Burden of Neisseria meningitidis infections in China: a systematic review and meta–analysis

Abstract

BackgroundNeisseria meningitidis is a leading cause of bacterial meningitis and septicemia in children and young adults worldwide. The disease burden associated with N. meningitidis infections has not been systematically assessed in China. Therefore, we undertook this study to determine the burden of meningococcal disease in China.MethodWe performed a systematic review and meta–analysis of articles on N. meningitidis incidence, carriage, seroprevalence and mortality rates in China by searching the Chinese BioMedical Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang database and PubMed for publications from January 2005 to Aug 2015.ResultsIn total, 50 articles were included in our analysis. The overall incidence of meningococcal disease and associated mortality were estimated to be 1.84 (95% confidence interval (CI) 0.91–3.37) per 100 000 persons per year and 0.33 (95% CI 0.12–0.86) per 100 000 persons per year, respectively. N. meningitidis carriage rate among the healthy population was estimated to be 2.7% (95% CI 2.0–3.5%). Prevalence of antibodies against N. meningitidis serogroup A and C were estimated to be 77.3% (95% CI 72.4%–81.6%) and 33.5% (95% CI 27.0%–40.8%), respectively. No studies were found for serogroup specific disease burden.ConclusionsThe overall incidence of meningococcal disease in China is low. The lower seroprevalence of serogroup C within the population suggests that it may pose a greater risk for meningococcal disease outbreak than serogroup A. The lack of data on serogroup disease burden by age groups suggests the implementation of laboratory based meningococcal surveillance systems are urgently needed in China.

The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations

“…Surveillance data indicated that the incidence and prevalence of Nm serogroups continually varies both geographically and temporally [23,24]. Currently, meningococcal serogroup B (MenB) is a major cause of IMD in North America, South America, Australia, North Africa, and Europe, although a decreasing incidence trend is being observed [25], which was supported by the data presented from other countries at the 2018 GMI meeting [10,11,[26][27][28][29][30].…”

Meningococcal disease and control in China: Findings and updates from the Global Meningococcal Initiative (GMI)

“…9 However, recent subnational estimates indicate an incidence rate of 1.84 cases per 100,000 population, suggesting that the overall incidence rate for China is underestimated. 10 Historically, China has experienced five epidemics of MD between 1938 and 1977. 10,11 The peak incidence of MD was recorded in 1967 with 403 cases per 100,000 population, >3,040,000 recorded cases and >160,000 deaths with a case fatality rate of approximately 5.5%.…”

“…10 Historically, China has experienced five epidemics of MD between 1938 and 1977. 10,11 The peak incidence of MD was recorded in 1967 with 403 cases per 100,000 population, >3,040,000 recorded cases and >160,000 deaths with a case fatality rate of approximately 5.5%. Following the universal use of serogroup A MD (MenA) polysaccharide vaccines in China in the 1980s and the introduction of MenA polysaccharide vaccines in to the Expanded Programme for Immunization (EPI) in China in 2008, the reported incidence of MD has steadily declined to <0.52 cases per 100,000 population in 2009 12 ; this decline has been particularly evident in the last five years owing to an increasing vaccination coverage rate.…”

“…The incidence and prevalence of Nm serogroups continually varies both geographically and temporally. 10,13 Meningococcal epidemiology suggests an increased incidence and prevalence of MD during mass gatherings that involve migration and travel. [14][15][16] Further, Nm is susceptible to frequent genetic transformations due to natural horizontal DNA exchanges between isolates.…”

“…China still faces many challenges in the treatment of acute BM, such as the notifiable diseases reporting system, etiology and surveillance, antibiotic resistance, societal and governmental awareness and vaccination status. 10,54…”