Why carry out this study?
|
Invasive meningococcal disease is a life-threatening disease that can mimic mild respiratory illness in the early stages but can rapidly progress to death within 24–48 h. |
The disease burden and epidemiology of meningococcal disease in India are not reliably known. |
In this comprehensive review with a systematically conducted literature search, we summarize information on the epidemiology, disease burden and vaccination recommendations for meningococcal disease in India. |
What was learned from this study?
|
In the last 25 years, meningococcal disease has not been limited to the pediatric population (cases were often documented in the adolescent and adult population). |
Data on the burden of meningococcal disease show that the country is susceptible to outbreaks. |
Data on the burden of endemic disease remains unreliable because of limited disease surveillance, insufficient laboratory capacity, misdiagnosis and extensive antibiotic use, which is prevalent in India. |
Outbreaks of meningococcal disease in India are most commonly caused by serogroup A. Other serogroups such as B, C, W and Y have also been reported in the non-outbreak studies. |
In India, there is no national policy on routine meningococcal vaccination to control the disease. |
Introduction
Methods
Search Sources and Strategy
Article Eligibility and Screening
Inclusion criteria | Exclusion criteria | |
---|---|---|
Population | All agesa Meningococcal disease caused by Neisseria meningitidis | Any other |
Intervention | All interventions | None |
Outcome | Incidence Number of cases Age-specific estimates Mortality Morbidity Clinical presentation Carriage | Outcomes other than those covering epidemiology and burden of disease |
Study design | Observational studies (retrospective and prospective) Surveillance studies (active, passive) Case–control cohort studies Case reports | Pre-clinical and clinical studies Meta-analysis Letters to the Editorb Editorial Commentaryb Opinion paper Reviewsc |
Time limit | 25 years (January 1994–September 2019) | Any other |
Language | English | Any other language |
Geographic scope | India | Areas/countries other than in scope |
Data Collection and Reporting
Compliance with Ethics Guidelines
Results
Overview of Included Studies
Author | Study design | Study period | Carriage (no. and %) | State/region | N (total no. enrolled) | Populationa | Antibiotic resistance/decreased sensitivity |
---|---|---|---|---|---|---|---|
Epidemic disease | |||||||
Dass Hazarika et al. 2013 [30] | Hospital-based (1 tertiary care centre), retrospective | January 2008–June 2009 | NR | Meghalaya | 110 patients with invasive meningococcal disease | Pediatric, adolescent | Ceftriaxone |
Majumdar et al. 2011 [42]b | Hospital-based | January–August 2009 | 22/69 (31.9%) | Tripura | 146 CSF and serum samples | Pediatric, adolescent, adult | Tetracycline |
Kushwaha et al. 2010 [41] | Observational epidemiologic study, prospective | February–May 2006 | 14/97 (14.4%) | Kashmir | 2976 troops | Adult | NR |
Jhamb et al. 2009 [39] | Hospital-based (tertiary care center), retrospective | April 2005–December 2006 | NR | Delhi (n = 94), Uttar Pradesh (n = 6) | 100 cases with meningococcal infection | Pediatric, adolescent | Ampicillin, erythromycin |
Nair et al. 2009 [45] | Hospital-based (1 tertiary care center) | April–July 2005 and January–March 2006 | NR | Delhi | 380 clinically suspected cases | Pediatric, adolescent, adult | Penicillin (15.4% of strains), levofloxacin (100% of strains), ofloxacin (84.6% of strains), ciprofloxacin (65.4% of strains), decreasing sensitivity to ceftriaxone |
