2. Surveillnace Meningitis.pptxhftutifutudhdh

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1. Meningitis epidemiology & challenges Presenter Name (Profession, Organization) Date,

2. Outlines Background Meningitis epidemic status in Africa 2004-2020 Méningites pathogènes within the year Bacteriological distribution of meningitis in Africa 2003-2020 Meningitis suspected cases & deaths in Africa 2017-20 Meningitis outbreaks in Africa 2017- 20 Epidemic season 2018-20: Status of advances/ gaps/challenges Epidemic season 2020-21: Way forward . 2

3. What is epidemiology?

4. Epidemiology is the study of the distribution & determinants of meningitis diseases in specified populations, & the application of this study to the control of this health problems Distribution (frequency & pattern) Determinant (cause & factors) Application . 4

5. Epidemiology… Meningitis remains a major public health problem in the 26 African meningitis belt countries . Before 2010, NmA was predominant Since 2011, S.Pn , NmC , NmW , & NmX are predominant, with major epidemics ( NmC , NmW & S.p ) 5

6. Epidemiology… To reduce the burden caused, the 5-pillar strategy to defeat meningitis in Africa by 2030; Prevention & epidemic control Diagnosis & treatment Disease surveillance Support & care for people affected by meningitis Advocacy & engagement 6

7. 26 African meningitis belt countries The African 'meningitis belt’ is an area that extends from Senegal to Ethiopia with an estimated total population of 500 million Epidemiology…

8. Meningitis epidemic status in Africa 2004-2020 1. Meningitis remains a dramatic public health problem in Africa, with thousands suspected cases & deaths reported 2. Reduction of suspected cases, CFR since 2010 with the introduction of MenAfriVac, also new vaccines against Hib, S.p MenAfriVac introduction

9.                                                                                                                                                                                                                Number of suspected & confirmed meningitis cases by week in the African meningitis belt of 2004 (red), 2005 (orange), 2006 (yellow), 2007 (light green), 2008 (green), 2009 (light blue), 2010 (blue), 2011 (purple), 2012 (pink), & 2013 (gray) Méningites pathogènes with in the year Source : Clin Infect Dis 2015;61( Suppl 5) : S410-15. 1. Around 90% of meningitis case occur during epidemic season January-June (W1-26)

10. Bacteriological distribution of meningitis in Africa 2003-2020-1 10 MenAfriVac introduction

11. Bacteriological distribution of meningitis in Africa 2003-2020-2 11 Predominance of S.p (36%) NmC (30%) NmX (11%) NmW (9%) Hib (6%) NmA

12. Epidemic 2015-18

13. Figure A  : Recapitulative map of cumulative Meningitis attack rates : epidemic season 2018 w 1-26 Figure B  : Recapitulative map of cumulative Meningitis attack rates : epidemic season 2019 w 1-26 S.p countries Suspected cases (2019) Deaths (2019) Burkina Faso 1 695 125 (CFR = 7.4%) Chad 336 49 (CFR = 14.6%) Togo 213 7 (CFR = 3.3 %) Ghana 746 20 (CFR = 2.7%) C C W W Sp Sp X X Epidemic 2018-19

14. Meningitis outbreak investigation

15. Outbreak investigation Outbreak investigation involves determining the cause of an outbreak & who is at risk, so that control measures can be implemented. O bjective of an outbreak investigation is to control the outbreak & thus reduce morbidity & mortality. Investigation should begin as soon as an alert is detected & has been verified. I nvestigation provides relevant information to use for taking immediate action & improving longer-term disease prevention activities. 15

16. What are the purpose of an investigation ???

17. Purpose of an investigation Verify the outbreak or the public health event & risk Identify & treat additional cases that have not been reported or recognized Collect information & laboratory specimens for confirming the diagnosis Identify the source of infection or cause of the outbreak. 17

18. Purpose of an investigation… Describe the epidemiological situation in time, place & person Describe how the disease is transmitted & the populations at risk Select appropriate response activities to control the outbreak or the public health event Strengthen prevention activities to avoid future reoccurrence of the outbreak

19. Who can tell as steps of Outbreak Investigation steps?

20. Steps of outbreak investigation Establish existence of an outbreak Prepare for Fieldwork Confirm & verify the diagnosis Define a case & search for additional cases Analyze data & generate hypothesis Test & refine hypothesis with analytic study Implement IPC Measures Reporting & Dissemination of findings Conduct Risk Assessments to determine if the outbreak is a potential Public Health Emergency Maintain & intensify surveillance 20

21. Definition case of meningitis-suspected meningitis Any person with sudden onset of: Fever (>38.5 ℃ rectal or 38 ℃ axillary) & Neck stiffness or Other meningeal signs, including bulging fontanelle in infants 21

