Global, regional, and national burden of meningitis and its aetiologies, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Wunrow, Han Yong; Bender, Rose G; Vongpradith, Avina; Sirota, Sarah Brooke; Swetschinski, Lucien R; Novotney, Amanda; Gray, Authia P; Ikuta, Kevin S; Sharara, Fablina; Wool, Eve; Aali, Amirali; Abd‐Elsalam, Sherief; Abdollahi, Ashkan; Aziz, Jeza Muhamad Abdul; Abidi, Hassan; Aboagye, Richard Gyan; Abolhassani, Hassan; Abu‐Gharbieh, Eman; Adamu, Lawan Hassan; Adane, Tigist Demssew; Addo, Isaac Yeboah; Adegboye, Oyelola A; Adekiya, Tayo Alex; Adnan, Mohammad; Adnani, Qorinah Estiningtyas Sakilah; Afzal, Saira; Aghamiri, Seyed Mahmoud Reza; Aghdam, Zahra Babaei; Agodi, Antonella; Ahinkorah, Bright Opoku; Ahmad, Aqeel; Ahmad, Sajjad; Ahmadzade, Mohadese; Ahmed, Ali; Ahmed, Ayman; Ahmed, Jivan Qasim; Ahmed, Meqdad Saleh; Akinosoglou, Karolina; Aklilu, Addis; Akonde, Maxwell; Alahdab, Fares; Al-Ahdal, Tareq; Alanezi, Fahad Mashhour; Albelbeisi, Ahmed Hassan; Alemayehu, Tinsae; Alene, Kefyalew Addis; Al‐Eyadhy, Ayman; Al‐Gheethi, Adel; Ali, Abid; Ali, Beriwan Abdulqadir; Ali, Liaqat; Ali, Syed Shujait; Alimohamadi, Yousef; Alipour, Vahid; Aljunid, Syed Mohamed; Almustanyir, Sami; Al‐Raddadi, Rajaa; Alvis‐Guzmán, Nelson; Al-Worafi, Yaser Mohammed; Aly, Hany; Ameyaw, Edward Kwabena; Ancuceanu, Robert; Ansar, Adnan; Ansari, Golnoosh; Anyasodor, Anayochukwu Edward; Arabloo, Jalal; Aravkin, Aleksandr Y.; Areda, Demelash; Artamonov, Anton A; Arulappan, Judie; Aruleba, Raphael Taiwo; Asaduzzaman, Muhammad; Atalell, Kendalem Asmare; Athari, Seyyed Shamsadin; Atlaw, Daniel; Atout, Maha Moh'd Wahbi; Attia, Sameh; Awoke, Tewachew; Ayalew, Melese; Ayana, Tegegn Mulatu; Ayele, Alemu Degu; Azadnajafabad, Sina; Azizian, Khalil; Badar, Muhammad; Badiye, Ashish; Baghcheghi, Nayereh; Bagheri, Mahboube; Bagherieh, Sara; Bahadory, Saeed; Baig, Atif Amin; Barać, Aleksandra; Tahmasebi, Fatemeh; Bardhan, Mainak; Basharat, Zarrin; Bashiri, Azadeh; Basnyat, Buddha; Bassat, Quique; Basu, Saurav; Bayileyegn, Nebiyou Simegnew; Bedi, Neeraj; Behnoush, Amir Hossein; Bekel, Abebe Ayalew; Belete, Melaku Ashagrie; Bello, O. O.; Bhagavathula, Akshaya Srikanth; Bhandari, Dinesh; Bhardwaj, Pankaj; Bhaskar, Sonu; Bhat, Ajay Nagesh; Bijani, Ali; Bineshfar, Niloufar; Boloor, Archith; Bouaoud, Souad; Buonsenso, Danilo; Burkart, Katrin; Cámera, Luis; Castañeda-Orjuela, Carlos; Cernigliaro, Achille; Charan, Jaykaran; Chattu, Vijay Kumar; Ching, Patrick R; Chopra, Hitesh; Choudhari, Sonali Gajanan; Christopher, Devasahayam J; Chu, Dinh‐Toi; Couto, Rosa A. S.; Cruz‐Martins, Natália; Dadras, Omid; Dai, Xiaochen; Dandona, Lalit; Dandona, Rakhi; Das, Saswati; Dash, Nihar