Duggal et al. 2007 [34] | Hospital-based (tertiary care center) | December 2005–June 2006 | NR | Delhi | 531 suspected cases of meningococcal meningitis | Pediatric, adolescent, adult | Decreasing sensitivity to cotrimoxazole |
Arya et al. 2006 [26]b | Hospital-based (tertiary care center), retrospective | March–April 2005 | NR | Delhi | 2 (cases of meningococcal meningitis) | Adult | No sensitivity to ciprofloxacin or cotrimoxazole |
Saha et al. 2006 [47]b | Hospital-based (tertiary care center) | From April 2005 (end period not defined) | NR | Delhi | 22 suspected cases of meningococcal disease | Pediatric, adult | NR |
Sachdeva et al. 2005 [16] | Hospital-based, retrospective | 2002–2004 | NR | Delhi | NR | Neonate (?), pediatric, adolescent, adult | NR |
Endemic disease | |||||||
Jayaraman et al. 2018 [38] | Hospital-based (10 sentinel surveillance sites), prospective | March 2012–February 2013 | NR | Tamil Nadu, Kerala, Karnataka, Odisha, Himachal Pradesh | 3104 clinically suspected cases of meningitis | Pediatric | NR |
Bali et al. 2017 [27] | National Institute-based, cross sectional, prospective | August–September 2014 | 4/274 (1.5%) | Jammu and Kashmir | 274 nasopharyngeal swabs of college freshmen | Adult | NR |
Devi et al. 2017 [32]b | Hospital-based (1 tertiary care center) | January 2013–January 2015 | NR | Assam | 303 CSF samples tested for pathogens | Neonate | NR |
Bhagawati et al. 2014 [28] | Hospital-based (tertiary care center), prospective | August 2009–July 2010 | NR | Assam | 316 CSF samples from suspected cases of acute meningitis | Neonate (?), pediatric, adolescent, adult | 50% sensitivity to penicillin G, amoxicillin-clavulanic acid, amikacin, ciprofloxacin, ceftriaxone, cefotaxime, ceftazidime, Imipenem |
Fitzwater et al. 2013 [35] | Hospital-based (pediatric hospital), prospective | January 2008–September 2011 | NR | Tamil Nadu | 2564 suspected cases of meningitis | Pediatric | NR |
Gangane and Kumar 2013 [36] | Hospital-based (tertiary care center), prospective | November 2010–December 2012 | NR | Karnataka | 308 CSF samples from clinical cases of bacterial meningitis (including 82 with aerobic bacterial growth) | Neonate (?), pediatric, adolescent, adult | 50% sensitivity to ampicillin, gentamicin, amikacin |
Shameem et al. 2008 [49] | Hospital-based (tertiary care center), prospective | February 2003–January 2007 | NR | Karnataka | 535 suspected cases of pyogenic meningitis | Pediatric | Tetracyclin, Amoxicillin |
Kumar et al. 2008 [40] | Hospital-based (tertiary care center), prospective | January 2005–June 2007 | NR | Delhi | 34 samples from suspected cases of meningococcal meningitis | Neonates (?), pediatric, adolescent, adult | 8.8% resistance to penicillin, 5.9% to erythromycin and intermediate sensitivity to erythromycin (11.8%) |
Mani et al. 2007 [43] | Hospital-based (tertiary care center), retrospective | January 1996–December 2005 | NR | Karnataka | 385 suspected cases of community acquired acute bacterial meningitis | Pediatric, adult | NR |
Shivaprakash et al. 2004 [50] | NR | NR | NR | Karnataka | 204 clinically suspected acute pyogenic meningitis | Pediatric | NR |
Singhi et al. 2004 [51] | Hospital-based (tertiary care center), retrospective | July 1993–December 1996 | NR | Punjab and Haryana | 220 children admitted with acute bacterial meningitis (among which 88 children admitted to the intensive care unit) | Pediatric | NR |
Chinchankar et al. 2002 [29] | Hospital-based (tertiary care center), prospective | April 1997–March 1999 | NR | Maharashtra | 54 cases of acute bacterial meningitis | Pediatric | NR |