22. Definition case of meningitis-Probable meningitis Any suspected case with macroscopic aspect of CSF turbid, cloudy/purulent or CSF leukocyte count >10 cells/mm3 or Bacteria identified by Gram stain in CSF or Positive antigen detection (for example, by latex agglutination testing) in CSF 22

23. In infants : CSF leucocyte count >100 cells/mm3 or CSF leucocyte count 10–100 cells/mm3 & Either an elevated protein (>100 mg/dl) or Decreased glucose (<40 mg/dl) level. Change with or positive antigen detection (for example, by latex agglutination testing) in CSF added 23 Definition case of meningitis-Probable meningitis

24. Definition case of meningitis- Confirmed meningitis case Any suspected or probable case that is laboratory confirmed by culturing or identifying (i.e. PCR ) a bacterial pathogen ( Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b) in the CSF or blood Change with positive antigen detection (for example, by latex agglutination testing) in CSF removed due to false positive, lack of proper use of RDT 24

25. Revised meningitis case definitions Indicators Population 30,000–100,000 Under 30,000 Alert threshold   3 suspected cases /100,000 inhabitants /week ( Minimum of 2 cases in one week ) 2 suspected cases/week Or An increased incidence compared to previous non-epidemic years Epidemic threshold   10 suspected cases /100,000 inhabitants /week   5 suspected cases/week Or Doubling of the number of cases in a three-week period; e.g. Week 1: 1 case, Week 2: 2 cases, Week 3: 4 cases For district populations with more than 100,000 inhabitants, it is recommended to calculate AR by sub-districts containing 30,000-100,000 inhabitants In special situations such as mass gathering refugees or displaced persons or closed institutions , two confirmed cases in a week should prompt mass vaccination. If a neighbouring area to a population targeted for vaccination is considered to be at risk ( cases early in the dry season, no recent relevant vaccination campaign, high population density ), it should be included in a vaccination programme

26. Actions to respond to meningitis epidemics related to thresholds-1 26 Epidemic thresholds Actions to be taken Alert threshold   Inform authorities Strengthen surveillance Investigate Confirm (including laboratory) Prepare for eventual response Epidemic threshold   Mass vaccination within 4 weeks of crossing the epidemic threshold*** Distribute treatment to health centres Treat according to epidemic protocol Inform the public 

27. Actions to respond to meningitis epidemics related to thresholds-2 Pre-epidemic phase A district is in pre-alert phase: when the weekly AR is below the alert threshold CSF sent to the nearest reference laboratory for bacteriological tests. Every meningitis case should be treated with recommended antibiotics according to the national treatment protocols. A district is in alert phase: attack rate is = the alert threshold Detailed data on the suspected cases should be recorded on a line list CSF sample collection should be strengthened, & samples sent to the nearest reference laboratory for bacteriological tests by CBF Many confirmations as possible including the identification of the bacterial pathogen should be done This will help in making a rapid decision as to the need for vaccination & the type of vaccine to be used in case the district reaches the epidemic threshold Hence, it is to strengthen laboratory capacity & particularly the using RDT & culturing specimens 27

28. Actions to respond to meningitis … at epidemics phase For NmA , NmC , NmW or NmY epidemic, a mass immunization campaign using multivalent polysaccharide or conjugate vaccines depending on availability within 4 weeks of crossing the threshold. MenAfriVac is depending on the age groups most affected It is also recommended to include any contiguous district or sub-district that is considered to be at risk A micro-plan for mass vaccination should be quickly finalized Sufficient vaccine must be immediately requested from either the MoH, which maintains the national stocks, or from the ICG CSF samples should continue to be collected & sent to thee reference lab RRT from central or regional/provincial level should be deployed

29. Actions to respond to meningitis epidemics related to thresholds-5 Inter-epidemic phase: Extends from the end of an epidemic season to the beginning of the next season PHS action d uring this phase: Facilitate strong collaboration among the surveillance officers, clinicians & the national reference laboratory officers to ensure a comprehensive sample collection & confirmation mechanism Continue surveillance & laboratory confirmation of suspected meningitis cases in all national, regional & district hospitals Ensure new staff are trained in relevant meningitis surveillance protocols & procedures such as lumbar puncture 29

30. Actions to respond to meningitis epidemics related to thresholds-4 Post-epidemic phase: Corresponds to the first four weeks after the end of an epidemic End of a meningitis epidemic is declared when the AR in the epidemic district descends below the alert threshold for two consecutive weeks Public health surveillance actions during this phase, Evaluate the detection & response of the epidemic Conduct a vaccine coverage survey Mobilize adequate resources for evaluation Collect all the documents 30

31. Conclusion Conduct outbreak investigation is relevant because it provides relevant information to use for taking immediate action & improving longer-term disease prevention activities. 31