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1. The epidemiology of invasive meningococcal disease in EU/EEA countries, 2004-2014

Author

Robert Whittaker, Joana Gomes Dias, Miriam Ramliden, Csaba Ködmön, Assimoula Economopoulou, Netta Beer, Lucia Pastore Celentano, Elisabeth Kanitz, Lukas Richter, Wesley Mattheus, Corinne Bleyenheuft, Teodora Georgieva, Ivan Simeonovski, Vesna Višekruna Vučina, Sanja Kurečić Filipović, Maria Koliou, Despo Pieridou Bagatzouni, Pavla Krizova, Helena Sebestova, Steen Hoffmann, Palle Valentiner-Branth, Natalia Kerbo, Rita Peetso, Markku Kuusi, Maija Toropainen, Isabelle Parent, Muhamed-Kheir Taha, Ulrich Vogel, Wiebke Hellenbrand, Theano Georgakopoulou, Georgina Tzanakaki, Katalin Krisztalovics, Tamás Tirczka, Thorolfur Gudnason, Hjordis Hardardottir, Piaras O'Lorcain, Desiree Bennett, Fortunato D'Ancona, Paola Stefanelli, Larissa Savrasova, Darja Vasilevska, Nerija Kuprevičienė, Rasa Liausedienė, Irène Demuth, Gérard Scheiden, Jackie Maistre Melillo, Paul Caruana, Arie van der Ende, Liesbeth Mollema, Dominique Caugant, Hans Blystad, Anna Skoczyńska, Lavinia Zota, Marina Pana, Marta Grgič Vitek, Metka Paragi, Rosa Cano, Raquel Abad, Tiia Lepp, Helen Campbell, AII - Infectious diseases, Medical Microbiology and Infection Prevention, European Centre for Disease Prevention and Control [Stockholm, Sweden] (ECDC), Tufts University [Medford], Hellenic Centre for Diseases Control and Prevention (HCDCP), and Members of the ECDC network for invasive meningococcal disease: Elisabeth Kanitz, Lukas Richter (Austria), Wesley Mattheus, Corinne Bleyenheuft (Belgium), Teodora Georgieva, Ivan Simeonovski (Bulgaria), Vesna Višekruna Vučina, Sanja Kurečić Filipović (Croatia), Maria Koliou, Despo Pieridou Bagatzouni (Cyprus), Pavla Krizova, HelenaSebestova (Czech Republic), Steen Hoffmann, PalleValentiner-Branth (Denmark), Natalia Kerbo, Rita Peetso (Estonia), Markku Kuusi, Maija Toropainen (Finland), Isabelle Parent, Muhamed-Kheir Taha (France), Ulrich Vogel, Wiebke Hellenbrand (Germany), Theano Georgakopoulou, Georgina Tzanakaki (Greece), Katalin Krisztalovics, Tamás Tirczka (Hungary), Thorolfur Gudnason, Hjordis Hardardottir (Iceland), Piaras O'Lorcain, Desiree Bennett (Ireland), Fortunato D'Ancona, Paola Stefanelli (Italy), Larissa Savrasova, Darja Vasilevska (Latvia), Nerija Kuprevičienė, Rasa Liausedienė (Lithuania), Irène Demuth, Gérard Scheiden (Luxembourg), Jackie Maistre Melillo, Paul Caruana (Malta), Arievan der Ende, Liesbeth Mollema (Netherlands), Dominique Caugant, Hans Blystad (Norway), Anna Skoczyńska (Poland), Lavinia Zota, Marina Pana (Romania), Marta Grgič Vitek, Metka Paragi (Slovenia), Rosa Cano, Raquel Abad (Spain), Tiia Lepp (Sweden), Helen Campbell (UK)

