Abstract
Among the different existing types of bacterial meningitis, the one caused by Neisseria meningitidis is the main presentation of invasive meningococcal disease (IMD). IMD is a significant public health concern and has a reported incidence rate in Argentina of 0.44 cases per 100 000 inhabitants in 2015. However, the actual incidence is thought to be higher as passive surveillance systems neither report nor identify 100% of all cases. The aim of this study is to develop an estimation of the burden of IMD in Argentina closer to reality by adjusting/correcting several limitations observed in the surveillance data available. A retrospective observational study has been performed using four Argentinean national databases recording the number of IMD cases and deaths, serogroups of N. meningitidis and ages, between 2007 to 2016. The reported data were adjusted to account for underreporting and to also integrate the cases missed due to well-known limitations associated with the diagnosis of N. meningitidis detection methods. Data were further analysed by serogroups of N. meningitidis and by age groups. After these adjustments, the potential numbers of IMD cases and IMD-related deaths are estimated to be 3.1 and 1.9 higher than reported, respectively. The study corrects the previous underestimation of the disease burden and provides expectedly more robust estimates aligned with international evidence and highlights the importance of active surveillance, with high-quality methods, for a better definition of preventive strategies against IMD in Argentina.
Highlights
Among the different existing types of bacterial meningitis, the one caused by Neisseria meningitidis is a serious disease associated with high mortality, survivors frequently keep severe and irreversible sequelae and it is one of the most frequent presentations of invasive meningococcal disease (IMD) [1]
The aim of this study is to develop an estimation of the burden of IMD in Argentina closer to reality by adjusting/correcting several limitations observed in the surveillance data available
Observational study (GSK study identifier : HO-17-19052) to obtain the reported number of IMD cases, hospital discharges, deaths associated with IMD and the data for serogroup characterisations in Argentina between 2007 and 2016 based on four different databases: (i) the National Clinical Surveillance System (SNVS) managed by the Health Ministry [22]; (ii) the Hospital Discharge System [23], (iii) Vital Statistics Database (VSD) under the responsibility of the National Directorate of Health Statistics [24] and (iv) the SIREVA II Laboratory network sponsored by the Pan American Health Organization (PAHO) [25, 26]
Summary
Among the different existing types of bacterial meningitis, the one caused by Neisseria meningitidis is a serious disease associated with high mortality, survivors frequently keep severe and irreversible sequelae and it is one of the most frequent presentations of invasive meningococcal disease (IMD) [1]. IMD is a significant public health concern with incidences largely varying geographically, ranging from 0.5 to 6.0 cases per 100 000 inhabitants in developed countries to up to 1000 cases per 100 000 inhabitants during outbreaks in sub-Saharan Africa [2]. Among the 12 classified serogroups of N. meningitidis, six (A, B, C, W, X and Y) account for most of the IMD worldwide but their distribution varies both in time and space [1, 4]. In Latin America, serogroups B and C predominated largely during the last two decades but with great variation between countries [4]. In Argentina, where serogroup B used to be predominant, changes have been observed with an outbreak associated with serogroup C during the 1990s and a consistent emergence of serogroup W in all the countries since 2006 [5,6,7]
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