Case reportsc | |||||||
Mutreja et al. 2018 [44] | Case report, retrospective | NR | NR | Karnataka | 1 (military recruit) | Adult | NR |
Gawalkar et al. 2017 [37] | Case report, retrospective | NR | NR | Punjab and Haryana | 1 | Adolescent | NR |
Devi et al. 2014 [33]b | Case report, retrospective | NR | NR | Assam | 1 | Neonate | NR |
Aggarwal et al. 2013 [25] | Case report, retrospective | NR | NR | Delhi | 1 | Pediatric | Penicillin, ciprofloxacin |
Abbas and Mujeeb 2013 [23] | Case report, retrospective | NR | NR | Uttar Pradesh | 1 | Pediatric | NR |
Sahu et al. 2013 [48] | Case report, retrospective | NR | NR | Odisha | 1 | Pediatric | Penicillin, ampicillin, chloramphenicol, gentamicin, ciprofloxacin |
Dass et al. 2013 [31] | Case report, retrospective | NR | NR | Meghalaya | 1 | Adolescent | No response to azithromycin, vancomycin or ceftriaxone |
Verma et al. 2011 [53] | Case report, retrospective | NR | NR | Delhi | 1 | Adult | NR |
Agarwal and Sharma 2010 [24] | Case report, retrospective | NR | NR | Delhi | 1 | Adolescent | NR |
Puri et al. 1995 [46] | Case report, retrospective | NR | NR | Delhi | 1 | Pediatric | NR |
Suri et al. 1994 [52] | Case report, retrospective | NR | NR | Delhi | 1 | Pediatric | NR |
Author | Age (enrolled population unless specified)a | Incidence | Mortality | Serogroup distribution | ||
---|---|---|---|---|---|---|
No. of confirmed cases | % of confirmed cases | No. of confirmed deaths | % of confirmed deaths | |||
Epidemic disease | ||||||
Dass Hazarika et al. 2013 [30] | 8.5 ± 5.1 years old (mean ± SD) | 68 (meningococcal meningitis) and 22 (meningococcemia) and 20 (both meningococcal meningitis and meningococcemia) 24 confirmed (meningococcal meningitis) and 7 confirmed (meningococcemia) and 8 confirmed (both meningococcal meningitis and meningococcemia) | 61.8% (meningococcal meningitis) and 20.0% (meningococcemia) and 18.2% (both meningococcal meningitis and meningococcemia) 35.3% (meningococcal meningitis) and 31.8% (meningococcemia) and 40.0% (both meningococcal meningitis and meningococcemia) | 2 (meningococcal meningitis) and 4 (meningococcemia) and 1 (both meningococcal meningitis and meningococcemia) Overall 7 Mortality data not provided for confirmed cases (but for the sum of probable and confirmed cases) | 2.9% (meningococcal meningitis) and 18.2% (meningococcemia) and 5.0% (both meningococcal meningitis and meningococcemia) Overall 6.4% Mortality data not provided for confirmed cases therefore no % reported for confirmed cases specifically | A (all cases) |
Majumdar et al. 2011 [42]b | From 2 months old to 60 years old (maximum reported cases in the age group 20–30 years old) | 28 (among all samples) | 19.2% (among all samples) | NR (district-wise: 62 of 285 suspected or confirmed cases) | NR (district-wise: 21.8%) | A (all confirmed cases) |
Kushwaha et al. 2010 [41] | NR | 17 (14 with meningococcal meningitis and 3 with meningococcemia); 88.2% were 21–26 years old | 0.6% (of all troops) | 2 (of 17 confirmed cases; both with meningococcemia) | 11.8% | A (all confirmed cases) |
Jhamb et al. 2009 [39] | < 1 year old (no neonates): n = 5, 5–12 years old: n = 82 | 100 (n = 67 for meningococcal meningitis, n = 20 for meningococcemia, n = 13 for both symptoms) | 100% | 17 (n = 3 for meningococcal meningitis, n = 5 for meningococcemia, n = 9 for both symptoms) | 17% (3.0% for meningococcal meningitis, 5.0% for meningococcemia, 9.0% for both symptoms) | A (all culture-positive cases) |