Subjects
0301 basic medicine, Male, Pediatrics, Epidemiology, MESH: Meningococcal Vaccines/administration & dosage, First year of life, Neisseria meningitidis, medicine.disease_cause, 0302 clinical medicine, MESH: Aged, 80 and over, MESH: Child, Medicine, 030212 general & internal medicine, MESH: Incidence, Child, MESH: Aged, Aged, 80 and over, education.field_of_study, Surveillance, MESH: Middle Aged, Incidence, MESH: Sex Distribution, Invasive meningococcal disease (IMD), Middle Aged, MESH: Infant, MESH: Sepsis/epidemiology, Vaccination, Europe, Infectious Diseases, Invasive meningococcal disease, MESH: Young Adult, Child, Preschool, Molecular Medicine, Bacterial meningitis, Female, Adult, medicine.medical_specialty, Adolescent, 030106 microbiology, Population, Meningococcal Vaccines, MESH: Meningitis, Meningococcal/epidemiology, Meningitis, Meningococcal, Serogroup, 03 medical and health sciences, Young Adult, Age Distribution, Environmental health, MESH: Meningitis, Meningococcal/prevention & control, Sepsis, Humans, Sex Distribution, education, MESH: Age Distribution, Aged, MESH: Adolescent, MESH: Humans, General Veterinary, General Immunology and Microbiology, business.industry, MESH: Child, Preschool, Public Health, Environmental and Occupational Health, Infant, MESH: Adult, MESH: Serogroup, MESH: Male, MESH: Europe/epidemiology, MESH: Neisseria meningitidis/isolation & purification, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Neisseria meningitidis/classification, business, Notification rate, MESH: Female
Abstract

International audience; Background: Invasive meningococcal disease (IMD) is a major cause of bacterial meningitis and septi-caemia although infection by some serogroups may be prevented through vaccination. We aimed to describe the epidemiology of IMD in EU/EEA countries during 2004-2014 to monitor serogroup-and age-specific trends, and compare country trends by the period of meningococcal C conjugate (MCC) vaccine introduction.Methods: We analysed IMD surveillance data by age, gender, serogroup, country and outcome. We estimated the percentage change in annual notification rate (NR), using linear regression analysis of the log of the annual NR. We grouped countries by the year they introduced MCC vaccination into their routine immunisation programmes. Results: The overall NR was 0.9/100 000 population, and decreased 6.6% (95%CI: À8.0%;À5.1%) annually. Infants had the highest NR (16.0/100 000), and there were decreasing trends in all age groups

Published
2017
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2. The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations

Author

Hajime Kamiya, Mehmet Ceyhan, Konstantin Mironov, Gabriela Echániz-Aviles, Jay Lucidarme, Susan Meiring, Yanet Climent, Muhamed-Kheir Taha, Philippe De Wals, Bianca Stenmark, Dominique A. Caugant, Xilian Bai, Marco Aurélio Palazzi Sáfadi, Josefina Carlos, Caroline Trotter, Ener Cagri Dinleyici, Vinny Smith, Reinaldo Acevedo, Bingqing Zhu, Hannah Christensen, Zhujun Shao, Ray Borrow, Andromachi Karachaliou, Julio A. Vázquez, Ahmed Hakawi, Robert Steffen, Finlay Institute of Vaccines, Public Health England [London], Norwegian Institute of Public Health [Oslo] (NIPH), University of the East – Ramon Magsaysay Memorial Medical Center [Philippines], Faculty of Medicine [Hacettepe University], Hacettepe University = Hacettepe Üniversitesi, University of Bristol [Bristol], Université Laval [Québec] (ULaval), Eskisehir Osmangazi University, National Institute of Public Health = Instituto Nacional de Salud Pública [Cuernavaca, Mexique] (INSP), Ministry of Health [Riyadh], National Institute of Infectious Diseases [Tokyo], University of Cambridge [UK] (CAM), National Institute for Communicable Diseases [Johannesburg] (NICD), Central Research Institute of Epidemiology [Moscow], FCM Santa Casa de São Paulo School of Medical Sciences [São Paulo], Chinese Centre for Disease Control and Prevention, Meningitis Research Foundation [Bristol], Universität Zürich [Zürich] = University of Zurich (UZH), Örebro University Hospital [Örebro, Sweden], Centre National de Référence des Méningocoques et Haemophilus influenzae - National Reference Center Meningococci and Haemophilus influenzae (CNR), Institut Pasteur [Paris], Institute of Health Carlos III, R. Borrow, J. Lucidarme and X. Bai perform contract work for Public Health England on behalf of GSK, PATH, Sanofi Pasteur and Pfizer. M.K. Taha performs contract work for the Institut Pasteur funded by GSK, Pfizer and Sanofi Pasteur. S. Meiring has received grant funding for a meningococcal carriage study by Sanofi Pasteur. G. Enchaniz-Aviles has received support for research projects from GSK and Pfizer. J.A. Vázquez performs contract work for the Institute of Health Carlos III funded by GSK and Pfizer. P. De Wals has received research grants, and reimbursements of travel expenses from vaccine manufacturers including GSK, Novartis, Sanofi Pasteur, and Pfizer, as well as from governmental agencies including the Quebec Ministry of Health and Social Services, Health Canada, and the Public Health Agency of Canada. M.A.P. Sáfadi has received grants to support research projects and consultancy fees from GSK, Pfizer and Sanofi Pasteur. C. Trotter has received consulting fees from GSK and an honorarium from Sanofi-Pasteur for developing and delivering a modeling workshop at a previous GMI meeting. H. Christensen has received reimbursements of travel expenses and, for previous GMI meetings, honoraria, from Sanofi-Pasteur, consultancy fees from IMS Health and AstraZeneca all paid to her employer. She is supported by the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care., Institut Pasteur [Paris] (IP), and Sanofi Pasteur