Ranjan; Dashti, Mohsen; Hoz, Fernando Pío De la; Debela, Sisay Abebe; Dejen, Demeke; Dejene, Hiwot; Demeke, Dessalegn; Demeke, Feleke Mekonnen; Demessa, Berecha Hundessa; Demetriades, Andreas K.; Demissie, Solomon; Dereje, Diriba; Dervišević, Emina; Desai, Hardik Dineshbhai; Dessie, Anteneh Mengist; Desta, Fikreab; Dhama, Kuldeep; Djalalinia, Shirin; Chi, Thanh; Dodangeh, Masoud; Dodangeh, Milad; Dominguez, Regina-Mae Villanueva; Dongarwar, Deepa; Dsouza, Haneil Larson; Durojaiye, Oyewole Christopher; Dziedzic, Arkadiusz; Ekat, Martin Herbas; Ekholuenetale, Michael; Ekundayo, Temitope Cyrus; Zaki, Maysaa El Sayed; El‐Abid, Hassan; Elhadi, Muhammed; El-Hajj, Victor Gabriel; El‐Huneidi, Waseem; El-Sakka, Amro A; Esayas, Hawi Leul; Fagbamigbe, Adeniyi Francis; Falahi, Shahab; Fares, Jawad; Fatehizadeh, Ali; Fatima, Syeda Tahniyath; Feasey, Nicholas; Fekadu, Ginenus; Fetensa, Getahun; Feyissa, Desalegn; Fischer, Florian; Foroutan, Behzad; Gaál, Péter; Gadanya, Muktar A; Gaipov, Abduzhappar; Ganesan, Balasankar; Gebrehiwot, Mesfin; Gebrekidan, Kahsu Gebrekirstos; Gebremeskel, Teferi Gebru; Gedef, Getachew Muluye; Gela, Yibeltal Yismaw; Gerema, Urge; Gessner, Bradford D.; Getachew, Motuma Erena; Ghadiri, Keyghobad; Ghaffari, Kazem; Ghamari, Seyyed‐Hadi; Ghanbari, Reza; Ghazy, Ramy Mohamed; Ghozali, Ghozali; Gizaw, Admasu Belay AB; Глушкова, Екатерина Владимировна; Goldust, Mohamad; Golechha, Mahaveer; Guadie, Habtamu Alganeh; Guled, Rashid Abdi; Gupta, Mohak; Gupta, Sapna; Gupta, Veer Bala; Gupta, Vijai Kumar; Gupta, Vivek Kumar; Hadi, Najah R; Haj-Mirzaian, Arvin; Haller, Sebastian; Hamidi, Samer; Haque, Shafiul; Harapan, Harapan; Hasaballah, Ahmed I.; Hasan, Ikramul; Hasani, Hamidreza; Hasanian, Mohammad; Hassankhani, Hadi; Hassen, Mohammed Bheser; Hayat, Khezar; Heidari, Mohammad; Heidari‐Foroozan, Mahsa; Heidari‐Soureshjani, Reza; Hezam, Kamal; Holla, Ramesh; Horita, Nobuyuki; Hossain, Md Mahbub; Hosseini, Mohammad-Salar; Hosseinzadeh, Mehdi; Hostiuc, Sorin; Hussain, Salman; Hussein, Nawfal R.; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Ilić, Irena; Ilic, Milena D; Imam, Mohammad Tarique; Iregbu, Kenneth; Ismail, Nahlah Elkudssiah; Iwu, Chidozie C D; Jaja, Cheedy; Jakovljević, Mihajlo; Jamshidi, Elham; Mamaghani, Amirreza Javadi; Javidnia, Javad; Jokar, Mohammad; Jomehzadeh, Nabi; Joseph, Nitin; Joshua, Charity Ehimwenma; Jóźwiak, Jacek Jerzy; Kabir, Zubair; Kalankesh, Laleh R.; Kalhor, Rohollah; Kamal, Vineet Kumar; Kandel, Himal; Karaye, Ibraheem M.; Karch, André; Karimi, Hanie; Kaur, Harkiran; Kaur, Navjot; Keykhaei, Mohammad; Khajuria, Himanshu; Khalaji, Amirmohammad; Khan, Ajmal; Khan, Imteyaz