Nair et al. 2009 [45] | Of 55 probable/confirmed cases: ≤ 5 years old: n = 3, 6–14 years old: n = 18, 15–29 years old: n = 25, 30–44 years old: n = 6, ≥ 45 years old: n = 3 | 32 | 58.2% (of 55 probable/confirmed cases) and 8.4% (of 380 suspected cases) | Present study: 8 (5 adults and 3 children) Overall: 62 of 444 meningococcal cases in April–July 2005 and 17 of 177 meningococcal cases in January–March 2006 | Present study: 14.5% (of 55 probable/confirmed) and 2.1% (of 380 suspected cases) Overall: 14.0% (of 444 meningococcal cases) in April–July 2005 and 9.6% (of 177 meningococcal cases) in January–March 2006 | A (all culture-positive cases) |
Duggal et al. 2007 [34] | 3 months old to 65 years old; | 124 based on NICD definition (of 257 cases with microbial evidence of meningococcal infection; < 1 year old: n = 6, 1–5 years old: n = 5, 6–14 years old: n = 51, 15–45 years old: n = 189, > 45 years old: n = 6) | 23.4% (of 531 suspected cases) and 48.2% (of 257 cases with microbial evidence of meningococcal infection) | 15 (11 adults and 4 children; of 257 cases with microbial evidence of meningococcal infection) Overall: 60 of 441 cases in March–July 2005 | 5.8% (of 257 cases with microbial evidence of meningococcal infection) Overall: 13.6% (of 441 cases in March–July 2005) | Of 195 CSF samples tested, 42 (21.5%) were identified as serogroup A and 63 (32.3%) as among serogroups ACYW |
Arya et al. 2006 [26]b | 25 years old | 2 (cases of meningococcal meningitis) | 100% | 0 | 0% | A (both cases) |
Saha et al. 2006 [47]b | From 2.5 to 70 years old (10 suspected cases in the pediatric group and 12 in the adult group) | 1 (4.5 years old, culture confirmed) | 4.5% | 0 | 0% | A (only one isolate tested) |
Sachdeva et al. 2005 [16] | For 258 cases reported: 0–5 years old: n = 27, 6–12 years old: n = 61, 13–20 years old: n = 71, 21–30 years old: n = 79, 31–40 years old: n = 12, 41–50 years old: n = 12, 50–75 years old: n = 8, > 75 years old, n = 4 | Overall: 971 | NR | Overall: 118 (12.2% of 971 confirmed cases of meningococcal disease) | NR | NR |
Endemic disease | ||||||
Jayaraman et al. 2018 [38] | 1 month old to 59 months old | 7 (of 257 confirmed cases of bacterial meningitis) | 2.7% (of 257 confirmed cases of bacterial meningitis) and < 0.1% (of 3104 clinically suspected cases of meningitis) | NR | NR | NR |
Bali et al. 2017 [27] | > 18 years old | NR | NR | NR | NR | B (all carriers) |
Devi et al. 2017 [32]b | < 30 days old | 2 (of 62 CSF samples positive for pathogens) | 3.2% (of 62 CSF samples positive for pathogens) and < 0.1% (of 303 CSF samples tested for pathogens) | NR | NR | Y (for at least one neonate, described in [33] |
Bhagawati et al. 2014 [28] | 0–10 years old: n = 163, 11–20 years old: n = 41, 21–70 years old: n = 111, > 70 years old: n = 1 | 2 (of 44 culture-positive samples); > 3 months old–10 years old: n = 1, > 45 years old: n = 1 | 4.5% (of 44 culture-positive samples) and 0.6% (of 316 suspected cases of bacterial meningitis) | NR | NR | NR |
Fitzwater et al. 2013 [35] | > 30 days old – < 24 months old (1–5 months old: 25%, 6–11 months old: 35%, 12–17 months old: 28%, 18–24 months old: 12%) | 2 (of 51 confirmed cases of bacterial meningitis) | 3.9% (of 51 confirmed cases of bacterial meningitis) and < 0.1% (of 2564 suspected cases of meningitis) | NR | NR | Among serogroups A/Y (n = 1), among serogroups C/W (n = 1) |
Gangane and Kumar 2013 [36] | 0–1 year old: n = 79, 1–5 years old: n = 50, 6–15 years old, n = 39, 16–60 years old: n = 129, > 60 years old: n = 11 | 2 (of 82 with aerobic bacterial growth) | 2.4% (of 82 with aerobic bacterial growth) and < 0.1% (of 308 CSF samples from clinical cases of bacterial meningitis) | NR | NR | NR |
