Disease burden of non-polio enterovirus-associated meningitis in children in G20 countries: an analysis based on GBD data and projections to 2050

BACKGROUND: Non-polio enteroviruses (NPEVs) have emerged as the leading etiological cause of childhood meningitis globally, yet the long-term disease burden and its epidemiological trends within G20 countries remain insufficiently characterized. This study aims to systematically evaluate the burden of pediatric NPEV-associated meningitis in G20 countries from 1990 to 2023 and to project future trends to 2050. METHODS: Data were extracted from the Global Burden of Disease Study 2023 (GBD 2023) database. The primary outcome measures were mortality and disability-adjusted life years (DALYs) due to NPEV-associated meningitis in children aged 0-14 years. Estimated annual percentage changes (EAPCs) were calculated to quantify temporal trends. Spearman's rank correlation was used to assess the relationship between disease burden and the Socio-demographic Index (SDI) across G20 countries. A Bayesian age-period-cohort (BAPC) model was employed to forecast disease burden to 2050. RESULTS: In G20 countries, the mortality rate for pediatric NPEV-associated meningitis declined from 1.153 per 100,000 (95% UI: 0.902-1.453) in 1990 to 0.088 per 100,000 (95% UI: 0.070-0.113) in 2023 (EAPC: -7.72%, 95% CI: -8.19 to -7.24). The DALY rate decreased from 107.732 to 9.487 per 100,000 over the same period (EAPC: -7.35%, 95% CI: -7.80 to -6.91). Significant age-related disparities were observed: infants younger than 1 year bore the highest burden (mortality: 0.890 per 100,000; DALY: 80.649 per 100,000), despite showing smaller relative declines compared to older children. At the national level, Indonesia had the highest mortality rate (0.374 per 100,000) and DALY rate (34.344 per 100,000)\. Notably, South Africa exhibited the slowest decline among all G20 members (mortality EAPC: -3.80%; DALY EAPC: -3.76%), far below the G20 averages. Both mortality and DALY rates showed significant negative correlations with SDI across G20 countries (r = -0.849 and - 0.832, respectively, both p < 0.001). Projections to 2050 indicate continued declines, with mortality and DALY rates decreasing by over 95% in G20 countries. CONCLUSIONS: From 1990 to 2023, the burden of pediatric NPEV meningitis in G20 countries declined significantly, yet substantial intra-G20 disparities persist. Indonesia had the highest rates, India the largest absolute numbers, and South Africa the slowest decline. Infants younger than 1 remain the most vulnerable group. Future efforts should prioritize enhanced surveillance and targeted interventions in high-burden countries including Indonesia, South Africa, and India, and strengthen diagnostic capacities in lower-resourced member states to narrow gaps within this influential group of nations.