Ahmad; Khan, Maseer; Khan, Taimoor; Khatab, Khaled; Khatatbeh, Moawiah; Kashani, Hamid Reza Khayat; Khubchandani, Jagdish; Kim, Min Seo; Kısa, Adnan; Kısa, Sezer; Kompani, Farzad; Koohestani, Hamid Reza; Kothari, Nikhil; Krishan, Kewal; Krishnamoorthy, Yuvaraj; Kulimbet, Mukhtar; Kumar, Manoj; Kumaran, Senthil; Kuttikkattu, Ambily; Kwarteng, Alexander; Laksono, Tri; Landires, Iván; Laryea, Dennis Odai; Lawal, Basira Kankia; Le, Thao T.; Ledda, Caterina; Lee, Sang-woong; Lee, Seung; Lema, Girmay Fitiwi; Levi, Miriam; Lim, Stephen S; Li, Xuefeng; Lopes, Graciliana; Saute, Ricardo Lutzky; Teixeira, Pedro Henrique Machado; Mahmoodpoor, Ata; Mahmoud, Mansour Adam; Rad, Elaheh Malakan; Malhotra, Kashish; Malik, Ahmad Azam; Martinez-Guerra, Bernardo A; Martorell, Miquel; Mathur, Vasundhara; Mayeli, Mahsa; Medina, John Robert C.; Melese, Addisu; Memish, Ziad A.; Mentis, Alexios-Fotios A; Merza, Muayad Aghali; Meštrović, Tomislav; Michałek, Irmina Maria; Minh, Le Huu Nhat; Mirahmadi, Alireza; Mirmosayyeb, Omid; Misganaw, Awoke; Misra, Arup Kumar; Moghadasi, Javad; Mohamed, Nouh Saad; Mohammad, Yousef; Mohammadi, Esmaeil; Mohammed, Shafiu; Sani, Maryam Mojarrad; Mojiri-Forushani, Hoda; Mokdad, Ali H.; Momtazmanesh, Sara; Monasta, Lorenzo; Moni, Mohammad Ali; Mossialos, Elías; Mostafavi, Ebrahim; Motaghinejad, Majid; Khaneghah, Amin Mousavi; Mubarik, Sumaira; Muccioli, Lorenzo; Muhammad, Jibran Sualeh; Mulita, Francesk; Mulugeta, Temesgen; Murillo-Zamora, Efrén; Mustafa, Ghulam; Muthupandian, Saravanan; Nagarajan, Ahamarshan Jayaraman; Nainu, Firzan; Nair, Tapas Sadasivan; Nargus, Shumaila; Nassereldine, Hasan; Natto, Zuhair S.; Nayak, Biswa Prakash; Negoi, Ionuț; Negoi, Ruxandra Irina; Nejadghaderi, Seyed Aria; Nguyen, Hien Quang; Nguyen, Phat Tuan; Nguyễn, Văn Thành; Niazi, Robina Khan; Noroozi, Nafise; Nouraei, Hasti; Núñez-Samudio, Virginia; Nuruzzaman, Khan M; Nwatah, Vincent Ebuka; Nzoputam, Chimezie Igwegbe; Nzoputam, Ogochukwu Janet; Oancea, Bogdan; Obaidur, Rahman Md; Odetokun, Ismail A.; Ogunsakin, Ropo Ebenezer; Okonji, Osaretin Christabel; Olagunju, Andrew T; Olana, Latera Tesfaye; Olufadewa, Isaac Iyinoluwa; Oluwafemi, Yinka Doris; Oumer, Kemal Sherefa; Ouyahia, Amel; Mahesh, P A; Pakshir, Keyvan; Palange, Paolo; Pardhan, Shahina; Parikh, Romil; Patel, Jay; Patel, Urvish; Patil, Shankargouda; Paudel, Uttam; Pawar, Shrikant; Pensato, Umberto; Perdigão, João; Pereira, Marcos; Peres, Mario F P; Petcu, Ionela-Roxana; Pinheiro, Marina; Piracha, Zahra Zahid; Pokhrel, Nayanum; Postma, Maarten J.; Prates, Elton Junio Sady; Qattea, Ibrahim; Raghav, Pankaja