Abstract
BackgroundNeisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD.MethodsA comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information.ResultsThere were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults.ConclusionsThe use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities’ decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.
Highlights
Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population
Data extracted from each study/website was categorised within three headings, as containing data on epidemiology, atypical presentation or clinical burden of Invasive menin‐ gococcal disease (IMD)
Summary information on the published studies included can be found in Epidemiology Incidence & Prevalence A number of studies/websites showed that, over time, an increasing proportion of IMD cases were in older adults, which may in part be because of improvements in surveillance programmes and as a consequence of meningitis vaccination campaigns focusing almost exclusively on infants and adolescents
Summary
Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive menin‐ gococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe Such information would assist decision-makers at national and international levels in developing future public health programmes for manag‐ ing IMD. The case fatality rate of meningococcal disease remains high (5–15%) despite treatment [5,6,7] and survivors can have significant sequelae, with around 20% suffering longterm disability [8]. Morbidity and mortality rates have essentially remained unchanged over the last two decades [24, 26,27,28,29]
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