Case fatality rates of invasive meningococcal disease by serogroup and age: A systematic review and meta-analysis |
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| Affiliation: | 1. The University of Adelaide, Adelaide Medical School, Adelaide, South Australia, Australia;2. The University of Adelaide, The Robinson Research Institute, Adelaide, South Australia, Australia;3. The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia;4. Vaccinology and Immunology Research Trials Unit (VIRTU), Women''s and Children''s Hospital, Adelaide, South Australia, Australia;5. Women''s and Children''s Hospital, Adelaide, South Australia, Australia;1. Kentucky Pediatric and Adult Research, Bardstown, KY, USA;2. Department of Pediatric Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland;3. Bluegrass Clinical Research Inc, Louisville, KY, USA;4. Department of Pediatrics, Medical Center of Postgraduate Education, Warsaw, Poland;5. Novartis Pharma BV, Amsterdam, Netherlands;6. Novartis Vaccines and Diagnostics, Inc., Cambridge, MA, USA;1. IBM Watson Health, 7700 Old Georgetown Rd, Suite 650, Bethesda, MD 20814, USA;2. GSK, 5 Crescent Drive, Philadelphia, PA 19112, USA;3. GSK, Hullenbergweg 83-85, 1101 CL Amsterdam, the Netherlands;1. GSK Vaccines, Siena, Italy;2. GSK Vaccines, Cambridge, MA, USA;1. Field Epidemiology Training Program (FETP), National Institute of Infectious Diseases, Tokyo, Japan;2. Department of Epidemiology for Infectious Diseases, Osaka University, Graduate School of Medicine, Japan;3. Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan;4. Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan;1. Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WZ, UK;2. Inha University Hospital, Incheon, Republic of Korea;3. Institute of Health Carlos III, Madrid, Spain;4. PATH Europe, Ferney Voltaire, France;5. Institut Pasteur, Paris, France;6. National Institute of Infectious Diseases, Infectious Disease Surveillance Center, Tokyo, Japan;7. Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea;8. Chonbuk National University Hospital, Jeonju, Republic of Korea;1. Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WZ, UK;2. Norwegian Institute of Public Health, (PO Box 4404) Nydalen, Oslo, N-0403, Norway;3. Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, 06100, Turkey;4. University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK;5. Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, TR-26480, Turkey;6. Meningitis Research Foundation, Newminster House 27, 29 Baldwin St, Bristol, BS1 1LT, UK;7. Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa;8. Microbiological Laboratory, Children''s Hospital of Tunis, Boulevard du 9 Avril, Tunis, 1938, Tunisia;9. Institute of Health Carlos III, Av. De Monforte de Lemos, Madrid, 28029, Spain;10. Institut Pasteur Morocco, Place Louis Pasteur Blvd., Casablanca, 20360, Morocco;11. Institut Pasteur, 25-28 Rue du Dr Roux, Paris, 75015, France;12. Institut Pasteur d''Algérie, Route de petit Staouéli, Algiers, Dély Ibrahim, Algeria;13. Faculty of Medicine and Pharmacy, University Hassan II Ain Chock, Rue Tarik Ibnou Ziad, Casablanca, Bp 9167 Mars Sultan, Morocco |
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| Abstract: | IntroductionInvasive meningococcal disease (IMD) is uncommon but still causes considerable public health burden due to its high mortality and morbidity. This review aims to quantitatively synthesise all published evidence pertinent to mortality caused by IMD and assess the effect of age and serogroup on case fatality rates (CFRs).MethodsThe PubMed and Embase databases, and the Cochrane Library were searched. Articles reporting national CFRs and published in English between January 2000 and May 2018 were eligible. The studies reporting mortality resulting from a specific symptom of IMD (e.g. meningococcal meningitis) were excluded. Mixed-effects logistic regression with a restricted cubic spline was used to analyse CFRs as a function of age. Random-effects meta-analyses were performed to estimate an overall CFR and CFRs by serogroup.ResultsAmong 48 eligible studies reporting national CFRs, 40 studies were included in meta-analyses representing 163,758 IMD patients. CFRs ranged from 4.1% to 20.0% with the pooled overall CFR of 8.3% (95% confidence interval (CI): 7.5–9.1%). Serogroup B was associated with a lower pooled CFR (6.9% (95%CI: 6.0–7.8%)) than other serogroups (W: 12.8% (95%CI: 10.7–15.0%); C: 12.0% (95%CI: 10.5–13.5%); Y: 10.8% (95%CI: 8.2–13.4%)). The meta-analysis was not performed for serogroup A (MenA) cases due to a small number of MenA patients who were enrolled in eligible studies. For laboratory confirmed IMD cases, the predicted CFR was 9.0% in infants, gradually decreased to 7.0% in 7-year olds, subsequently increased to 15.0% in young adults aged 28 years, stabilised between 15 and 20% in mid-aged adults and reached a high in elderly people.ConclusionsOur findings can provide useful information for better understanding the mortality risks, and quantifying the burden associated with IMD mortality. |
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