Systematic analysis and projections of the global and regional burden of meningitis among children under 5 years, 1990 to 2021, with forecasts to 2050.

Using Global Burden of Disease 2021 estimates, we characterized long-term trends (1990-2021), age-specific patterns, and socioeconomic/geographic disparities in the global meningitis burden, and descriptively benchmarked country-level burden relative to development level using frontier analysis. We analyzed incidence, mortality, prevalence, and disability-adjusted life years using age-standardized rates across locations and time. We further assessed temporal trends, age-specific patterns, socioeconomic and geographic inequalities, decomposition of burden changes, and development-conditioned frontier benchmarks, and generated projections to 2050 using Bayesian age-period-cohort forecasting models. From 1990 to 2021, the global meningitis burden among children under 5 years declined across major indicators. Projections suggested continued overall reductions to 2050 under the continuation of observed historical patterns. Despite this progress, the burden remained unevenly distributed. Neonates had the highest burden across major metrics, and low-SDI settings continued to experience substantially higher incidence, mortality, and disability-adjusted life year rates than high-SDI settings. Inequality analyses further indicated that relative disparities persisted over time. The global burden of meningitis among children under 5 years has declined and is projected to continue decreasing. However, the remaining burden is concentrated among neonates and in lower-SDI settings. Because these patterns were identified consistently across age-specific, SDI-stratified, and inequality analyses, sustained progress will require continued burden reduction together with equity-oriented prevention, diagnostic access, and newborn-care strategies targeted to neonates and lower-SDI high-burden settings.