Meningococcal Meningitis Outbreaks in the African Meningitis Belt After Meningococcal Serogroup A Conjugate Vaccine Introduction, 2011–2017

Abstract Background In 2010–2017, meningococcal serogroup A conjugate vaccine (MACV) was introduced in 21 African meningitis belt countries. Neisseria meningitidis A epidemics have been eliminated here; however, non-A serogroup epidemics continue. Methods We reviewed epidemiological and laboratory World Health Organization data after MACV introduction in 20 countries. Information from the International Coordinating Group documented reactive vaccination. Results In 2011–2017, 17 outbreaks were reported (31 786 suspected cases from 8 countries, 1–6 outbreaks/year). Outbreaks were of 18–14 542 cases in 113 districts (median 3 districts/outbreak). The most affected countries were Nigeria (17 375 cases) and Niger (9343 cases). Cumulative average attack rates per outbreak were 37–203 cases/100 000 population (median 112). Serogroup C accounted for 11 outbreaks and W for 6. The median proportion of laboratory confirmed cases was 20%. Reactive vaccination was conducted during 14 outbreaks (5.7 million people vaccinated, median response time 36 days). Conclusion Outbreaks due to non-A serogroup meningococci continue to be a significant burden in this region. Until an affordable multivalent conjugate vaccine becomes available, the need for timely reactive vaccination and an emergency vaccine stockpile remains high. Countries must continue to strengthen detection, confirmation, and timeliness of outbreak control measures.

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Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine

Clinical Infectious Diseases ◽

10.1093/cid/ciz474 ◽

2019 ◽

Vol 69 (Supplement_2) ◽

pp. S81-S88 ◽

Cited By ~ 2

Author(s):

Beckie N Tagbo ◽

Rowan E Bancroft ◽

Iretiola Fajolu ◽

Mohammed B Abdulkadir ◽

Muhammad F Bashir ◽

...

Keyword(s):

Bacterial Meningitis ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Invasive Disease ◽

Latex Agglutination ◽

World Health ◽

Vaccine Introduction ◽

Vaccine Type ◽

Health Organization ◽

Species Specific

Abstract Background Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). Methods From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. Results A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. Conclusions Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the country.

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Toward Control? The Prospects and Challenges of Typhoid Conjugate Vaccine Introduction

Clinical Infectious Diseases ◽

10.1093/cid/ciz483 ◽

2019 ◽

Vol 69 (Supplement_5) ◽

pp. S408-S411 ◽

Cited By ~ 2

Author(s):

Megan E Carey ◽

Zoey I Diaz ◽

Martin Broadstock ◽

Roderick Bailey ◽

Adwoa D Bentsi-Enchill ◽

...

Keyword(s):

Conjugate Vaccine ◽

Vaccine Development ◽

Low Cost ◽

Control Program ◽

World Health ◽

Vaccine Hesitancy ◽

Vaccine Introduction ◽

Optimal Deployment ◽

Health Organization ◽

Communication Planning

Abstract With a newly World Health Organization (WHO)–prequalified typhoid conjugate vaccine (TCV), Gavi funding for eligible countries, and a WHO policy recommendation for TCV use, now is the time for countries to introduce TCVs as part of an integrated typhoid control program, particularly in light of the increasing burden of antimicrobial resistance. Continued vaccine development efforts will lead to secure supply of low-cost vaccines, and ongoing vaccine studies will provide critical vaccine performance data and inform optimal deployment strategies, in both routine use and in outbreak settings. TCV programs should include thoughtful communication planning and community engagement to counter vaccine hesitancy.

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Changes in the Molecular Epidemiology of Pediatric Bacterial Meningitis in Senegal After Pneumococcal Conjugate Vaccine Introduction

Clinical Infectious Diseases ◽

10.1093/cid/ciz517 ◽

2019 ◽

Vol 69 (Supplement_2) ◽

pp. S156-S163 ◽

Cited By ~ 2

Author(s):

Mouhamadou A Sonko ◽

Felix S Dube ◽

Catherine Bi Okoi ◽

Amadou Diop ◽

Aliou Thiongane ◽

...