Subjects
0301 basic medicine, Antibiotic resistance, MESH: Anti-Bacterial Agents/administration & dosage, MESH: Anti-Bacterial Agents/pharmacology, MESH: Global Health, Neisseria meningitidis, medicine.disease_cause, Global Health, Disease Outbreaks, MESH: Meningococcal Infections/epidemiology, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, vaccine, Drug Discovery, Epidemiology, 030212 general & internal medicine, MESH: Disease Outbreaks, immunization program, Vaccination, 3. Good health, Anti-Bacterial Agents, conjugate vaccine, surveillance, Molecular Medicine, Epidemiology / Surveillance, epidemiology, bacterial meningitis, serogroup, medicine.medical_specialty, Immunology, MESH: Meningococcal Infections/microbiology, Meningococcal Vaccines, Polysaccharide Vaccine, Meningococcal disease, 03 medical and health sciences, Conjugate vaccine, Drug Resistance, Bacterial, MESH: Drug Resistance, Bacterial, medicine, Humans, MESH: Meningococcal Vaccines/administration & dosage, Pharmacology, meningococcal disease, High risk populations, MESH: Humans, business.industry, MESH: Vaccination, medicine.disease, Virology, polysaccharide vaccine, Meningococcal Infections, 030104 developmental biology, MESH: Meningococcal Infections/prevention & control, business
Abstract

Introduction: The 2018 Global Meningococcal Initiative (GMI) meeting focused on evolving invasive meningococcal disease (IMD) epidemiology, surveillance, and protection strategies worldwide, with emphasis on emerging antibiotic resistance and protection of high-risk populations. The GMI is comprised of a multidisciplinary group of scientists and clinicians representing institutions from several continents. Areas covered: that the incidence and prevalence of IMD continually varies both geographically and temporally, and surveillance systems differ worldwide, the true burden of IMD remains unknown. Genomic alterations may increase the epidemic potential of meningococcal strains. Vaccination and (to a lesser extent) antimicrobial prophylaxis are the mainstays of IMD prevention. Experiences from across the globe advocate the use of conjugate vaccines, with promising evidence growing for protein vaccines. Multivalent vaccines can broaden protection against IMD. Application of protection strategies to high-risk groups, including individuals with asplenia, complement deficiencies and human immunodeficiency virus, laboratory workers, persons receiving eculizumab, and men who have sex with men, as well as attendees at mass gatherings, may prevent outbreaks. There was, however, evidence that reduced susceptibility to antibiotics was increasing worldwide. Expert commentary: The current GMI global recommendations were reinforced, with several other global initiatives underway to support IMD protection and prevention. This paper was in part supported by Sanofi Pasteur. Sí

Published
2018
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3. Meningococcal disease in the Middle East and Africa: Findings and updates from the Global Meningococcal Initiative