Raghav; Rahbarnia, Leila; Rahimi-Movaghar, Vafa; Rahman, Mosiur; Rahman, Muhammad Aziz; Rahmanian, Vahid; Rahnavard, Niloufar; Ramadan, Hazem M.; Ramasubramani, Premkumar; Rani, Usha; Rao, Indu Ramachandra; Rapaka, Deepthi; Ratan, Zubair Ahmed; Rawaf, Salman; Redwan, Elrashdy Moustafa Mohamed; Reiner, Robert C.; Rezaei, Nazila; Riad, Abanoub; Silva, Tércia Moreira Ribeiro da; Roberts, Tamalee; Aguilar, Gisela Robles; Rodriguez, Jefferson Antonio Buendia; Rosenthal, Victor; Saddik, Basema; Sadeghian, Saeid; Saeed, Umar; Safary, Azam; Sharif-Askari, Fatemeh Saheb; Sharif-Askari, Narjes Saheb; Sahebkar, Amirhossein; Sahu, Monalisha; Sajedi, Seyed Aidin; Saki, Morteza; Salahi, Saina; Salahi, Sarvenaz; Saleh, Mohamed A.; Sallam, Malik; Samadzadeh, Sara; Samy, Abdallah M.; Sanjeev, Rama Krishna; Satpathy, Maheswar; Seylani, Allen; Sha’aban, Abubakar; Shafie, Mahan; Shah, Pritik A; Shahrokhi, Shayan; Shahzamani, Kiana; Shaikh, Masood Ali; Sham, Sunder; Shannawaz, Mohammed; Sheikh, Aziz; Shenoy, Suchitra; Shetty, Pavanchand; Shin, Jae Il; Shokri, Fereshteh; Shorofi, Seyed Afshin; Shrestha, Sunil; Sibhat, Migbar Mekonnen; Siddig, Emmanuel Edwar; Silva, Luís Manuel Lopes Rodrigues; Singh, Harpreet; Singh, Jasvinder A; Singh, Paramdeep; Singh, Surjit; Sinto, Robert; Skryabina, Anna Aleksandrovna; Socea, Bogdan; Сохань, Антон Васильович; Solanki, Ranjan; Solomon, Yonatan; Sood, Prashant; Soshnikov, Sergey; Stergachis, Andy; Sufiyan, Mu’awiyyah Babale; Abdulkader, Rizwan Suliankatchi; Sultana, Abida; Y, Sree Sudha T; Taheri, Ensiyeh; Taki, Elahe; Tamuzi, Jacques L.; Tan, Ker‐Kan; Tat, Nathan Y; Temsah, Mohamad-Hani; Terefa, Dufera Rikitu; Thangaraju, Pugazhenthan; Tibebu, Nigusie Selomon; Ticoalu, Jansje Henny Vera; Tillawi, Tala; Tincho, Marius Belmondo; Tleyjeh, Imad I; Toghroli, Razie; Tovani‐Palone, Marcos Roberto; Tufa, Derara Girma; Turner, Paul; Ullah, Irfan; Umeokonkwo, Chukwuma David; Unnikrishnan, Bhaskaran; Vahabi, Seyed Mohammad; Vaithinathan, Asokan Govindaraj; Valizadeh, Rohollah; Varthya, Shoban Babu; Vos, Theo; Waheed, Yasir; Tariku, Mandaras; Wang, Cong; Weerakoon, Kosala; Wickramasinghe, Nuwan Darshana; Winkler, Andrea Sylvia; Woldemariam, Melat; Worku, Nahom Alemseged; Wright, Claire; Yada, Dereje Y.; Yaghoubi, Sajad; Yahya, Gahin Abdulraheem Tayib Yahya; Yenew, Chalachew; Yeşiltepe, Metin; Yi, Siyan; Yiğit, Vahit; You, Yuyi; Yusuf, Hadiza; Zakham, Fathiah; Zaman, Muhammad; Zaman, Sojib Bin; Zare, Iman; Zareshahrabadi, Zahra; Zarrintan, Armin; Застрожин, М. С.; Zhang, Jintao; Zhang, Jingya; Zhang, Zhijiang; Zheng, Peng; Zoladl, Mohammad; Zumla, Alimuddin; Hay, Simon I; Murray, Christopher J L; Naghavi, Mohsen; Kyu, Hmwe Hmwe