Keyword(s):

Bacterial Meningitis ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Pneumococcal Meningitis ◽

Case Fatality ◽

World Health ◽

Sentinel Site ◽

Surveillance Period ◽

Vaccine Introduction ◽

Health Organization

AbstractBackgroundBacterial meningitis is a major cause of mortality among children under 5 years of age. Senegal is part of World Health Organization–coordinated sentinel site surveillance for pediatric bacterial meningitis surveillance. We conducted this analysis to describe the epidemiology and etiology of bacterial meningitis among children less than 5 years in Senegal from 2010 and to 2016.MethodsChildren who met the inclusion criteria for suspected meningitis at the Centre Hospitalier National d’Enfants Albert Royer, Senegal, from 2010 to 2016 were included. Cerebrospinal fluid specimens were collected from suspected cases examined by routine bacteriology and molecular assays. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed.ResultsA total of 1013 children were admitted with suspected meningitis during the surveillance period. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus accounted for 66% (76/115), 25% (29/115), and 9% (10/115) of all confirmed cases, respectively. Most of the suspected cases (63%; 639/1013) and laboratory-confirmed (57%; 66/115) cases occurred during the first year of life. Pneumococcal meningitis case fatality rate was 6-fold higher than that of meningococcal meningitis (28% vs 5%). The predominant pneumococcal lineage causing meningitis was sequence type 618 (n = 7), commonly found among serotype 1 isolates. An ST 2174 lineage that included serotypes 19A and 23F was resistant to trimethoprim-sulfamethoxazole.ConclusionsThere has been a decline in pneumococcal meningitis post–pneumococcal conjugate vaccine introduction in Senegal. However, disease caused by pathogens covered by vaccines in widespread use still persists. There is need for continued effective monitoring of vaccine-preventable meningitis.

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Introducing Typhoid Conjugate Vaccine in South Asia: Lessons From the Surveillance for Enteric Fever in Asia Project

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1296 ◽

2020 ◽

Vol 71 (Supplement_3) ◽

pp. S191-S195

Author(s):

Alice S Carter ◽

Stephen P Luby ◽

Denise O Garrett

Keyword(s):

Conjugate Vaccine ◽

Large Scale ◽

Enteric Fever ◽

World Health ◽

Health Concern ◽

Vaccine Introduction ◽

The World ◽

Health Organization ◽

Drug Resistant Strains ◽

Sanitation Infrastructure

Abstract Enteric fever remains a public health concern in communities lacking sanitation infrastructure to separate sewage from drinking water. To bridge the gap until large-scale civil-engineering projects are implemented in high-burden countries, typhoid conjugate vaccine presents a promising disease-prevention technology. A new typhoid conjugate vaccine was prequalified by the World Health Organization in 2017 and is beginning to be introduced in countries around the world. To help inform vaccine introduction, the Surveillance for Enteric Fever in Asia Project (SEAP) conducts prospective enteric fever surveillance in Bangladesh, Nepal, and Pakistan. This supplement presents findings from Phase II of the study (2016–2019) on burden of disease, clinical presentation, the growing spread of drug-resistant strains, and policy and economic ramifications. These findings are delivered to support policymakers in their deliberations on strategies to introduce typhoid conjugate vaccine as a preventive tool against enteric fever.

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Characterizing the effectiveness of COVID-19 mitigation measures: A data-centric approach (Preprint)

10.2196/preprints.21321 ◽

2020 ◽

Author(s):

Lukman Olagoke ◽

Ahmet E. Topcu

Keyword(s):

