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International Journal of
eISSN: 2577-8269

Family & Community Medicine

Research Article Volume 5 Issue 1

Epidemiological profile of meningitis cases in the state of Alagoas, Brazil (2007-2018)

Antônio Barros,1 Gabriela Amaral,1 Lucas Silva,1 Dalson Figueiredo Filho,2 Thiago Rocha1

1Faculty of Medicine, Universidade Estadual de Ciências da Saúde de Alagoas, Brazil
2Department of Political Science, Universidade Federal de Pernambuco, Brazil

Correspondence: Lucas Silva, Faculty of Medicine, Alagoas State University of Health Sciences (UNCISAL)

Received: January 08, 2021 | Published: February 9, 2021

Citation: Barros A, Amaral G, Silva L, et al. Epidemiological profile of meningitis cases in the state of Alagoas, Brazil (2007-2018). Int J Fam Commun Med. 2021;5(1):23-25. DOI: 10.15406/ijfcm.2021.05.00216

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Abstract

Objective: To explore the epidemiological incidence of meningitis cases in one of the poorest Brazilian states, Alagoas, between 2007 and 2018.

Methodology: The research design employs descriptive statistics to examine secondary data from the Information System on Diseases of Compulsory Declaration (SINAN).

Results: In total, there were 1,683 cases of meningitis registered in Alagoas during the analyzed period. 2013 was the year with the highest number of records (221 cases). The most affected age group is between 20-39 years (438 cases). Bacterial meningitis is the most recurrent modality (416 cases), followed by viral meningitis (336 cases) and unspecified meningitis (278 cases). In general, men (994 cases) are more affected than women (686 cases).

Conclusions: This information contributes to the expansion of the epidemiological panorama, allowing the formulation of public health policies that are up-to-date in poor locations in the face of biological problems.

Keywords: meningitis, public health, immunization programs, public policy

Abbreviations

SINAN, system on diseases of compulsory declaration; WHO, world health organization; MB, bacterial meningitis; MH, Haemophilus influenza; HR, health regions; HDI, human development index

Introduction

Meningitis is characterized by the inflammation of the meninges and cerebrospinal fluid. It has a rapid clinical evolution and diverse etiology - viruses and bacteria being the most common agents.1 The classic symptoms are fever, vomiting, headache, altered mental status, and a stiff neck.1 Diagnostic procedures may include lumbar puncture, blood testing and computed tomography scan. The prevalence is higher among children under five and people over 60.2 Each year, 380,000 people die from meningitis Worldwide.3 In addition to fatalities, the disease often causes irreversible neuropsychological sequelae to survivors such as significant motor impairment and serious deafness.4,5 Economically, direct hospitalization costs to treat meningitis can reach up to R$ 20,000 (approximately U$$ 4,000 at current prices).7 In 2018, the World Health Organization (WHO) started the project “Defeating meningitis by 2030”. The policy aims to globally eradicate meningitis epidemic by expanding medical coverage and developing new vaccines.3 In addition, the initiative also seeks to improve the quality of life of the population affected by the disease.3 In Brazil, meningitis is considered an mandatory notifiable disease.8 Despite of government efforts to offer vaccines through the Unified Health System on a regular basis calendar, many states continue to record meningitis cases, including novel outbreaks and sporadic epidemics.8

According to the Brazilian Information System on Diseases of Compulsory Declaration (SINAN), the average number of cases per year grew from 20 (1975-2006) to 20,000 (2007-2018). In particular, the State of Alagoas, one of the poorest in the federation, recorded, in 2018, the 2nd largest increase (36.59%) in the number of cases across the country. In this paper, we explore epidemiological profile of meningitis cases in Alagoas (2007-2018).

Methodology

The research design employs descriptive statistics to examine secondary data from Brazilian Notifiable Diseases Information System from 2007 to 2018. The geographical coverage selected was only the State of Alagoas.9 On the original dataset, the information from 2007 to 2013 is consolidated. Data from 2014 to 2017 and 2018 were updated in August 2019 and are subject to review. The distribution of meningitis cases is examined by: a) time; b) age group; c) gender; etiological agent; and d) health administrative region. All analyzes were performed using the software R Statistical 3.6. Replication materials, including data and computational scripts, are available at <https://osf.io/dm69v/>.

