2023 American Academy of Neurology Abstract Website

Objective:

To evaluate the public health surveillance system (PHSS) for bacterial meningitis (2007-2020) in Colombia using Benford’s Law (BL) for digits distribution.

Background:

Bacterial meningitis is a significant cause of disability and premature death, mainly in vulnerable populations. Due to its rapid spread, it is recognized as a threat to public health. Therefore, effective PHSS should be implemented and optimized for an adequate response to the epidemiological dynamics. In Colombia, bacterial meningitis is endemic mainly, but there has been a significant increase in incident cases, and lethality seems higher compared to the previous decade. Evaluation of PHSS through the BL has been performed before for epidemics.

Design/Methods:

The number of cases was obtained from the national PHSS (SIVIGILA), which actively registries meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides. BL was tested on the distribution of the second digits of the case number using a log-likelihood ratio. Analysis by year (2007-2020) and department were included for detecting potential flaws in the system.

Results:

During the study period, 3821 cases were reported in Colombia, with a fatality rate of 19.10%. Analysis of the global performance of the PHSS demonstrated the fulfillment of BL every year. Departments with ≥10 cases per year showed a distribution similar to that tested (p>0.050). San Andrés, Vaupes, and Vichada’s reports were null for >75% of the period. BL testing could not be performed due to an unexpectedly small number of cases for multiple departments, especially those with high fatality (≤45%; Quindío, La Guajira, and Cesar) and prevalence of infectious meningitis (≤18 cases per 100.000 inhabitants; Huila, Putumayo, Amazonas, Vichada and Casanare).

Conclusions:

The PHSS for bacterial meningitis in Colombia exhibited an adequate performance according to the fulfillment of the BL. The system’s precision at multiple departments needs to be explored to determine the potential lack of coverage (epidemiological silence).