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MenAfriNet Approach

MenAfriNet was established in the context of a long history of strong national meningitis surveillance in a region supported by multiple partners including non-governmental organizations, academic institutions, the World Health Organization (WHO), and U.S. government agencies with the goals of:

  • Leveraging the strengths of existing surveillance approaches in the region to develop a high-quality meningitis surveillance network using standardized laboratory and data collection protocols
  • Developing innovative and sustainable systems for data management and analysis to monitor the impact of the vaccine in the long term
  • Using the surveillance network as a platform to perform special studies (with additional or outside resources) to answer critical questions

In the 1990s, WHO established an aggregate case reporting framework for meningitis surveillance in the region based upon the Integrated Disease Surveillance and Response (IDSR) platform. After large meningitis epidemics in 1996 to 1997, WHO-AFRO established Enhanced Meningitis Surveillance protocols. The goal of enhanced surveillance is early detection and response to epidemics using aggregated data counts to estimate weekly incidence at the district level. Alert and epidemic thresholds are set and as soon as an epidemic is identified an investigation and, when needed, emergency response is launched. Laboratory confirmation is only required for the first cases when an epidemic is suspected to identify the pathogen responsible and select an appropriate intervention.

In 2009, prior to the introduction of the new meningococcal A conjugate vaccine (MACV/PsA-TT, manufactured by the Serum Institute of India, Ltd. as MenAfriVac™), WHO-AFRO recommended and established case-based meningitis surveillance guidelines to help monitor the impact of MACV. A case-based surveillance system collects information at the individual level on each suspected case and links epidemiological and microbiological information. Case-based surveillance can be conducted within a population-based system by collecting case-level data from a defined subset of cases and using the population as the denominator to calculate rates. Case-based surveillance can provide population-based information (e.g., meningitis rates per district), as well as individual data (e.g., MACV vaccination status). In 2015, these surveillance guidelines were updated by the MenAfriNet consortium based on the experiences of Burkina Faso, Mali, and Niger.

Partners have supported these activities and their rollout in several countries across the meningitis belt. The WHO Inter-Country Support Team for West Africa, located in Burkina Faso, coordinates all meningitis surveillance and response activities in the region. In addition to national meningitis surveillance protocols, several sentinel site and case-based meningitis surveillance systems are supported in the region, such as active surveillance in Togo and Western Burkina Faso conducted by Agence de Médicine Préventive (AMP, a MenAfriNet Partner) and WHO’s Invasive Bacterial Vaccine Preventable Diseases (IB-VPD) Network. In 2014, WHO published a document to assist national public health policy-makers with information that can be used to decide on a surveillance strategy that is most appropriate to the needs and capacity of a country

MenAfriNet’s intent is for all cases of meningitis to be reported centrally to ensure the burden of disease is accurately reflected even in the setting of lower rates of laboratory confirmation. While multiple countries in the meningitis belt have national meningitis surveillance or special meningitis projects, it is difficult to compare case-based data from these systems and draw inferences on meningitis epidemiology from a regional perspective. MenAfriNet collaborates with country partners to harmonize current meningitis surveillance activities and support the strategic implementation of standardized case-based surveillance guidelines, tools, and laboratory methods to ensure representative and timely data are available to:

  • Monitor impact of MACV
  • Guide national immunization program implementation of strategies to protect unvaccinated individuals, including those born since the initial MACV mass vaccination campaigns
  • Monitor epidemiological shifts in meningitis epidemics to guide decisions about surveillance, response, and case management strategies
  • Develop and implement new meningitis vaccines for non-A serogroups and non-meningococcal causes of bacterial meningitis in sub-Saharan Africa