ArticleInfection2026
The persistent challenge of meningitis in the vaccine era: a three-decade longitudinal analysis of residual burden in the United States.
Article in Infection, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study evaluates evolutionary trajectories, structural pathogen shifts, and geographical efficiency of the 1990-2021 United States (US) meningitis burden to identify vulnerable populations and drivers in the post-vaccine era.
methodsIntegrating Global Burden of Disease (GBD) 2021 and American Community Survey (ACS) data, we employed Joinpoint regression, decomposition, and frontier analyses to assess trends and efficiency. Multivariable regression and interrupted time series (ITS) analysis assessed socioeconomic associations and vaccine-related trend discontinuities.
resultsAge-standardized incidence (ASIR), mortality (ASMR), and years lived with disability (YLDs) rates fell by 72.15%, 68.57%, and 80.25%, respectively, between 1990 and 2021, while age-standardized disability-adjusted life years (DALYs) rates fell by 75.53%. Pathogen patterns underwent structural shifts; the share of years of life lost (YLLs) attributable to Neisseria meningitidis fell from 20.81% to 8.02%, while Klebsiella pneumoniae became the leading contributor to pathogen-attributable YLLs (15.58%). Inter-state DALYs rates varied 2.72-fold, with efficiency gaps notable even in high socio-demographic index (SDI) regions. Poverty was associated with mortality-related burdens (ASMR aRR = 1.057, 95% CI: 1.043-1.071; DALYs 1.057, 1.041-1.073; YLLs 1.060, 1.044-1.077; all P < 0.001) but not incidence; the American Indian and Alaska Native population proportion was independently associated with all six indicators. After PCV7, Streptococcus pneumoniae DALYs showed a level change of -0.553 and a trend change of -0.241 (both P < 0.001); no MenACWY or MenB parameter reached significance (all P > 0.24). Since 2012, the rate of decline has slowed.
conclusionPoverty was the state-level factor most strongly associated with inequalities in US meningitis mortality, although the American Indian and Alaska Native and Black population proportions were also independently associated with mortality-related outcomes. Neonates and the elderly represent critical structural gaps in the post-vaccine era. Maternal GBS immunization is a prospective strategy contingent on licensure, and attention to the material conditions associated with poverty may help address the residual burden.
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