doi:10.1016/s1474-4422(23)00195-3

Cited by 21 publications

(6 citation statements)

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“…Infectious diseases of the central nervous system (CNS), including meningitis, encephalitis, and meningoencephalitis, carry a high disease burden. These typically acute infections present significant morbidity and mortality, especially in children [ 1 ]. Rapid diagnosis is crucial for these medical emergencies to guide early and appropriate therapy.…”

Section: Introductionmentioning

confidence: 99%

Hybrid capture shotgun sequencing detected unexpected viruses in the cerebrospinal fluid of children with acute meningitis and encephalitis

Launes,

Camacho,

Pons-Espinal

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purpose Investigation of undiagnosed cases of infectious neurological diseases, especially in the paediatric population, remains a challenge. This study aimed to enhance understanding of viruses in CSF from children with clinically diagnosed meningitis and/or encephalitis (M/ME) of unknown aetiology using shotgun sequencing enhanced by hybrid capture (HCSS). Methods A single-centre prospective study was conducted at Sant Joan de Déu University Hospital, Barcelona, involving 40 M/ME episodes of unknown aetiology, recruited from May 2021 to July 2022. All participants had previously tested negative with the FilmArray Meningitis/Encephalitis Panel. HCSS was used to detect viral nucleic acid in the patients’ CSF. Sequencing was performed on Illumina NovaSeq platform. Raw sequence data were analysed using CZ ID metagenomics and PikaVirus bioinformatics pipelines. Results Forty episodes of M/ME of unknown aetiology in 39 children were analysed by HCSS. A significant viral detection in 30 CSF samples was obtained, including six parechovirus A, three enterovirus ACD, four polyomavirus 5, three HHV-7, two BKV, one HSV-1, one VZV, two CMV, one EBV, one influenza A virus, one rhinovirus, and 13 HERV-K113 detections. Of these, one sample with BKV, three with HHV-7, one with EBV, and all HERV-K113 were confirmed by specific PCR. The requirement for Intensive Care Unit admission was associated with HCSS detections. Conclusion This study highlights HCSS as a powerful tool for the investigation of undiagnosed cases of M/ME. Data generated must be carefully analysed and reasonable precautions must be taken before establishing association of clinical features with unexpected or novel virus findings.

show abstract

Section: Introductionmentioning

confidence: 99%

Hybrid capture shotgun sequencing detected unexpected viruses in the cerebrospinal fluid of children with acute meningitis and encephalitis

Launes,

Camacho,

Pons-Espinal

et al. 2024

Eur J Clin Microbiol Infect Dis

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“…Meningitis, peritonitis, septic arthritis, and pleural empyema are only a few of the potentially fatal diseases caused by bacterial infections in sterile body sites ( 3–8 ). A worldwide study found that there were 2.5 million cases of meningitis and 236,000 deaths from the disease ( 9 ). Also Wunrow et al ( 9 ), bacterial meningitis affects approximately 1.2 million people each year and causes almost 170,000 deaths globally ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

“…A worldwide study found that there were 2.5 million cases of meningitis and 236,000 deaths from the disease ( 9 ). Also Wunrow et al ( 9 ), bacterial meningitis affects approximately 1.2 million people each year and causes almost 170,000 deaths globally ( 10 ). In developing nations, bacterial meningitis continues to pose a serious threat to public health ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Bacterial etiologies, antimicrobial susceptibility pattern and associated factors among patients suspected sterile body site infections at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia

Admas,

Demeke,

Adugna

et al. 2024

Front. Med.

