Global trends and vaccine-associated changes in meningitis burden, 2000–2023: a multi-country ecological panel study
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Background
Meningitis remains a major cause of global morbidity and mortality. We aimed to quantify the association between vaccine introduction and meningitis- related disability-adjusted life year (DALY) rates globally and across high-burden regions from 2000 to 2023.
Methods
We conducted a longitudinal panel study of 188 countries using health metrics from the Global Burden of Disease study and WHO vaccine data. We estimated associations using two-way fixed effects regression models, adjusting for GDP and healthcare access. Analyses were stratified by baseline burden and included the African meningitis belt.
Findings
Globally, meningitis DALY rates declined by 4.97% per year (p<0.0001). Introduction of the Hib vaccine was associated with a 6.7% reduction in DALY rates, and PCV with a 4.8% reduction. In high-burden countries, both vaccines were associated with larger reductions (∼10%), while no significant effects were detected in low-burden settings. In the African meningitis belt, PCV introduction was associated with a substantial 16.8% reduction in DALY rates (p<0.0001). No significant global association was observed for meningococcal vaccines.
Interpretation
Global declines in meningitis burden are strongly associated with Hib and PCV scale-up, with the greatest benefits in high-burden settings. These findings support prioritized vaccine deployment in endemic regions to maximize public health impact. However, the presence of pre-treatment trends for Hib suggests these estimates represent vaccine-associated population-level changes rather than strictly causal effects.
