Compartmental models for seasonal hyperendemic bacterial meningitis in the African meningitis belt

Thibaut Koutangni (1, 2) , Pascal Crepey (3, 4, 5) , Maxime Woringer (6) , S. Porgho (7) , B.W. Bicaba (7) , H. Tall (8) , Judith E Mueller (5, 9, 10, 2)

1 UPMC - Université Pierre et Marie Curie - Paris 6
2 Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology
3 REPERES - Recherche en Pharmaco-épidémiologie et Recours aux Soins
4 UVE - Unité des Virus Emergents
5 EHESP - École des Hautes Études en Santé Publique [EHESP]
6 IBENS - Institut de biologie de l'ENS Paris
7 Ministère de la Santé [Burkina Faso]
8 Agence de Médecine Préventive [Burkina Faso]
9 METIS - Département Méthodes quantitatives en santé publique
10 IP - Institut Pasteur [Paris]

The pathophysiological mechanisms underlying the seasonal dynamic and epidemic occurrence of bacterial meningitis in the African meningitis belt remain unknown. Regular seasonality (seasonal hyperendemicity) is observed for both meningococcal and pneumococcal meningitis and understanding this is critical for better prevention and modelling. The two principal hypotheses for hyperendemicity during the dry season imply (1) an increased risk of invasive disease given asymptomatic carriage of meningococci and pneumococci; or (2) an increased transmission of these bacteria from carriers and ill individuals. In this study, we formulated three compartmental deterministic models of seasonal hyperendemicity, featuring one (model1-‘inv’ or model2-‘transm’), or a combination (model3-‘inv-transm’) of the two hypotheses. We parameterised the models based on current knowledge on meningococcal and pneumococcal biology and pathophysiology. We compared the three models' performance in reproducing weekly incidences of suspected cases of acute bacterial meningitis reported by health centres in Burkina Faso during 2004–2010, through the meningitis surveillance system. The three models performed well (coefficient of determination R2, 0.72, 0.86 and 0.87, respectively). Model2-‘transm’ and model3-‘inv-transm’ better captured the amplitude of the seasonal incidence. However, model2-‘transm’ required a higher constant invasion rate for a similar average baseline transmission rate. The results suggest that a combination of seasonal changes of the risk of invasive disease and carriage transmission is involved in the hyperendemic seasonality of bacterial meningitis in the African meningitis belt. Consequently, both interventions reducing the risk of nasopharyngeal invasion and the bacteria transmission, especially during the dry season are believed to be needed to limit the recurrent seasonality of bacterial meningitis in the meningitis belt.

Keywords: Seasonality; Mathematical model; African meningitis belt; Meningitis; Hyperendemicity

Domains: Life Sciences [q-bio]; Santé publique et épidémiologie; Life Sciences [q-bio]; Human health and pathology; Infectious diseases

Thibaut Koutangni, Pascal Crepey, Maxime Woringer, S. Porgho, B.W. Bicaba, et al.. Compartmental models for seasonal hyperendemic bacterial meningitis in the African meningitis belt. Epidemiology and Infection, 2019, 147, pp.e14. ⟨10.1017/S0950268818002625⟩. ⟨hal-02043813⟩