Case-fatality and sequelae following acute bacterial meningitis in South Africa, 2016 through 2020

Int J Infect Dis. 2022 Sep:122:1056-1066. doi: 10.1016/j.ijid.2022.07.068. Epub 2022 Aug 5.

Abstract

Objectives: Providing country-specific estimates of case fatality and sequelae from bacterial meningitis (BM) is important to evaluate and monitor progress toward the World Health Organization's roadmap to "defeating meningitis by 2030".

Methods: From 2016-2020, GERMS-SA conducted enhanced surveillance at 26 hospitals across South Africa. Episodes of laboratory-confirmed BM due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis were included. Risk factors for in-hospital death and sequelae at hospital discharge among survivors were analyzed.

Results: Of 12,717 invasive bacterial infections reported nationally, 39% (4980) were from enhanced surveillance sites, including 4159 pneumococcal, 640 H. influenzae, and 181 meningococcal infections. BM accounted for 32% (1319/4159) of pneumococcal, 21% (136/640) of H. influenzae, and 83% (151/181) of meningococcal invasive diseases. Clinical data were available for 91% (1455/1606) of BM: 26% (376/1455) were aged <5 years, 50% (726/1455) were female, and 62% (723/1171) with known HIV results, were HIV-infected. In-hospital case fatality was 37% (534/1455), and 24% (222/921) of survivors had adverse sequelae. Risk factors for death included altered mental status, HIV infection, and comorbidities. Risk factors for adverse sequelae included altered mental status and antimicrobial nonsusceptibility.

Conclusion: BM in South Africa has a high case fatality, and adverse sequelae frequently occur among survivors. Those with comorbidities (including HIV) are at the highest risk.

Keywords: Complications; Haemophilus influenzae; Meningitis; Mortality; Neisseria meningitidis; Streptococcus pneumoniae.

MeSH terms

  • Disease Progression
  • Female
  • HIV Infections*
  • Haemophilus influenzae
  • Hospital Mortality
  • Humans
  • Infant
  • Male
  • Meningitis, Bacterial* / complications
  • Meningitis, Bacterial* / epidemiology
  • Meningitis, Bacterial* / microbiology
  • Meningitis, Meningococcal* / epidemiology
  • Meningitis, Pneumococcal*
  • Neisseria meningitidis*
  • South Africa / epidemiology
  • Streptococcus pneumoniae