Sizing Up A Killer: Understanding Meningococcal Disease in Latin America
Few illnesses have as much power to cause panic among the population as meningococcal disease. And the facts are scary: meningococcal disease is one of the most severe and rapidly progressive community acquired infections. At any given time 10 to 25 percent of the global population carry meningococcal bacteria in the back of their throats or in their noses, but this percentage may be much higher during an epidemic. Up to 20 percent of patients who come down with the die, typically within 24-48 hours of the onset of symptoms. The disease, which infects the membranes of the brain and spinal cord, is debilitating and potentially fatal for children, adolescents and people living in overcrowded conditions. And while meningococcal disease is considered a disease of mandatory notification in most countries of the region, the exceedingly low rates of the disease reported by some countries and the high proportion of meningitis reported by others send conflicting messages about its real burden. Information about the true burden of this disease is usually neither published nor easily accessible.
What can we do about it?
Today, I write from Buenos Aires, where Latin American researchers, economists and global health leaders have gathered to focus on meningococcal disease in the region – 181 experts attended the meeting with 21 countries of the region being represented. Latin America has high meningococcal-associated morbidity and mortality, even in the face of early therapeutic intervention. But we still need to have a greater understanding of the true burden of meningococcal disease in the region so that we can help promote programs and introduce vaccines to fight this killer.
Our work on this project, coordinated by the Sabin Vaccine Institute in partnership with the Pan American Health Organization, the International Vaccine Access Center at Johns Hopkins University and the Centers for Diseases Control and Prevention, set out to accomplish two primary goals: to review available epidemiological data on meningococcal disease in Latin America and the Caribbean (LAC) to estimate the burden of disease in the region; and to estimate the costs associated with management of meningococcal disease cases and outbreaks in selected countries of the LAC region.
Through this first-ever study, by estimating the burden and costs of meningococcal disease in the region, we can begin to determine what obstacles impede its prevention through vaccination.
What did we find?
This is the first study in the region to estimate the cost of meningococcal disease, and the numbers are striking, giving us new urgency for our work: Meningococcal disease incurs a considerable societal economic burden in countries of the region, generating up to $6,228 (USD) in costs per patient. This burden represents the cost of treating an endemic case, not a case during an outbreak.
A detailed socioeconomic study during the 2007 epidemic in Burkina Faso showed that each case of meningitis in a family results in a sudden expenditure of about US$90—what amounts to three or four months of the family's disposable income. Families with few resources cycle inexorably downward to the next level of poverty. In addition, about 25 percent of survivors have permanent after-effects such as deafness, leaving them less likely to be economically productive citizens, and they often become wards of an already financially stretched extended family. Furthermore, what is not captured in the above analysis is the chaos to health systems engendered by a meningitis epidemic.
Closer to home, in Brazil, one community had a meningitis outbreak causing nine cases and spent $143,000 (USD) on investigation and outbreak management alone. This study did not consider the cost of treating the outbreak cases, which would bring the costs of the outbreak even higher. The new study concluded that more and better information is needed to help control outbreaks.
Given the availability of new highly effective vaccines, better epidemiological information, carriage studies and characterization of N. meningitidis isolates are critical to understand the epidemiology of meningococcal disease in Latin American countries.
Along with understanding the biology of disease itself, we must also examine the economic impact, which can vary widely across countries in the LAC region. An economic study is one way of providing such information. Yet what is clear from our research is that coordinated vaccination programs would not only significantly reduce outbreaks, but would also reduce the overall financial burden the disease can have on local health systems.
Our work concludes that through improved surveillance and better understanding of meningococcal epidemiology and costs, we can help devise meningitis vaccination programs that can not only save lives but also prevent these extraordinary economic impacts.
We can eliminate meningitis as a public health problem in the LAC region by increasing awareness of the disease and economic burden, and through the development, testing, introduction, and widespread use of meningococcal vaccines.
Dr. Dagna Constenla is the Director of Economics & Finance at the International Vaccine Access Center.