A Comprehensive Review of Meningococcal Disease Burden in India

Abstract

Introduction: Meningococcal disease caused by Neisseria meningitidis has a high case fatality rate. Of 12 distinct serogroups, A, B, C, W-135 (W) and Y cause the majority of infections. The meningococcal disease burden and epidemiology in India are not reliably known. Hence, we performed a narrative review with a systematically conducted search to summarize information on meningococcal disease burden and epidemiology and vaccination recommendations for meningococcal disease in India.

Mass gatherings: a review of the scope for meningococcal vaccination in the Indian context

“…IMD is recognized as a notifiable disease in India and a recent literature review concluded there is a significant burden of meningococcal disease-related complications in this country. 21 The review also found that meningococcal disease is increasingly reported among adolescents and adults, with large outbreaks described in these populations, the most recent of which occurred in Meghalaya 58 and Tripura. 59 The Meghalaya outbreak occurred from January 2008 until June 2009 with 110 cases aged up to 18 years and seven deaths from one center as per the study by Hazarika et al, 58 whereas the total number of cases in the state were 2100 with 260 deaths.…”

“…58,59 Meningococcal disease in India appears to be caused almost exclusively by serogroup A, although serogroups B, C, W, and Y have also been documented. 21 Further epidemiological information is also available from the military in India. In 2005-2010, the Indian Armed Forces had an average attack rate of 9 or 10 cases of meningococcal disease per year and the N. meningitidis carrier rate among recruits was estimated in the 1990s to be 12%.…”

“…44 The background incidence of IMD in India has been estimated to be low, with N. meningitidis responsible for 1.9% of the meningitis cases, although this estimation is based on data gathered from 1950 to 2007. 62 Moreover, as discussed in detail previously, 21 there is a lack of comprehensive information on the epidemiology of meningococcal disease, with few data from the last decade. Small outbreaks are likely to be unreported, particularly those in rural areas, and the true magnitude of larger-scale outbreaks is considered to be underestimated.…”

“… 62 , 63 This underestimation occurs because, although IMD is a notifiable disease, disease surveillance is not enforced and reporting is passive only. 21 The focus is therefore on disease management rather than the collection of surveillance data. 63 Most of the available epidemiological data were collected during outbreaks 64 and case reporting and disease monitoring activities were discontinued once the epidemic had resolved.…”

“…A comprehensive review of the burden of meningococcal disease in this country has been published recently. 21 We highlight the difficulty in determining the current epidemiology of IMD in India and outline the measures used to contain outbreaks, presenting the case for adjusting the existing public health policy toward this vaccine-preventable disease ( Figure 1 ).

Figure 1.

…”