Systematic review of invasive meningococcal disease epidemiology in the Eastern Mediterranean and North Africa region

Abstract

Background Invasive meningococcal disease (IMD) represents a global health burden. However, its epidemiology in the Eastern Mediterranean (EM) and North Africa (NA) regions is currently not well understood. This review had four key objectives: to describe asymptomatic meningococcal carriage, IMD epidemiology (e.g. serogroup prevalence, case-fatality rates [CFRs]), IMD presentation and management (e.g. clinical diagnosis, antibiotic treatments) and economic impact and evaluation (including health technology assessment [HTA] recommendations) in EM and NA. Methods A systematic literature search (MEDLINE and EMBASE) was conducted (January 2000 to February 2021). Search strings included meningococcal disease and the regions/countries of interest. Identified publications were screened sequentially by title/abstract, followed by screening of the full-text article; articles were also assessed on methodological quality. Literature reviews, genetic sequencing or diagnostic accuracy studies, or other non-pertinent publication type were excluded. An additional grey literature search (non-peer-reviewed sources; start date January 2000) was conducted to the end of April 2019. Results Of the 1745 publications identified, 79 were eligible for the final analysis (n = 61 for EM and n = 19 for NA; one study was relevant to both). Asymptomatic meningococcal carriage rates were 0–33% in risk groups (e.g. military personnel, pilgrims) in EM (no data in NA). In terms of epidemiology, serogroups A, B and W were most prevalent in EM compared with serogroups B and C in NA. IMD incidence was 0–20.5/100,000 in EM and 0.1–3.75/100,000 in NA (reported by 7/15 countries in EM and 3/5 countries in NA). CFRs were heterogenous across the EM, ranging from 0 to 57.9%, but were generally lower than 50%. Limited NA data showed a CFR of 0–50%. Data were also limited in terms of IMD presentation and management, particularly relating to clinical diagnosis/antibiotic treatment. No economic evaluation or HTA studies were found. Conclusions High-risk groups remain a significant reservoir of asymptomatic meningococcal carriage. It is probable that inadequacies in national surveillance systems have contributed to the gaps identified. There is consequently a pressing need to improve national surveillance systems in order to estimate the true burden of IMD and guide appropriate prevention and control programmes in these regions.

A mathematical interpretation for outbreaks of bacterial meningitis under the effect of time-dependent transmission parameters

“…The incidence of IMD in infants and young children (aged less than 5 years) occupies 75% of all cases of meningococcal meningitis and meningococcaemia in children. Further, the second peak of incidence according to age scala appears in adolescents and young adults Dogu et al (2021). In this sense, the population is divided into two age groups: adults and children, indicated by the subscripts A and C in this paper.…”

“…To visualize the dynamical behaviour of the mathematical model (1) in the light of the theoretical results obtained from mathematical analysis, we perform numerical simulations using the standard Matlab routines for solving systems of differential equations MATLAB (2020). Although local and international outbreaks of IMD have been strictly associated with Umrah/Hajj travel in different researches, data on IMD are still sparse or lacking in the Eastern Mediterranean and North Africa regions Cooper et al (2019); Dinleyici and Ceyhan (2012); Dogu et al (2021). For this reason, we cannot fit the model (1) to a particular data set, but we use the findings from different studies when choosing the model parameters.…”

“…Since we have noted seasonal outbreaks of IMD outside the meningitis belt, we perform our simulations for a hypothetical upper-middle income country. Dogu et al Dogu et al (2021) presented a recent review of available IMD data where by scanning the literature between January 2000-February 2021. Based on 11 different studies, they report that the rates of asymptomatic carriage in the pilgrim risk group range from 0.0% Husain et al (2010); Metanat et al (2015) to 27.4% Ceyhan et al (2013).…”

“…The geographic and ethnic diversity of the people promote the transmission of respiratory infections during the Hajj Gautret et al (2015). Furthermore, pilgrims from hyper-endemic areas including the African meningitis belt carry different N. meningitidis strains to this community that will soon transfer the disease to their home country, and thus, seasonal outbreaks all over the world come forward Alasmari et al (2021); Ceyhan et al (2012); Dogu et al (2021); Lingappa et al (2003); Wilder-Smith et al (2003); Yezli (2018).…”

Correction to: Systematic review of invasive meningococcal disease epidemiology in the Eastern Mediterranean and North Africa region

“…Following the publication of the original article [ 1 ], some errors were identified in the text and in Table 3a.…”