Shameem et al. 2008 [49] | Most cases: > 30 days old–3 years old | 18 (of 236 untreated cases of pyogenic meningitis) | 7.6% (of 236 untreated cases of pyogenic meningitis) and 3.4% (of 535 suspected cases of pyogenic meningitis) | NR | NR | NR |
Kumar et al. 2008 [40] | 0–10 years old: n = 9, 11–20 years old: n = 8, 21–30 years old: n = 12, 31–40 years old, n = 3, 41–50 years old: n = 1, 51–60 years old, n = 1 | 34 | 100% (of 34 samples from suspected cases of meningococcal meningitis) | NR | NR | A (all samples) |
Mani et al. 2007 [43] | < 12 years old: n = 51, adults: n = 334 | 4 (all adults) | 1.0% (of 385 suspected cases of community acquired acute bacterial meningitis) | NR | NR | NR |
Shivaprakash et al. 2004 [50] | NR | 2 | 7.4% (of 27 culture-positive samples) and 1.0% (of 204 CSF samples) | NR | NR | NR |
Singhi et al. 2004 [51] | < 1 year old: n = 49, 1–5 years old: n = 26, 5–12 years old, n = 13 (of 88 children admitted to the intensive care unit) | 1 | 1.1% (of 88 children admitted to the intensive care unit) and 0.5% (of 220 children admitted with acute bacterial meningitis) | NR | NR | NR |
Chinchankar et al. 2002 [29] | From 1 month old to 5 years old (42 cases < 1 year old) | 1 | 1.9% (of 54 cases of acute bacterial meningitis) | NR | NR | NR |
Case reportsc | ||||||
Mutreja et al. 2018 [44] | 21 years old | 1 (case of meningococcemia) | 100% | 1 | 100% | NR |
Gawalkar et al. 2017 [37] | 17 years old | 1 (case of meningococcemia) | 100% | 0 | 0% | NR |
Devi et al. 2014 [33]b | 38 weeks old gestation male baby, 14 days old | 1 | 100% | 0 | 0% | Y |
Aggarwal et al. 2013 [25] | 1 year old | 1 | 100% | 0 | 0% | B |
Abbas and Mujeeb 2013 [23] | 6 months old | 1 | 100% | 0 | 0% | NR |
Sahu et al. 2013 [48] | 11 years old | 1 (septic arthritis) | 100% | 0 | 0% | Among serogroups A-D |
Dass et al. 2013 [31] | 13 years old | 1 (polyarthritis) | 100% | 0 | 0% | NR |
Verma et al. 2011 [53] | 19 years old | 1 | 100% | 0 | 0% | NR |
Agarwal and Sharma 2010 [24] | 15 years old | 1 | 100% | 0 | 0% | A |
Puri et al. 1995 [46] | 11 years old | 1 (Guillain-Barré syndrome possibly caused by meningococcal infection) | 100% | 0 | 0% | NR |
Suri et al. 1994 [52] | 4 months old | 1 | 100% | 1 | 100% | B |
Epidemic Meningococcal Disease in India
Overall Incidence and Mortality
Age- and Serogroup-Specific Distribution
Endemic Meningococcal Disease in India
Overall Incidence and Mortality
Age- and Serogroup-Specific Distribution
Clinical Characteristics
Antibiotic Sensitivity and Resistance
Case Reports
Overview of Case Reports
Age- and Serogroup-Specific Distribution
Clinical Characteristics
Challenges in Estimating Meningococcal Disease Burden
Recommendations on Meningococcal Vaccination
Countrya | Vaccination schedule |
---|---|
Chile [63] | 12 months old: 1 dose |
Argentina [64] | 3 doses at 3, 5 and 15 (booster) months of age 11 years old: 1 dose |
UK [65] | 14 years old: 1 dose |
Australia [66] | 12 months old: 1 dose 14–16 years old: 1 dose (15–19 years old for catch-up) |
The Netherlands [67] | 14 months old: 1 dose 14 years old: 1 dose |
Spain [68] | 12 years old: 1 dose (13–18 years old for catch-up) |
Switzerland [69] | 2 years old: 1 dose 11–15 years old: 1 dose |
Austria [70] | 11–13 years old: 1 dose (14–18 years old for catch-up) |
Canada [71] | 12–24 years old: 1 dose of either Men C or Men ACWY |
Greece [72] | 11–12 years old: 1 dose (13–18 years old for catch up) |
Italy [73] | 12–14 years old: 1 dose |
Saudi Arabia [74] | 2 doses at 9 and 12 months of age 18 years old: 1 dose |
USA [75] | 2 doses at 11–12 and 16 years of age (13–15 and/or 16–18 years old for catch-up) |
Belgium [76] | At 15 months and 15–16 years |