Our vision is a world free of meningitis. Knowledge, and its application, is transformative in the fight to defeat meningitis, which is why we strive to connect people and research to drive action, so lives can be saved. One of the ways we achieve this goal is by bringing together the world’s leading scientific and medical experts to share their latest advances and discuss today’s challenges for meningitis, and meningitis-related sepsis, with the aim of creating the world’s leading forum for meningitis research.
This year, we hosted more than 200 delegates, with 46 speakers coming from seventeen countries to our 14th international conference, which took place in the beautiful setting of the British Museum, London.
Understanding the experience of meningitis survivors
Over the two days, we took a deep dive into the latest science behind the disease, studying all aspects of meningitis prevention, diagnosis, surveillance and care. Following a carefully crafted agenda (guided by our conference steering committee) the conference began by listening to the experiences of meningitis survivors, illustrating how support and care differs between countries.
“It [meningitis] shaped my life at every point…” Dr Ella Bailey, a meningitis survivor and an ambassador for Meningitis Research Foundation since the age of 12, brought to life the reality of a meningitis diagnosis. She explained how a ‘normal Sunday afternoon’ as a young child saw her health rapidly deteriorate, with a call to the emergency services leading to urgent care and a 50% chance of survival. She detailed each stage of her journey, from diagnosis through to aftercare and life beyond meningitis, which ultimately led to her chosen career in medicine and her current role as a doctor.
Her story was followed by video testimony from Opuda Mitchell Bennett. He spoke about his experience in Nigeria, which, in stark contrast, served as a sobering reminder of the disparities in treatment and after care for meningitis around the world. He spoke movingly about the lack of care and access to affordable medication as well as the challenges of building a life after meningitis, with his after-effects making it hard for him to work alongside needing to counter the attitudes of others to his health issues.
“It is a problem for me to even survive, my family still believe it is not a medical condition, people like me need help.” he said.
With the context firmly grounded around those directly affected, the sessions that followed were packed with insights and discussions on every aspect of meningitis. Read on for the emerging themes:
- A lack of data documenting the lifetime impacts of meningitis must be addressed
Throughout the conference, it was clear much progress had been made in meningitis prevention, diagnosis and treatment. In one example, Professor Muhamed-Kheir Taha, from the Institut Pasteur in Paris, highlighted that before treatment was developed, invasive meningococcal disease killed more than 80% of people who contracted it.
But many were also quick to point out there is still a huge amount of work to be done, and a recurring theme throughout the conference, was a call for further research and evidence to better understand the life time impacts of meningitis, known as sequelae.
They included Dr Nicoline Schiess, from the World Health Organization (WHO), whose presentation focused on improving diagnosis, treatment and care for people affected by meningitis in low- and middle-income countries. She explained that [between 1990-2016] there has been a 21% decrease in global deaths due to meningitis but this pales in comparison to other vaccine-preventable pediatric diseases, such as measles and tetanus. For those that contract bacterial meningitis, there is a 20% risk of having sequelae – and that risk is three times higher in Africa and Asia compared to Europe. However, the true impact of meningitis remains hard to gauge because of “a profound lack of data within low-resource settings”.
This has resulted in some after effects, such as cognitive impairments and behavioral abnormalities, regularly not being recognised and reported, meaning “…often adolescents and young adults fall through the cracks as far as their care.”
To improve the diagnosis, treatment and care for people who have been affected by meningitis, such as Opuda, Nicoline explained that the WHO are currently developing evidence based WHO guidance, that in particular, will focus on improving the recognition and early treatment of meningitis sequelae in low and middle income countries.’Dr Merijn Bijlsma, from the University Medical Centre in Amsterdam, also called for further research. After highlighting the outcomes and impact of bacterial meningitis he pinpointed a stark contrast between low- and middle-income countries in comparison to the Netherlands and Denmark, with its well-resourced welfare state. He stressed the need for more studies on long-term outcomes, particularly in low-resource settings, with longer follow-up periods of patient monitoring and evaluation, and the use of standardised definitions, assessments and outcomes.
- Vaccines have a key role to play in preventing anti-microbial resistant (AMR) meningitis
In a panel discussion exploring meningitis and anti-microbial resistance (AMR), AMR was flagged as rapidly becoming “a global threat”. A well-reported issue over recent years, its scale was summarised by Dr Mateusz Hasso-Agopsowicz from the WHO. Figures from the Institute for Health Metrics and Evaluation were referenced, which showed that, in 2019, it was estimated that around 1.3 million deaths were attributable to AMR and almost five million deaths were associated with AMR worldwide.
A number of pathogens have been identified and categorised by the WHO as priorities for the development of new antimicrobials – and many of these can be causes of bacterial meningitis, including the pneumococcus, Haemophilus Influenzae (Hi), salmonellae (a significant cause of neonatal meningitis), staphylococcus aureus and some versions of enetrobacteriacae. He went on to highlight the latest thinking around strategies to reduce AMR, focusing on the vital role vaccines could play by:
- Protecting people on an individual level from getting sick.
- Helping to safeguard communities by decreasing transmission and preventing illness among the wider community through herd immunity.
- Preventing complications such as secondary infections. Using vaccines to prevent infectious disease would ultimately decrease the use of antibiotic treatment in a hospital, and the body's resistance to those germs. This, in turn, would ensure antibiotics remain effective when they most need to be used, reducing the pressure to develop new antibiotics.
However, today, the role of vaccines as tools to reduce antimicrobial resistance is under-represented, with less than half of countries including it in existing plans to tackle AMR.
- Progress to defeat meningitis by 2030 is well underway.
Progress towards defeating meningitis lags behind other infectious diseases and the WHO Global Road Map to Defeat Meningitis by 2030 was borne out of a call to do more to tackle meningitis in all regions of the world.
Antoine Durupt, from the WHO, shared progress made to date, which included the development of updated guidelines for diagnostic treatment and care and the recommendation that the new MenFive vaccine, which offers protection against five of the leading causes of invasive meningococcal disease (A, B, C, W Y and X)…should be introduced to countries within the African meningitis belt.
The African region were highlighted as leading the way in Road Map implementation, with 30 countries beginning the development of their national strategic plans to defeat meningitis, a true moment of progress and one which CoMO members in Nigeria and Kenya have been part of, representing the role civil society can play in supporting community initiatives.
Progress is also being made by WHO’s Pan American Health Organization (PAHO), with a regional framework completed and examples of work underway, included training between countries, such as Costa Rica partnering with Chile to learn from their experiences on best practices and surveillance.
Despite significant, global progress being made, the resounding agreement among all the delegates was that there is still much work to be done to prevent, diagnose, treat, monitor and care for meningitis patients.
But there is also a huge amount of on-going and breakthrough research underway in all areas of this infectious disease, though with much long-term, coordinated and targeted investment and support still needed.
In continuing to work towards, and champion this, we can, and will, defeat meningitis.