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BackgroundSterile body locations are usually associated with clinical urgency and life-threatening illnesses, and they are typically contaminated with diverse bacterial etiologies. If the bacteria acquire resistance to antimicrobial drugs, the public health crisis will only worsen. In developing countries, drug-resistant bacteria are common because of poor surveillance, diagnostic capacity, and control measures. Early diagnosis, and assessing the drug resistance and factors associated with infection are important to combat the drug resistance and treatment. This study aimed to assess the bacterial etiologies, antimicrobial susceptibility pattern, and possible associated factors among patients suspected of sterile body sites.MethodsA hospital-based cross-sectional study was conducted from June 2022 to August 2022 at Debre Markos Comprehensive Specialized Hospital in Amhara regional state, Ethiopia. One hundred seven study participants were selected using consecutive convenient sampling techniques. A structured questionnaire was used to collect socio-demographic and clinical data. Gram stain was done for a preliminary report and inoculated into blood agar, MacConkey agar, and chocolate agar and incubated aerobically and micro aerobically at 37°C for 24 h. Antimicrobial susceptibility testing was done by the modified Kirby Bauer’s disk diffusion method. Data were analyzed using bivariate and multivariate logistic regression was used. A p-value less than 0.05 is considered as statistically significant.ResultsThe overall magnitude of sterile body site infection among study participants was 7.5% (14/187). The majority of the isolates were Gram-negative bacteria with the predominant species Enterobacter cloacae accounting for 28.57% (4/14). Among isolates 78.57%(11/14) of them were multidrug-resistant isolates. Being inpatient, co-morbidity, and alcohol consumption were significantly associated with sterile body site infection.ConclusionIn our study, Gram-negative bacteria were the predominant bacteria that infects sterile body fluid. The prevalence of multi-drug resistance bacteria isolates was significantly high. Therefore, before prescribing an empirical treatment, a medical professional should identify the bacterial etiology of sterile body fluids and the susceptibility of microbes to the drug.

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“…Streptococcus pneumoniae is a significant cause of morbidity and mortality worldwide producing different types of infections such as bacteremic pneumonia, meningitis, sepsis and other invasive pneumococcal diseases (IPD). Evidence supports nasopharyngeal pneumococcal carriage as a reservoir for transmission and precursor of pneumococcal disease [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Nasopharyngeal carriage of Streptococcus pneumoniae in Latin America and the Caribbean: A systematic review and meta-analysis

Brizuela,

Palermo,

Alconada

et al. 2024

PLoS ONE

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Background Streptococcus pneumoniae is a leading cause of morbidity and mortality globally, causing bacteremic pneumonia, meningitis, sepsis, and other invasive pneumococcal diseases. Evidence supports nasopharyngeal pneumococcal carriage as a reservoir for transmission and precursor of pneumococcal disease. Objectives To estimate the pneumococcal nasopharyngeal burden in all age groups in Latin America and the Caribbean (LAC) before, during, and after the introduction of pneumococcal vaccine conjugate (PVC). Methods Systematic literature review of international, regional, and country-published and unpublished data, together with reports including data from serotype distribution in nasopharyngeal carriage in children and adults from LAC countries following Cochrane methods. The protocol was registered in PROSPERO database (ID: CRD42023392097). Results We included 54 studies with data on nasopharyngeal pneumococcal carriage and serotypes from 31,803 patients. In children under five years old, carriage was found in 41% and in adults over 65, it was 26%. During the study period, children under five showed a colonization proportion of 34% with PCV10 serotypes and 45% with PCV13 serotypes. When we analyze the carriage prevalence of PCV serotypes in all age groups between 1995 and 2019, serotypes included in PCV10 and those included in PCV13, both showed a decreasing trend along analysis by lustrum. Conclusion The data presented in this study highlights the need to establish national surveillance programs to monitor pneumococcal nasopharyngeal carriage to monitor serotype prevalence and replacement before and after including new pneumococcal vaccines in the region. In addition, to analyze differences in the prevalence of serotypes between countries, emphasize the importance of approaches to local realities to reduce IPD effectively.

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Global, regional, and national burden of meningitis and its aetiologies, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Cited by 21 publications

References 54 publications

Hybrid capture shotgun sequencing detected unexpected viruses in the cerebrospinal fluid of children with acute meningitis and encephalitis

Hybrid capture shotgun sequencing detected unexpected viruses in the cerebrospinal fluid of children with acute meningitis and encephalitis

Bacterial etiologies, antimicrobial susceptibility pattern and associated factors among patients suspected sterile body site infections at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia

Nasopharyngeal carriage of Streptococcus pneumoniae in Latin America and the Caribbean: A systematic review and meta-analysis

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