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    Epidemiology: Mortality

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    Epidemiology: Mortality

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    Epidemiology: Mortality

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    of 2

    ntreated, bacterial meningitis is almost always fatal.

    According to the WHO, bacterial meningitis has an overall mortality rate of


    16.7% (with treatment).[12] Viral meningitis, in contrast, tends to resolve spontaneously and is rarely fatal. With
    treatment, mortality (risk of death) from bacterial meningitis depends on the age of the person and the underlying cause. Of
    newborns, 20–30% may die from an episode of bacterial meningitis. This risk is much lower in older children, whose mortality is
    about 2%, but rises again to about 19–37% in adults.[2][3]

    Risk of death is predicted by various factors apart from age, such as the pathogen and the time it takes for the pathogen to be
    cleared from the cerebrospinal fluid,[2] the severity of the generalized illness, a decreased level of consciousness or an abnormally
    low count of white blood cells in the CSF.[3] Meningitis caused by H. influenzae and meningococci has a better prognosis than cases
    caused by group B streptococci, coliforms and S. pneumoniae.[2] In adults, too, meningococcal meningitis has a lower mortality (3–
    7%) than pneumococcal disease.[3]

    In children there are several potential disabilities which may result from damage to the nervous system, including sensorineural
    hearing loss, epilepsy, learning and behavioral difficulties, as well as decreased intelligence.[2] These occur in about 15% of
    survivors.[2] Some of the hearing loss may be reversible.[85] In adults, 66% of all cases emerge without disability. The main problems
    are deafness (in 14%) and cognitive impairment (in 10%).[3]

    Tuberculous meningitis in children continues to be associated with a significant risk of death even with treatment (19%), and a
    significant proportion of the surviving children have ongoing neurological problems. Just over a third of all cases survives with no
    problems.[86]

    Epidemiology
    [edit]

    Demography of meningococcal meningitis.

    meningitis belt

    epidemic zones

    sporadic cases only

    Deaths from meningitis per million people in 2012

     0–2
     3-3
     4–6
     7–9
     10–20
     21–31
     32–61
     62–153
     154–308
     309–734
    Although meningitis is a notifiable disease in many countries, the exact incidence rate is unknown.[22] In 2013 meningitis resulted in
    303,000 deaths – down from 464,000 deaths in 1990.[87] In 2010 it was estimated that meningitis resulted in 420,000 deaths,
    [88]
    excluding cryptococcal meningitis.[42]

    Bacterial meningitis occurs in about 3 people per 100,000 annually in Western countries. Population-wide studies have shown that
    viral meningitis is more common, at 10.9 per 100,000, and occurs more often in the summer. In Brazil, the rate of bacterial
    meningitis is higher, at 45.8 per 100,000 annually.[17] Sub-Saharan Africa has been plagued by large epidemics of meningococcal
    meningitis for over a century,[89] leading to it being labeled the "meningitis belt". Epidemics typically occur in the dry season
    (December to June), and an epidemic wave can last two to three years, dying out during the intervening rainy seasons. [90] Attack
    rates of 100–800 cases per 100,000 are encountered in this area, [91] which is poorly served by medical care. These cases are
    predominantly caused by meningococci.[17] The largest epidemic ever recorded in history swept across the entire region in 1996–
    1997, causing over 250,000 cases and 25,000 deaths.[92]

    Meningococcal disease occurs in epidemics in areas where many people live together for the first time, such as army barracks
    during mobilization, university and college campuses[2] and the annual Hajj pilgrimage.[64] Although the pattern of epidemic cycles in
    Africa is not well understood, several factors have been associated with the development of epidemics in the meningitis belt. They
    include: medical conditions (immunological susceptibility of the population), demographic conditions (travel and large population
    displacements), socioeconomic conditions (overcrowding and poor living conditions), climatic conditions (drought and dust storms),
    and concurrent infections (acute respiratory infections).[91]

    There are significant differences in the local distribution of causes for bacterial meningitis. For instance, while N.
    meningitides groups B and C cause most disease episodes in Europe, group A is found in Asia and continues to predominate in
    Africa, where it causes most of the major epidemics in the meningitis belt, accounting for about 80% to 85% of documented
    meningococcal meningitis cases.[91]

    History
    [edit]
    Some suggest that Hippocrates may have realized the existence of meningitis,[17] and it seems that meningism was known to pre-
    Renaissance physicians such as Avicenna.[93] The description of tuberculous meningitis, then called "dropsy in the brain", is often
    attributed to Edinburgh physician Sir Robert Whytt in a posthumous report that appeared in 1768, although the link with tuberculosis
    and its pathogen was not made until the next century.[93][94]

    It appears that epidemic meningitis is a relatively recent phenomenon.[95] The first recorded major outbreak occurred in Geneva in
    1805.[95][96] Several other epidemics in Europe and the United States were described shortly afterward, and the first report of an
    epidemic in Africa appeared in 1840. African epidemics became much more common in the 20th century, starting with a major
    epidemic sweeping Nigeria and Ghana in 1905–1908.[95]

    The first report of bacterial infection underlying meningitis was by the Austrian bacteriologist Anton Weichselbaum, who in 1887
    described the meningococcus.[97] Mortality from meningitis was very high (over 90%) in early reports. In 1906, antiserum was
    produced in horses; this was developed further by the American scientist Simon Flexner and markedly decreased mortality from
    meningococcal disease.[98][99] In 1944, penicillin was first reported to be effective in meningitis.[100] The introduction in the late 20th
    century of Haemophilus vaccines led to a marked fall in cases of meningitis associated with this pathogen, [60] and in 2002, evidence
    emerged that treatment with steroids could improve the prognosis of bacterial meningitis. [76][79][99]

    See also
    [edit]

     aseptic meningitis
     CSF/serum glucose ratio
    References

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