Control Measure ◽

Control Measures ◽

World Health ◽

Mitigation Measures ◽

Effective Control ◽

The World ◽

Decision Making Processes ◽

And Performance ◽

Health Organization ◽

The Impact

BACKGROUND COVID-19 represents a serious threat to both national health and economic systems. To curb this pandemic, the World Health Organization (WHO) issued a series of COVID-19 public safety guidelines. Different countries around the world initiated different measures in line with the WHO guidelines to mitigate and investigate the spread of COVID-19 in their territories. OBJECTIVE The aim of this paper is to quantitatively evaluate the effectiveness of these control measures using a data-centric approach. METHODS We begin with a simple text analysis of coronavirus-related articles and show that reports on similar outbreaks in the past strongly proposed similar control measures. This reaffirms the fact that these control measures are in order. Subsequently, we propose a simple performance statistic that quantifies general performance and performance under the different measures that were initiated. A density based clustering of based on performance statistic was carried out to group countries based on performance. RESULTS The performance statistic helps evaluate quantitatively the impact of COVID-19 control measures. Countries tend show variability in performance under different control measures. The performance statistic has negative correlation with cases of death which is a useful characteristics for COVID-19 control measure performance analysis. A web-based time-line visualization that enables comparison of performances and cases across continents and subregions is presented. CONCLUSIONS The performance metric is relevant for the analysis of the impact of COVID-19 control measures. This can help caregivers and policymakers identify effective control measures and reduce cases of death due to COVID-19. The interactive web visualizer provides easily digested and quick feedback to augment decision-making processes in the COVID-19 response measures evaluation. CLINICALTRIAL Not Applicable

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Countries with delayed COVID-19 introduction – characteristics, drivers, gaps, and opportunities

Globalization and Health ◽

10.1186/s12992-021-00678-4 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Zheng Li ◽

Cynthia Jones ◽

Girum S. Ejigu ◽

Nisha George ◽

Amanda L. Geller ◽

...

Keyword(s):

Geographic Location ◽

Control Measures ◽

World Health ◽

Small Island ◽

Influenza Surveillance ◽

Middle Income ◽

School Closing ◽

Travel Restrictions ◽

Potential Factors ◽

Health Organization

Abstract Background Three months after the first reported cases, COVID-19 had spread to nearly 90% of World Health Organization (WHO) member states and only 24 countries had not reported cases as of 30 March 2020. This analysis aimed to 1) assess characteristics, capability to detect and monitor COVID-19, and disease control measures in these 24 countries, 2) understand potential factors for the reported delayed COVID-19 introduction, and 3) identify gaps and opportunities for outbreak preparedness, particularly in low and middle-income countries (LMICs). We collected and analyzed publicly available information on country characteristics, COVID-19 testing, influenza surveillance, border measures, and preparedness activities in these countries. We also assessed the association between the temporal spread of COVID-19 in all countries with reported cases with globalization indicator and geographic location. Results Temporal spreading of COVID-19 was strongly associated with countries’ globalization indicator and geographic location. Most of the 24 countries with delayed COVID-19 introduction were LMICs; 88% were small island or landlocked developing countries. As of 30 March 2020, only 38% of these countries reported in-country COVID-19 testing capability, and 71% reported conducting influenza surveillance during the past year. All had implemented two or more border measures, (e.g., travel restrictions and border closures) and multiple preparedness activities (e.g., national preparedness plans and school closing). Conclusions Limited testing capacity suggests that most of the 24 delayed countries may have lacked the capability to detect and identify cases early through sentinel and case-based surveillance. Low global connectedness, geographic isolation, and border measures were common among these countries and may have contributed to the delayed introduction of COVID-19 into these countries. This paper contributes to identifying opportunities for pandemic preparedness, such as increasing disease detection, surveillance, and international collaborations. As the global situation continues to evolve, it is essential for countries to improve and prioritize their capacities to rapidly prevent, detect, and respond, not only for COVID-19, but also for future outbreaks.

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Public Health Control Measures in Response to Global Pandemics and Drug Resistance

The Journal of Law Medicine & Ethics ◽

10.1111/jlme.12266 ◽

2015 ◽

Vol 43 (S2) ◽

pp. 49-56

Author(s):

Polly J. Price

Keyword(s):

Public Health ◽

Communicable Disease ◽

International Health ◽

Control Measures ◽

World Health ◽

Legal Authority ◽

List Type ◽

Resistant Disease ◽

Global Pandemic ◽

Health Organization

These teaching materials explore the specific powers of governments to implement control measures in response to communicable disease, in two different contexts:The first context concerns global pandemic diseases. Relevant legal authority includes international law, World Health Organization governance and the International Health Regulations, and regulatory authority of nations.The second context is centered on U.S. law and concerns control measures for drug-resistant disease, using tuberculosis as an example. In both contexts, international and domestic, the point is to understand legal authority to address public health emergencies.