Results

Figure 1 illustrates the distribution of meningitis cases in Alagoas during the analyzed series. In all, 1,683 cases of meningitis were recorded in the State. The year 2013 concentrated the highest number of cases during the period, while 2016 and 2017 concentrated the lowest number. There is an average of 140 cases per year during the series. Figure 2 illustrates the number of cases by age group (2a) and sex (2b). The age group that concentrates the most cases is 20-39 years, followed by children aged 5-9 years. The elderly, over 60 years old, form the group with the lowest number of registered cases. In general, men are more affected than women. Table 1 outlines the distribution of cases by the etiologic agent. Bacterial meningitis (MB) tops the list, followed by viral meningitis. In turn, meningitis caused by Haemophilus influenzae (MH) has the least number of cases. It is worth noting that 276 cases failed to have a specified etiologic agent (MNE). In addition, 104 cases had the etiological category ignored (missing). Geographically, the capital, Maceió, concentrates 95% of meningitis cases across the State (1,598). About 82 municipalities did not present any case during the analyzed period. From an administrative point of view, the State is divided into ten health regions (HR). The 1st HR was the one with the largest number of cases, followed by the 7th HR, 9th HR, 3rd HR, 4th and 6th HR, and 5th and 10th HR. The 2nd and 8th HR did not register cases. Figure 3 illustrates the distribution of cases in Alagoas according to the Health Regions.

Figure 1 Meningitis cases over time (2007-2018).

Figure 2 Distribution of cases by (a) age group and (b) gender.

SIGLA

Description

Quantity

MB

Meningitis due to other bacteria and unspecified bacterial meningitis

416

MV

Viral meningitis

336

MNE

Unspecified meningitis

278

MP

Pneumococcal meningitis

124

MM+MCC

Meningococcemia with meningococcal meningitis

118

MTBC

Tuberculous meningitis

117

MCC

Meningococcemia

107

MM

Meningococcal meningitis

84

MOE

Meningitis due to another etiology

81

MH

Haemophilic meningitis

16

IGN

Missing cases

5

Total

1,683

Table 1 Distribution of cases by etiology

Figure 3 Distribution of cases by Health Region.

Discussion

The dynamics of meningitis cases in the State of Alagoas reflects a set of actions that occur at the national level, which is vaccination coverage. According to the Ministry of Health, the country has found it difficult to achieve vaccination coverage goals for some diseases, including meningitis.11 Only 44.6% of the country's municipalities manage to reach the target set by the Federal Government.11 The increase in the number of cases in the year 2018, illustrated in Figure 1, is closely linked to the previous year's vaccination coverage, 2017. In that year, Alagoas, despite having reached the BCG coverage goal (100%), was below in the other vaccines against meningitis: Meningococcus C (88.92%), Pentavalent (81.06%), and Pneumococcal (91.68%). The immunization target is 90% for BCG and 95% for Meningococcus C, Pentavalent, and Pneumococcal.12 In 2012, the coverage pattern was repeated. However, the magnitude of the values was different. The BCG goal was reached (100%) and the others were below: Meningococcus C (92.87%), Pentavalent (29%), and Pneumococcal (82.50%). What calls attention is Pentavalent's low level of coverage. This reduction was seen in all other states as well. This factor may have contributed to the increase in the number of cases in the following year, 2013. From the moment that adult individuals (20-39 years old), as shown in Figure 2, are the most affected by the disease, this may be an indication of some failure in vaccination coverage, since these individuals, supposedly, should be immune to the disease because they have already been vaccinated in childhood.

Currently, vaccination coverage rates are not the same as those of past decades.13,14 The literature points to some factors that explain this fall: a) the false feeling that it is not necessary to be vaccinated because the disease is not in circulation; b) ignorance about the importance of vaccines; c) the role of anti-vaccine movements in spreading false news on social networks.11,14 Several studies in the national literature show the reducing role of vaccines in meningitis cases in the country.15–18 Besides, the performance of the health epidemiological surveillance systems at the state or municipal levels has a significant role in reducing cases through instruction and inspection.19,20 Given the State's whole vaccination and bureaucratic framework to fight infectious diseases, it is paradoxical to find such a number of cases, not only at the state level but at the national level. After the increase in the number of cases between 2017 and 2018, shown in Figure 1, one of the measures taken by the Department of Health has been the investment in epidemiological surveillance services, in the transmission of information about the disease and reinforcing the importance of the vaccine.21 

The higher prevalence of bacterial meningitis, shown in Table 1, is also data that draws attention from the social perspective. The literature points out that this etiological agent has the highest morbidity and mortality in populations with socioeconomic vulnerability.22 According to the Atlas of Human Development in Brazil, Alagoas occupies the last position in the ranking of the Human Development Index (HDI) among the federation states, with 0.631.23 The limitation of this study lies in the data. The information present in large information systems ends up being underreported, either due to problems with feeding by the users and updating the information. Information at SINAN takes at least two years to consolidate. Even the disease's rapid evolution would prevent proper registration in the system, as it could disguise some clinical signs. The data would still need to go through a correction process, which would minimize the effects of underreporting.24 The findings found in the study reinforce the importance of vaccination campaigns in the control of meningitis cases not only in Alagoas but also across the country. The data analysis contributes to the expansion of the epidemiological panorama of the Alagoas territory, providing a more accurate knowledge of the reality. With this, it allows the formulation of public health policies that are heated to face biological problems.

