Meningitis y mortalidad infantil – ISGLOBAL

Meningitis contributes to infant mortality rates higher than those estimated by the WHO, according to a new study by the CHAMPS network and led by the Barcelona Institute for Global Health (ISGlobal), an institution that has the support of the ”la Caixa” Foundation. ”. The study, published in Infection diaryreveals a high prevalence of drug-resistant bacteria in hospital cases, which alleviates the need for earlier suspicion and faster and more appropriate diagnosis and treatment to reduce mortality.

meningitis It remains a serious disease, especially for young children, with high mortality rates and long-lasting neurological effects in survivors. Vaccines can protect against the most common types of bacteria that cause

meningitis, such as Haemophilus influenzae type B (Hib), Streptococcus pneumonia and Neisseria meningitidis. However, to achieve the World Health Organization (WHO) goal of eliminate meningitis by 2030 There is a need to better understand the global impact of this disease and the specific pathogens involved.

“Meningitis poses a diagnostic challenge due to its nonspecific symptomsthat often resemble those of other serious illnesses,» explains Quique Bassatcoordinator of the study, ICREA researcher and General Director of ISGlobal. «Identify specific pathogens who are behind the cases of meningitis “It would allow us to make better use of resources and guide the development of new, highly anticipated vaccines,” he adds.

The study is based on data from the red championswhich investigates in depth the causes of child deaths in seven countries: Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa. Through a technique called MITS (minimally invasive tissue sampling), the research team performs biopsies to obtain samples of major organs or fluids, including cerebrospinal fluid, and analyze them through histopathological examination, molecular testing for 126 pathogens, and microbiological cultures.

A major mortality factor

The study revealed that meningitis was a contributing factor in 7% of the 3,857 deaths analyzed. The highest proportions of childhood deaths from meningitis were observed in South Africa (16.6%) and Ethiopia (15.6%), followed by Mali and Sierra Leone. The majority of these deaths (66%) occur in newbornsand the remaining cases were diagnosed in older infants and young children. “The higher incidence among newborns may be due to the vertical transmission of pathogens that infect their mothers and the lack of specific strategies to protect them during childbirth. In addition, their underdeveloped immune system also makes them more vulnerable,» he points out. Sara AjanovicISGlobal researcher and co-author of the study.

A shift toward antibiotic-resistant bacteria

The prevalence of pathogens associated with meningitis deaths in hospital and in the community varied by region. However, the most frequent pathogens were Acinetobacter baumannii and Klebsiella pneumoniaeespecially in deaths that occur in healthcare environments. are multiresistant bacteria They are usually purchased in the hospitalTherefore, improving infection prevention practices in hospitals is essential to reduce cases of meningitis. Worryingly, this also means that without proper antibiotics, the risk of dying from meningitis remains high.

almost half of deaths from meningitis occur in communityprobably due to limited access to healthcare. Although vaccines have significantly reduced cases of Streptococcus pneumoniaThis bacteria continues to cause many cases of community-acquired meningitis.

These results indicate a change in pathogen profile associated with meningitis, with an increase in bacteria such as K. pneumonia and A. baumanniialong with a decrease in S. pneumonia and Hib thanks to vaccination efforts. This change, the authors note, “challenges the fundamentals of the current antibiotic guidelines empirical.”

Implications for public health

The CHAMPS findings suggest that meningitis has a highest infant mortality rate (7%) than the WHO estimate (5.1%). Critically, many of these cases had not been recognized as meningitis before death, underscoring the need for faster diagnosis and treatment to prevent deaths. “Less than a quarter of all confirmed cases of meningitis had undergone surgery.” lumbar puncture -the reference technique for diagnosing meningitis- before failing, which alleviates the urgent need to more actively deploy this diagnostic method to prevent high cases of this potentially fatal infection from being overlooked,” says Bassat.

“The changing landscape of pathogens causing lethal meningitis in children in these settings underscores the positive effect of vaccination campaigns carried out in recent decades, which must continue,” adds Ajanovic. However, the results highlight the need to develop new vaccines against emerging pathogens such as K. pneumoniaand of update clinical guidelines. This includes testing for these pathogens and their resistance patterns, as well as tailoring antibiotics to ensure effective treatment.

Recognition of the work of CHAMPS in Catalonia

On October 26, the Catalan Society of Clinical Microbiology and Infectious Diseases awarded the Josep Barrio Prize for Infectious Diseases to Quique Bassat for the best scientific work published in 2023 by a member of the society. The work was a CHAMPS network study which showed that infectious diseases remain the leading cause of death in infants and children, often in combination with malnutrition.

Reference

Mahtab S, Madewell ZJ, Baillie V et al. Etiologies and comorbidities of meningitis deaths in children under 5 years of age in high-mortality settings: insights from the CHAMPS network in the post-pneumococcal vaccine era. J infection. 10.1016/j.jinf.2024.106341