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Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine

Journal of Dental Research ◽

10.1177/0022034520914246 ◽

2020 ◽

Vol 99 (5) ◽

pp. 481-487 ◽

Cited By ~ 364

Author(s):

L. Meng ◽

F. Hua ◽

Z. Bian

Keyword(s):

Public Health ◽

Infection Control ◽

Control Measures ◽

World Health ◽

Infection Control Measures ◽

Dental Practitioners ◽

The World ◽

Essential Knowledge ◽

Novel Coronavirus ◽

Health Organization

The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. The World Health Organization announced that the outbreaks of the novel coronavirus have constituted a public health emergency of international concern. As of February 26, 2020, COVID-19 has been recognized in 34 countries, with a total of 80,239 laboratory-confirmed cases and 2,700 deaths. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. Due to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about COVID-19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas.

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Investigating the effectiveness of re-opening policies before vaccination during a pandemic: SD modelling research based on COVID-19 in Wuhan

BMC Public Health ◽

10.1186/s12889-021-11631-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ying Qian ◽

Wei Xie ◽

Jidi Zhao ◽

Ming Xue ◽

Shiyong Liu ◽

...

Keyword(s):

Model Simulation ◽

Control Measures ◽

World Health ◽

Contact Tracing ◽

Infection Prevention And Control ◽

Real World Data ◽

Medical Resources ◽

Health Organization ◽

The Impact ◽

Different Levels

Abstract Background Lockdown policies were widely adopted during the coronavirus disease 2019 (COVID-19) pandemic to control the spread of the virus before vaccines became available. These policies had significant economic impacts and caused social disruptions. Early re-opening is preferable, but it introduces the risk of a resurgence of the epidemic. Although the World Health Organization has outlined criteria for re-opening, decisions on re-opening are mainly based on epidemiologic criteria. To date, the effectiveness of re-opening policies remains unclear. Methods A system dynamics COVID-19 model, SEIHR(Q), was constructed by integrating infection prevention and control measures implemented in Wuhan into the classic SEIR epidemiological model and was validated with real-world data. The input data were obtained from official websites and the published literature. Results The simulation results showed that track-and-trace measures had significant effects on the level of risk associated with re-opening. In the case of Wuhan, where comprehensive contact tracing was implemented, there would have been almost no risk associated with re-opening. With partial contact tracing, re-opening would have led to a minor second wave of the epidemic. However, if only limited contact tracing had been implemented, a more severe second outbreak of the epidemic would have occurred, overwhelming the available medical resources. If the ability to implement a track-trace-quarantine policy is fixed, the epidemiological criteria need to be further taken into account. The model simulation revealed different levels of risk associated with re-opening under different levels of track-and-trace ability and various epidemiological criteria. A matrix was developed to evaluate the effectiveness of the re-opening policies. Conclusions The SEIHR(Q) model designed in this study can quantify the impact of various re-opening policies on the spread of COVID-19. Integrating epidemiologic criteria, the contact tracing policy, and medical resources, the model simulation predicts whether the re-opening policy is likely to lead to a further outbreak of the epidemic and provides evidence-based support for decisions regarding safe re-opening during an ongoing epidemic. Keyords COVID-19; Risk of re-opening; Effectiveness of re-opening policies; IPC measures; SD modelling.

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Early Insights From Clinical Trials of Typhoid Conjugate Vaccine

Clinical Infectious Diseases ◽

10.1093/cid/ciaa370 ◽

2020 ◽

Vol 71 (Supplement_2) ◽

pp. S155-S159

Author(s):

Kathleen M Neuzil ◽

Buddha Basnyat ◽

John D Clemens ◽

Melita A Gordon ◽

Priyanka D Patel ◽

...

Keyword(s):

Clinical Trials ◽

World Health Organization ◽

Conjugate Vaccine ◽

Trial Data ◽

Early Data ◽

World Health ◽

Data Support ◽

Health Organization

Abstract Clinical trials of typhoid conjugate vaccine (TCV) are ongoing in 4 countries. Early data confirm safety, tolerability, and immunogenicity of typhoid conjugate vaccine, and early efficacy results are promising. These data support World Health Organization recommendations and planned country introductions. Forthcoming trial data will continue to inform programmatic use of typhoid conjugate vaccine.

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