Vaccine preventable meningitis in Malaysia: epidemiology and management

Abstract

Worldwide bacterial meningitis accounts for more than one million cases and 135,000 deaths annually. Profound, lasting neurological complications occur in 9–25% of cases. This review confirms the greatest risk from bacterial meningitis is in early life in Malaysia. Much of the disease burden can be avoided by immunization, particularly against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae. Despite inclusion of the Hib vaccine in the National Immunisation Programme and the licensure of pneumococcal vaccines, these two species are the main contributors to bacterial meningitis in Malaysia, with Neisseria meningitidis and Mycobacterium tuberculosis, causing a smaller proportion of disease. The high Hib prevalence may partly be due to dated, small-scale studies limiting the understanding of the current epidemiological situation. This highlights the need for larger, better quality surveillance from Malaysia to evaluate the success of Hib immunization and to help guide immunization policy for vaccines against S. pneumoniae and N. meningitidis.

Keywords:

• etiology
• disease surveillance
• Haemophilus influenzae
• immunization
• Malaysia
• meningitis
• Mycobacterium tuberculosis
• Neisseria meningitides
• Streptococcus pneumoniae

Financial & competing interests disclosure

SC Clarke receives unrestricted research funding from Pfizer Vaccines (previously Wyeth Vaccines) and has participated in advisory boards and expert panels for GSK, Pfizer and Novartis. SC Clarke and JMC Jefferies are investigators on studies conducted on behalf of University Hospital Southampton NHS Foundation Trust/University of Southampton/Public Health England that are sponsored by vaccine manufacturers but receives no personal payments from them. SC Clarke and JMC Jefferies have received financial assistance from vaccine manufacturers to attend conferences. All grants and honoraria are paid into accounts within the respective NHS Trusts or universities, or to independent charities. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• The evidence base for vaccine preventable meningitis in Malaysia is inadequate, particularly for adults and elderly populations.

• Haemophilus influenzae is the single greatest bacterial cause of meningitis in the country; however, no study into its prevalence, compared with other causes of meningitis, has been conducted since inclusion of the H. influenzae type b vaccine into Malaysia’s National Immunisation Programme in 2002.

• Children under 5 years old are at greatest risk from vaccine preventable meningitis with those under 2 years of age particularly susceptible.

• According to extremely limited data, Streptococcus pneumoniae has the highest case fatality rate in Malaysia, almost 27%, for meningitis.

• H. influenzae, Neisseria meningitidis exhibited roughly similar case fatality rates, around 13%, again based on very small-scale studies.

• Introduction of PCV7 has been adjudged cost–effective on the basis of the expected reduction in the burden of meningitis, notwithstanding the additional cost savings, which could result with the decrease in other invasive pneumococcal diseases. Similar analysis is needed for the more contemporaneous PCV10 and PCV13.

• All forms of pneumococcal conjugate vaccine would likely protect against the majority of pneumococcal serotypes in circulation in Malaysia.

Notes