Global Meningitis Burden Remains High Despite Progress, New GBD 2023 Study Finds

Despite decades of progress, meningitis remains a significant global health threat, responsible for an estimated 259,000 deaths and 2.54 million cases worldwide in 2023, with young children bearing the greatest burden.

New findings from the Global Burden of Disease 2023 study, “Global, regional, and national burden of meningitis, its risk factors, and aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023,” published in The Lancet Neurology, provide the most comprehensive analysis to date, examining 17 pathogens and key risk factors driving disease and mortality.

While vaccination efforts have reduced bacterial meningitis, progress has slowed, and emerging challenges, including viral pathogens, antimicrobial resistance, and gaps in surveillance, continue to threaten global gains. In this Q&A, Hmwe Hmwe Kyu, MBBS, MPH, PhD; and Sarah Brooke Sirota, MA,the study’s authors, discuss what these findings mean for infection prevention, vaccination strategies, and the path forward to meeting global targets.

Hmwe Hmwe Kyu, MBBS, MPH, PhD, is an associate professor in the Department of Health Metrics Sciences, School of Medicine, and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Sarah Brooke Sirota, MA, is a researcher at the IHME.

ICT: From an infection prevention perspective, what do these findings signal about gaps in meningitis surveillance and early detection, particularly in high-burden regions?

Hmwe Hmwe Kyu, MBBS, MPH, PhD; and Sarah Brooke Sirota, MA: Although mortality and incidence have declined substantially since 1990, progress since 2015 has slowed and remains insufficient to meet the World Health Organization (WHO) 2030 targets for vaccine-preventable meningitis. The burden of disease remains disproportionately high, particularly in the African meningitis belt. To accelerate progress, it is crucial to prioritize improved surveillance systems, early diagnosis through low-cost and accurate rapid tests, and expanded health care access to ensure life-saving treatment reaches those most at risk.

ICT: With nearly 100,000 deaths linked to vaccine-preventable pathogens, what role can IPC professionals play in improving vaccination uptake within health systems and communities?

HHK and SBS: Infection prevention and control (IPC) professionals serve as the bridge between data and community action by translating these figures into culturally resonant, digestible communications. Within health systems, IPC professionals can integrate vaccination screening into every patient touchpoint. Within communities, they can address vaccine hesitancy by clearly communicating that vaccination is not just an individual choice, but a vital safeguard for the entire community.

ICT: How should IPC teams adapt their strategies given the growing contribution of viral and fungal causes of meningitis alongside traditional bacterial pathogens?

HHK and SBS: IPC teams can adapt their strategies by broadening their focus beyond traditional bacterial pathogens. For viral threats like nonpolio enteroviruses (NPEVs), it is crucial to prioritize robust hygiene education and outbreak preparedness. Our results highlight a pressing need for surveillance frameworks and diagnostic readiness in regions where enterovirus outbreaks often go undetected. While there is no global surveillance network for NPEVs, regional networks, such as the European Non-Polio Enterovirus Network (ENPEN) and the Asia-Pacific Network for Enterovirus Surveillance (APNES), can serve as global models for early detection. For fungal threats, such as Candida spp., the strategy should focus on strengthening infection control within hospital settings to prevent healthcare-associated transmission. Additionally, it is essential to support the continued development of novel antifungal and antimicrobial agents to address these evolving pathogens.

ICT: What infection prevention challenges are unique to protecting high-risk populations, especially children under 5, in both hospital and community settings?

HHK and SBS: In the community, the challenge is both biological and behavioral: young children have developing immune systems and engage in exploratory behaviors, such as frequent hand-to-mouth contact in settings like daycares, which can facilitate rapid transmission.

In hospital settings, the primary challenge is neonatal vulnerability. Our results show that Group B streptococcus (GBS) mortality is highest in the early neonatal period. Because there is currently no licensed GBS vaccine, prevention currently relies on maternal screening and intrapartum antibiotic prophylaxis, though this approach carries the risk of an infant being born before antibiotics can be administered. A maternal GBS vaccine serves as a potential solution to these challenges, and several promising candidates are currently in development.

ICT: Given the influence of factors like low birthweight and household air pollution, how can IPC efforts better integrate with broader public health initiatives to reduce meningitis risk?

HHK and SBS: Educating parents and guardians about the risks associated with low birth weight and household air pollution is vital to helping them recognize the increased vulnerability to infection in their children. IPC professionals can advocate for clean air initiatives alongside early and consistent antenatal care, while highlighting that smoking and alcohol cessation, as well as optimal maternal nutrition, are critical for preventing low birthweight.