Incidence and aetiology of bacterial meningitis among children aged 1–59 months in South Asia: systematic review and meta-analysis

Mohsin Ali, Brian A. Chang, Kipp W. Johnson, Shaun K. Morris

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations


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 (I 2 > 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.

Original languageEnglish
Pages (from-to)5846-5857
Number of pages12
Issue number39
StatePublished - 18 Sep 2018


  • Aetiology
  • Bacterial meningitis
  • Bangladesh
  • Bhutan
  • Epidemiology
  • Haemophilus influenzae type b
  • Incidence
  • India
  • Meta-analysis
  • Neisseria meningitidis
  • Nepal
  • Pakistan
  • South Asia
  • Sri Lanka
  • Streptococcus pneumoniae
  • Systematic review


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