demands global cooperation. In this regard, global surveillance of meningitis needs to be expanded, particularly in low- and middle-income countries with high disease rates. Meningitis surveillance in the meningitis belt of sub-Saharan Africa has been supported by the MenAfriNet consortium, established in 2014 (
      • Patel J.C.
      • Soeters H.M.
      • Oumar Diallo A.
      • Bicaba B.W.
      • Kadadé G.
      • Dembélé A.Y.
      • et al.
      MenAfriNet Consortium. MenAfriNet: a network supporting case-based meningitis surveillance and vaccine evaluation in the meningitis belt of Africa.
      ). Worldwide, a Global Meningitis Genome Partnership has been formed to improve strain identification and global tracking of meningococcus, pneumococcus, H. influenzae and GBS (
      • Rodgers E.
      • Bentley S.D.
      • Borrow R.
      • Bratcher H.B.
      • Brisse S.
      • Brueggemann A.B.
      • et al.
      The global meningitis genome partnership.
      ). Whole-genome sequencing data can enable a more effective public health response to bacterial meningitis pathogens by contributing to improved diagnosis, improved knowledge on pathogen evolution and optimization or development of vaccines.
      There are, however, other external and maybe unpredictable variables that can affect the already dynamic epidemiology of infectious diseases, which underline the importance of a global and sustained surveillance approach. As a contagious human-to-human spread disease, the development of bacterial meningitis and transmission of related pathogens is dependent on close contact between the source and the susceptible host, which can be favored in crowded environments and cooler seasons. Anthropogenic-related climate change may have an impact on meningitis incidence (
      • Mazamay S.
      • Broutin H.
      • Bompangue D.
      The environmental drivers of bacterial meningitis epidemics in the Democratic Republic of Congo, central Africa.
      ). Moreover, measures implemented worldwide to mitigate the spread of SARS-CoV2, such as increased use of antiseptics and disinfectants and social distancing, can reduce meningitis incidence (
      • Luciani L.
      • Ninove L.
      • Zandotti C.
      • Nougairede A.
      COVID-19 pandemic and its consequences disrupt epidemiology of enterovirus meningitis, South-East France.
      ). On the other hand, the viral infection itself may represent an opportunity for secondary bacterial infections (
      • Singh V.
      • Upadhyay P.
      • Reddy J.
      • Granger J.
      SARS-CoV-2 respiratory co-infections: incidence of viral and bacterial co-pathogens.
      ). Furthermore, the widespread use of antibiotics during the pandemic may promote the emergence and dissemination of antimicrobial resistance among bacterial pathogens (
      • Lucien M.A.B.
      • Canarie M.F.
      • Kilgore P.E.
      • Jean-Denis G.
      • Fénélon N.
      • Pierre M.
      • et al.
      Antibiotics and antimicrobial resistance in the COVID-19 era: perspective from resource-limited settings.
      ), including those associated with acute bacterial meningitis.
      Although undeniably complex, the scenario imposed by COVID-19 has strengthened our efforts and capacity for global public health response, showing that coordinated actions are needed to tackle infectious diseases effectively. This World Meningitis Day amid the COVID-19 pandemic is a moment to reflect and consider that although the present is a result of the past, it is the greatest resource to lead us to a better future.

      Conflict of interest

      The authors declare no conflict of interest.

      Funding source

      This manuscript did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      Ethical approval

      Not applicable.

      Acknowledgments

      We acknowledge and thank the ISID Emerging Leaders Program for fostering the career of the next global leaders in international infectious diseases.

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