Analysis of the Epidemiological Impact of a Public Health Policy against Meningococcal Meningitis in Children in Maranhão, Brazil

Abstract

Aims: Over the years, Meningococcal Disease (MD), an acute infection characterized by inflammation of the meninges in response to the agent N. meningitidis, has been affecting different regions of Brazil in different ways. Therefore, the meningococcal C vaccine (MeCV) was introduced to the Brazilian vaccination schedule in 2010, following the increase in lethality associated with meningitis in the country. The state of Maranhão, in Brazil, has challenging socioeconomic characteristics, such as low coverage of basic sanitation and high prevalence of poverty, which are factors that may favor the spread of MD. Thus, this article aimed to analyze the epidemiological data of meningitis in children up to 9 years old, in the state of Maranhão, before and after the implementation of the Meningococcal C vaccine in the vaccination schedule in Brazil. Study Design:  This is a retrospective, cross-sectional, descriptive and quantitative epidemiological study. Place and Duration of Study: The study was conducted in the state of Maranhão, Brazil, using data from 2001 to 2020. Methodology: The study used data from the SINAN/DATASUS and SIH/DATASUS databases, between 2001–2020, in children aged 0 to 9 years. Results: Our results pointed to a reduction in the incidence of MD in children aged 0 to 9 years, especially after the implementation of MeCV, suggesting the effectiveness of the vaccine in preventing the disease. In addition, especially after the introduction of MeCV, the data show a decrease in the number of notifications of meningitis (of etiological agents in general) and in the number of hospitalizations due to bacterial meningitis. However, paradoxically, there was an increase in lethality. Conclusion: These results reinforce that the introduction of the Meningococcal C vaccine (MeCV) into the Brazilian immunization program was a preventive strategy in vulnerable populations. However, the observed paradoxical increase in lethality highlights the need for further investigation into factors influencing disease outcomes, such as delays in diagnosis, access to health services, and the presence of coexisting conditions.