Author

Anne von Gottberg, Ener Cagri Dinleyici, Linda Glennie, Aziza Razki, Khalid Zerouali, Hannah Christensen, Muhamed-Kheir Taha, Ray Borrow, Dominique A. Caugant, Mehmet Ceyhan, Vincent Smith, Amel Kechrid, Jamie Findlow, Julio A. Vázquez Moreno, Hassiba Tali-Maamar, Manchester Royal Infirmary, University of Manchester [Manchester], Norwegian Institute of Public Health [Oslo] (NIPH), Faculty of Medicine [Hacettepe University], Hacettepe University = Hacettepe Üniversitesi, University of Bristol [Bristol], Eskisehir Osmangazi University, Meningitis Research Foundation [Bristol], Centre for Respiratory Diseases and Meningitis, a division of the National Health Laboratory Services, National Institute for Communicable Diseases [Johannesburg] (NICD), Children’s Hospital of Tunis, Institute of Health Carlos III, Institut Pasteur du Maroc, Réseau International des Instituts Pasteur (RIIP), Centre National de Référence des Méningocoques et Haemophilus influenzae - National Reference Center Meningococci and Haemophilus influenzae (CNR), Institut Pasteur [Paris], Institut Pasteur d'Algérie, Université Hassan II [Casablanca] (UH2MC), Medical writing support was provided by Debaditya Das, PhD, and Robert Axford-Gatley, MD, of the GMI Secretariat, PAREXEL International, which was funded by Sanofi Pasteur. HC is supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England., Global Meningococcal Initiative (GMI), and Institut Pasteur [Paris] (IP)

Subjects
0301 basic medicine, Pediatrics, Turkey, MESH: Meningococcal Vaccines/administration & dosage, Neisseria meningitidis, MESH: Immunization Programs, Disease Outbreaks, MESH: Neisseria meningitidis/immunology, MESH: Meningococcal Infections/epidemiology, MESH: Meningococcal Infections/prevention & control, 0302 clinical medicine, Africa, Northern, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine, 030212 general & internal medicine, MESH: Disease Outbreaks, Meningococcal disease, Sub-Saharan Africa, Vaccination, MESH: Middle East/epidemiology, 3. Good health, Infectious Diseases, Meningitis, Microbiology (medical), medicine.medical_specialty, 030106 microbiology, MESH: Meningococcal Infections/microbiology, Meningococcal Vaccines, MESH: Meningitis, Meningococcal/epidemiology, Meningitis, Meningococcal, MESH: Turkey/epidemiology, Serogroup, Pentavalent vaccine, 03 medical and health sciences, Middle East, MESH: Meningococcal Vaccines/adverse effects, Environmental health, Humans, Disease burden, Africa South of the Sahara, MESH: Humans, business.industry, Immunization Programs, MESH: Africa, Northern/epidemiology, MESH: Serogroup, MESH: Vaccination, medicine.disease, North Africa, Meningococcal Infections, Carriage, MESH: Neisseria meningitidis/isolation & purification, MESH: Africa South of the Sahara/epidemiology, Global Meningococcal Initiative (GMI), Hajj, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MenAfriVac
Abstract

Preventing invasive meningococcal disease (MD) through education, research, and cooperation is the mission of the scientists, clinicians, and public health officials comprising the Global Meningococcal Initiative (GMI). The GMI roundtable meeting for the Middle East and Africa, held in Lisbon, Portugal, October 2016, produced two recommendations: vaccination of attendees should be considered for some types of mass-gathering events, as some countries mandate for the Hajj, and vaccination of people with human immunodeficiency virus, because of increased MD risk. Differences exist between Middle Eastern and African countries regarding case and syndrome definitions, surveillance, and epidemiologic data gaps. Sentinel surveillance provides an overview of trends and prevalence of different capsular groups supporting vaccine selection and planning, whereas cost-effectiveness decisions require comprehensive disease burden data, ideally counting every case. Surveillance data showed importance of serogroup B MD in North Africa and serogroup W expansion in Turkey and South Africa. Success of MenAfriVac® in the African “meningitis belt” was reviewed; the GMI believes similar benefits may follow development of a low-cost meningococcal pentavalent vaccine, currently in phase 1 clinical trial, by 2022. The importance of carriage and herd protection for controlling invasive MD and the importance of advocacy and awareness campaigns were also highlighted.

