Disease burden of Streptococcus pneumoniae and Neisseria meningitidis meningitis in children and adolescents: A population-based study

Bacterial meningitis remains a major, life-threatening infection in children and adolescents, with Streptococcus pneumoniae meningitis (SPM) and Neisseria meningitidis meningitis (NMM) accounting for most cases. This study aimed to quantify the global burden and spatiotemporal patterns of SPM and NMM in individuals aged 0 to 19 years from 1990 to 2021, and to provide evidence for integrated, cross-pathogen prevention and improved clinical pathways. Using Global Burden of Disease 2021 estimates for 204 countries and territories, we extracted deaths and disability-adjusted life years (DALYs) for SPM and NMM in individuals aged 0 to 19 years (1990-2021). Trends were assessed using estimated annual percentage change and Joinpoint regression. Spearman correlation and concentration indices quantified inequalities across socio-demographic index (SDI) levels, decomposition analysis identified burden drivers, and Bayesian age-period-cohort modeling projected trends to 2050. In 2021, SPM caused 20,718 deaths (95% UI 14,718-29,192) and 1,823,058 disability-adjusted life years (DALYs; 95% UI 1,301,814-2,561,107), while NMM caused 17,389 deaths (95% UI 12,705-23,603) and 1,552,383 DALYs (95% UI 1,146,164-2,096,751) among those aged 0 to 19. From 1990 to 2021, the overall burden of both pathogens fell substantially worldwide, with a steeper decline for NMM. Decomposition pointed to epidemiological change as the main driver. Burden clustered in children under 5; among those younger than ten, males exceeded females. The magnitude of decline diminished with age. NMM showed a brief global uptick around 1996. Around 2011, Streptococcus pneumoniae supplanted Neisseria meningitidis as the principal pathogen contributing to meningitis burden in this population. Relative inequality between high-SDI and low-SDI countries has continued to widen, with the burden becoming increasingly concentrated in low-SDI regions. From 1990 to 2021, the global burden of SPM and NMM in children and adolescents declined substantially, with NMM declining faster and SPM overtaking NMM around 2011. Burden is highest in children under 5, with males more affected than females under 10. Despite absolute reductions, relative inequality widened, concentrating burden in low-SDI regions such as Western Sub-Saharan Africa. Integrated strategies including expanded vaccination, rapid diagnostics, and strengthened pediatric critical care are essential to reduce burden and narrow inequities.