02 Dec, 2024
In today’s advance world of medicine and immunization still approximately 5 million children died in 2019 with about half in initial 28 days of life.1 One of the causes of mortality in children is infectious meningitis which although is preventable disease but has high fatality and neurological sequelae if not treated at appropriate time and can be a major public health concern as well.2 Meningitis has contributed to higher child mortality rates as estimated by WHO and in accordance to CHAMPS network new study and led by the Barcelona Institute for Global Health (ISGlobal). This study has been published in Journal of Infection and has emphasized on prevalence of drug resistant bacteria in hospital cases and the need of early diagnosis and right treatment to decrease the fatality rate.
Vaccines are available which protect against bacteria that causes meningitis like Hemophilus influenza type B (Hib), Streptococcus pneumoniae and Neisseria meningitidis. WHO aims to eliminate meningitis by 2030 however it needs more understanding of the global impact of the disease and the involved bacteria specifically for meningitis.
Senior author, ICREA researcher and General Director at ISGlobal has stated that meningitis is diagnostically challenging as the symptoms are quite non-specific initially and can resemble other illnesses, and by detecting specific pathogens causing meningitis better utilization of resources can be done to develop new effective vaccines.
Researchers part of this study has performed biopsies using minimally invasive tissue sampling called MITS to get samples from organs or fluids like cerebrospinal fluid, and tissue underwent histopathological examination, molecular testing for about 126 organisms and cultures.3 “After analyzing the data, they found that about 7% of the deaths were due to meningitis and higher incidence was seen in newborns which could be attributed to vertical transmission of the pathogens and lack of protective measures taken during delivery. Also their immature immune system make them more vulnerable to infections” says Sara Ajanovic, ISGlobal researcher and co-author of the study.
The deaths caused due to meningitis in hospital and community the microbiological profile varied. The common bacteria seen in hospital setting were Acinetobacter baumannii and Klebsiella pneumoniae. They are often multi-drug resistant which means infection prevention practices should be stringently followed in hospitals to reduce multi-drug resistant bugs. This also implies that without appropriate antibiotics mortality will remain high in children due to meningitis. Also due to vaccination there is decrease in trend of S. pneumoniae and Hib causing meningitis and a shift is seen towards klebsiella and Acinetobacter questioning the current empirical antibiotic guidelines and probably requiring newer ones soon.
Very less children had undergone lumbar-puncture the gold standard technique for diagnosing meningitis- this shows that there is urgent need to inculcate this diagnostic method to prevent missing of this disease.
The changing pathogen profile and increase in resistance warrants development of new vaccine against these new emerging pathogens and newer antibiotic guidelines for the management to prevent fatality.3
References:
- World Health Organization. Children: improving survival and well-being; 2020.
- Perin J, Mulick A, Yeung D, Villavicencio F, Lopez G, Strong KL, Prieto-Merino D, Cousens S, Black RE, Liu L. Global, regional, and national causes of under-5 mortality in 2000–19: an updated systematic analysis with implications for the Sustainable Development Goals. The Lancet Child & Adolescent Health. 2022 Feb 1;6(2):106-15.
- Sana Mahtab et al, Etiologies and comorbidities of meningitis deaths in children under 5 years in high-mortality settings: Insights from the CHAMPS Network in the post-pneumococcal vaccine era, Journal of Infection (2024)