Published
2017
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4. Characteristics and changes in invasive meningococcal disease epidemiology in France, 2006-2015

Author

Ala-Eddine Deghmane, Eva Hong, Daniel Lévy-Bruhl, Denise Antona, I. Parent du Chatelet, L. Fonteneau, Muhamed-Kheir Taha, Santé publique France - French National Public Health Agency [Saint-Maurice, France], Centre National de Référence des Méningocoques et Haemophilus influenzae - National Reference Center Meningococci and Haemophilus influenzae (CNR), Institut Pasteur [Paris], No external funding was used for this work, however the work of the National Reference Center for meningococci was funded by Santé publique France and the Institut Pasteur., and Institut Pasteur [Paris] (IP)

Subjects
0301 basic medicine, Male, Pediatrics, Epidemiology, MESH: Meningococcal Vaccines/administration & dosage, MESH: Epidemics/statistics & numerical data, Neisseria meningitidis, Neisseria meningitidis, Serogroup B, Group B, MESH: Genotype, MESH: Meningococcal Infections/epidemiology, 0302 clinical medicine, MESH: Epidemics/prevention & control, Cost of Illness, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, MESH: Neisseria meningitidis, Serogroup B/pathogenicity, MESH: Child, Case fatality rate, Medicine, MESH: Vaccination/statistics & numerical data, 030212 general & internal medicine, MESH: Incidence, Young adult, Child, MESH: Aged, MESH: Middle Aged, MESH: France/epidemiology, Incidence (epidemiology), Incidence, Vaccination, MESH: Cost of Illness, Middle Aged, MESH: Infant, MESH: Neisseria meningitidis, Serogroup B/genetics, 3. Good health, MESH: Neisseria meningitidis/pathogenicity, Infectious Diseases, MESH: Neisseria meningitidis/genetics, MESH: Young Adult, Child, Preschool, Female, France, Microbiology (medical), Adult, medicine.medical_specialty, Adolescent, Genotype, 030106 microbiology, Meningococcal C conjugate vaccination, MESH: Meningococcal Infections/microbiology, Meningococcal Vaccines, Meningococcal disease, 03 medical and health sciences, Young Adult, [SDV.BBM.GTP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN], Humans, Epidemics, Disease burden, MESH: Neisseria meningitidis, Serogroup B/isolation & purification, Aged, MESH: Adolescent, MESH: Humans, business.industry, MESH: Child, Preschool, Invasive meningococcal disease, Infant, MESH: Adult, medicine.disease, MESH: Male, Meningococcal Infections, MESH: Meningococcal Infections/mortality, MESH: Neisseria meningitidis/isolation & purification, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract

International audience; OBJECTIVES:This work aimed to describe the epidemiology of invasive meningococcal disease (IMD) in France, 2006-2015, including group- and genotype-specific disease burden, incidence trends before and after introduction of meningococcal C conjugate vaccines (MCCV) in 2010, and factors influencing the case fatality rate.METHODS:Mandatory notification data on incidence and IMD case characteristics were used. Genotyping of invasive strains and whole genome sequencing were performed by the French National Reference Center. Vaccination coverage was estimated from the National Health Insurance Information System's reimbursement data.RESULTS:The decrease in annual IMD incidence rates (per 100,000 inhabitants) from 1.23 in 2006 to 0.78 in 2016 was mainly related to the decrease in group B IMD. Group C incidence decreased from 0.29 in 2006 to 0.13 in 2010 but increased thereafter in age groups not targeted by MCCV. From 2010 onwards, MCCV coverage gradually increased but remained below 25% in 15-19 year-olds in 2015. Age, clinical presentation and, to a lesser extent, clonal complex 11 were the most significant factors determining mortality.CONCLUSIONS:The limited impact of vaccination on group C IMD incidence may be explained by the emergence of a new epidemic cycle in 2011 and the low vaccination coverage rates among adolescents and young adults.

