International Journal of Infectious Diseases (Sep 2022)

Case-fatality and sequelae following acute bacterial meningitis in South Africa, 2016 through 2020

  • Susan Meiring,
  • Cheryl Cohen,
  • Linda de Gouveia,
  • Mignon du Plessis,
  • Vanessa Quan,
  • Jackie Kleynhans,
  • Colin Menezes,
  • Gary Reubenson,
  • Halima Dawood,
  • Maphoshane Nchabeleng,
  • Mohamed Said,
  • Nomonde Mvelase,
  • Prasha Mahabeer,
  • Rispah Chomba,
  • Ruth Lekalakala,
  • Trusha Nana,
  • Vindana Chibabhai,
  • Marianne Black,
  • Anne von Gottberg

Journal volume & issue
Vol. 122
pp. 1056 – 1066

Abstract

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Objectives: Providing country-specific estimates of case fatality and sequelae from bacterial meningitis (BM) is important to evaluate and monitor progress toward the World Health Organization's roadmap to “defeating meningitis by 2030”. Methods: From 2016-2020, GERMS-SA conducted enhanced surveillance at 26 hospitals across South Africa. Episodes of laboratory-confirmed BM due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis were included. Risk factors for in-hospital death and sequelae at hospital discharge among survivors were analyzed. Results: Of 12,717 invasive bacterial infections reported nationally, 39% (4980) were from enhanced surveillance sites, including 4159 pneumococcal, 640 H. influenzae, and 181 meningococcal infections. BM accounted for 32% (1319/4159) of pneumococcal, 21% (136/640) of H. influenzae, and 83% (151/181) of meningococcal invasive diseases. Clinical data were available for 91% (1455/1606) of BM: 26% (376/1455) were aged <5 years, 50% (726/1455) were female, and 62% (723/1171) with known HIV results, were HIV-infected. In-hospital case fatality was 37% (534/1455), and 24% (222/921) of survivors had adverse sequelae. Risk factors for death included altered mental status, HIV infection, and comorbidities. Risk factors for adverse sequelae included altered mental status and antimicrobial nonsusceptibility. Conclusion: BM in South Africa has a high case fatality, and adverse sequelae frequently occur among survivors. Those with comorbidities (including HIV) are at the highest risk.

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