Acknowledgments

None.

Conflicts of interest

The author declares there is no conflict of interest.

References

  1. Zunt JR, Kassebaum NJ, Blake N, et al. Global, regional, and national burden of meningitis, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(12):1061–1082.
  2. BRASIL MDSAÚDES de V em SaúdeD de V das DT. Guia de Vigilância em Saúde: volume único [Internet]. Ministério da Saúde, Secretaria de Vigilância em Saúde, Coordenação-Geral de Desenvolvimento da Epidemiologia em Serviços; 2017. p. 1–741.
  3. WHO. Defeating meningitis by 2030 - First meeting of the Technical Taskforce. 2018.
  4. Romero JH, Carvalho MS, Feniman MR. Achados audiológicos em indivíduos pós-meningite. Rev Saúde Pública. 1997;31(4):398–401.
  5. Antoniuk SA, Hamdar F, Ducci RD, et al. Meningite bacteriana aguda na infância: fatores de risco para complicações agudas e sequelas. J Pediatr (Rio J). 2011;87(6):535–540.
  6. WHO. Meningococcal meningitis. WHO. 2019.
  7. Lucarevschi BR, Escobar AM de U, Grisi S. Custos hospitalares da meningite causada por Streptococcus pneumoniae na cidade de São José dos Campos, São Paulo, Brasil. Cad Saúde Pública. 2012;28(4):740–748.
  8. BRASIL M da S. Meningite: o que é, causas, sintomas, tratamento, diagnóstico e prevenção. 2020.
  9. TabNet Win32 3.0: MENINGITE - Casos confirmados Notificados no Sistema de Informação de Agravos de Notificação - Alagoas. 2021.
  10. Figueiredo Filho D, Lins R, Domingos A, et al. Seven Reasons Why: A User’s Guide to Transparency and Reproducibility. Braz Polit Sci Rev. 2019;13(2):e0001.
  11. Domingues CMA. Queda nos índices das coberturas vacinais no Brasil. Ministério da Saúde; 2018.
  12. BRASIL M da S. Programa Nacional de Imunizações - Coberturas vacinais no Brasil - Período: 2010 - 2014. 2015. .p 1–212.
  13. Domingues CMAS, Teixeira AM da S. Coberturas vacinais e doenças imunopreveníveis no Brasil no período 1982-2012: avanços e desafios do Programa Nacional de Imunizações. Epidemiol E Serviços Saúde. 2013;22(1):9–27.
  14. Sato APS, Sato APS. Qual a importância da hesitação vacinal na queda das coberturas vacinais no Brasil? Rev Saúde Pública. 2018. p. 52.
  15. Grando IM, Moraes C de, Flannery B, et al. Impacto da vacina pneumocócica conjugada 10-valente na meningite pneumocócica em crianças com até dois anos de idade no Brasil. Cad Saúde Pública. 2015;31:276–84.
  16. Schossler JGS, Beck ST, Campos MMA de, et al. Incidência de meningite por Haemophilus influenzae no RS 1999-2010: impacto da cobertura vacinal. Ciênc Saúde Coletiva. 201318:1451–1458.
  17. Simões LLP, Andrade ALSS, Laval CA, et al. Impacto da vacinação contra o Haemophilus influenzae b na redução de meningites, Goiás. Rev Saúde Pública. 2004;38(5):664–670.
  18. Nascimento Costa M da C, Andrade Mota EL, Silva Pinto LL. Efeito protetor do BCG intradérmico na meningite tuberculosa. Bol Oficina Sanit Panam. 1991.
  19. Figueira G de CN, Carvalhanas TRMP, Okai MIG, et al. Avaliação do sistema de vigilância das meningites no município de São Paulo, com ênfase para doença meningocócica. BEPA Bol Epidemiológico Paul Online. 2012 Jan;9(97):05–25.
  20. Escosteguy CC, Medronho R de A, Madruga R, et al. Vigilância epidemiológica e avaliação da assistência às meningites. Rev Saúde Pública. 2004;38(5):657–663.
  21. ALAGOAS SE de. Sesau orienta sobre prevenção e tratamento da meningite – SESAU – Secretaria de Estado da Saúde de Alagoas. 2019.
  22. Souza SF de, Costa M da CN, Paim JS, et al. Meningites bacterianas e condições de vida. Rev Soc Bras Med Trop. 2012;45(3):323–328.
  23. Atlas Brasil. 2021.
  24. Emmerick ICM, Campos MR, Schramm JM de A, et al. Estimativas corrigidas de casos de meningite, Brasil 2008-2009. Epidemiol E Serviços Saúde. 2014;23:215–26.
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