Published
2016
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5. The current situation of meningococcal disease in Latin America and updated Global Meningococcal Initiative (GMI) recommendations

Author

Maria Teresa Valenzuela Bravo, Ray Borrow, Miguel O'Ryan, Ana Paula Silva de Lemos, Maria Cecília Gorla, Muhamed-Kheir Taha, Global Meningococcal Initiative, Marco Aurélio Palazzi Sáfadi, Julio A. Vázquez, Maria Cristina de Cunto Brandileone, Gabriela Moreno, Eduardo López, FCM da Santa Casa de São Paulo, Faculty of Medicine, University of Chile, Department of Public Health and Epidemiology [Chile], Universidad de los Andes [Santiago] (UANDES), Instituto Adolfo Lutz [São Paulo, Brazil], Jefa de la División de Planificación Sanitaria [Chile], Instituto de Salud Carlos III [Madrid] (ISC), Sociedad Argentina de Infectología Pediátrica [Buenos Aires], Centre National de Référence des Méningocoques et Haemophilus influenzae - National Reference Center Meningococci and Haemophilus influenzae (CNR), Institut Pasteur [Paris], Manchester Royal Infirmary, University of Manchester [Manchester], and Institut Pasteur [Paris] (IP)

Subjects
Male, Economic growth, Pediatrics, Latin Americans, Standardization, Epidemiology, MESH: Disease Outbreaks/statistics & numerical data, International Cooperation, Redress, MESH: Meningococcal Vaccines/administration & dosage, MESH: Meningococcal Vaccines/immunology, MESH: Global Health, Global Health, Disease Outbreaks, MESH: Meningococcal Infections/epidemiology, MESH: Meningococcal Infections/prevention & control, 0302 clinical medicine, MESH: Brazil/epidemiology, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Global health, MESH: Vaccination/statistics & numerical data, MESH: Chile/epidemiology, 030212 general & internal medicine, Chile, Surveillance, Global Meningococcal Initiative, Meningococcal disease, Vaccination, MESH: Infant, Newborn, MESH: Disease Outbreaks/prevention & control, MESH: Infant, 3. Good health, Infectious Diseases, Child, Preschool, MESH: Argentina/epidemiology, Molecular Medicine, Female, Public Health, MESH: Public Health, Brazil, medicine.medical_specialty, Revolving fund, 030231 tropical medicine, Argentina, Meningococcal Vaccines, Meningococcal vaccine, 03 medical and health sciences, Serogroup W, medicine, Humans, MESH: Humans, General Veterinary, General Immunology and Microbiology, business.industry, Public health, MESH: Child, Preschool, Public Health, Environmental and Occupational Health, Infant, Newborn, Infant, medicine.disease, MESH: Male, Meningococcal Infections, MESH: International Cooperation, Latin America, MESH: Latin America/epidemiology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract

International audience; The Global Meningococcal Initiative (GMI) was established in 2009 and comprises an international team of scientists, clinicians, and public health officials with expertise in meningococcal disease (MD). Its primary goal is to promote global prevention of MD through education, research, international cooperation, and developing recommendations that include decreasing the burden of severe disease. The group held its first roundtable meeting with experts from Latin American countries in 2011, and subsequently proposed several recommendations to reduce the regional burden of MD. A second roundtable meeting was convened with Latin American representatives in June 2013 to reassess MD epidemiology, vaccination strategies, and unmet needs in the region, as well as to update the earlier recommendations. Special emphasis was placed on the emergence and spread of serogroup W disease in Argentina and Chile, and the control measures put in place in Chile were a particular focus of discussions. The impact of routine meningococcal vaccination programs, notably in Brazil, was also evaluated. There have been considerable improvements in MD surveillance systems and diagnostic techniques in some countries (e.g., Brazil and Chile), but the lack of adequate infrastructure, trained personnel, and equipment/reagents remains a major barrier to progress in resource-poor countries. The Pan American Health Organization's Revolving Fund is likely to play an important role in improving access to meningococcal vaccines in Latin America. Additional innovative approaches are needed to redress the imbalance in expertise and resources between countries, and thereby improve the control of MD. In Latin America, the GMI recommends establishment of a detailed and comprehensive national/regional surveillance system, standardization of laboratory procedures, adoption of a uniform MD case definition, maintaining laboratory-based surveillance, replacement of polysaccharide vaccines with conjugate formulations (wherever possible), monitoring and evaluating implemented vaccination strategies, conducting cost-effectiveness studies, and developing specific recommendations for vaccination of high-risk groups.

Published
2015
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