RevisedStandardOpera/ngProceduresformeningi/sControl–
riskofgroupCoutbreaksandpreparednessintheBeltfor2016
TheMeningi)sVaccineProjectClosureConference
AddisAbaba,23February2016
Outbreakresponseguidelines,revision2014
Publica/ons– WER(December2014)– GuidelinehIp://www.who.int/csr/resources/publica/ons/meningi/s/guidelines2014/en/
– Quickreferenceguide
1. Surveillance2. Treatmentandcare3. Vaccina)on
2
1.Surveillance:Meningi)sincidencethresholds
§ AlertThresholdØ Preparedness
§ EpidemicThresholdØ Ac/on
Weekly surveillance - suspected case attack rates
alertepidemic
Ø Timingisessen/alü Vaccineresponsewithin4weeksofcrossingtheepidemicthresholdü Confirmatorydiagnos/ccapacityshouldbeavailableincountry
Ø Sub-district=levelofinterven/on(30000-100000)
3cases/100,000/week(previously5)
10cases/100,000/week(previously10ifatrisk,otherwise15)
Surveillance:useofRapidDiagnos)cTests(RDTs)2014Recommenda)ons
Ø RDTs(latexagglu/na/onordips/cks)recommendedinoutbreaks
Ø IfRDTsposi/veforavaccinepreventableserogroup,valida/onbyPCRorculturerecommendedbeforevaccineresponse
Ø Need– Topromotedevelopmentofmoreaffordabledips/cks– TopromotedevelopmentofNmXdips/ck– Todomorefieldevalua/onsofalltests
Picturecourtesyof
Surveillance-laboratory• Confirma)onasearlyaspossibleiscri/cal
– Ideallyin-country(na/onalreferencelaboratory-NRL)– Preposi/oningoflumbarpuncturekitsandlabsupplies– Decreasesampletransporta/ondelay
• UsefulnessofLabMobil• PCRconfirma/onbutalsoculture
– TIproduc/oninWHOOuagadougou– OtherTIop/onstobeexplored
• Interna/onallabsupportshouldbefacilitatedshipmentofsamplestoWHOCollabora)ngCentres– Straincharacteriza/on– Qualitycontrol
2.An)bio)cTreatmentduringoutbreaks2014Recommenda)ons
Ø Foradultsandchildren>=2monthsofage5dayscedriaxonerecommended(previouslysingledose)Important%ofcasesduetoSpnandHibinNmepidemics(9%)
ü 2015Nigerepidemic:successfulfollow-upinthecommunityØ Forsuspectedbacterialmeningi/sinchildren<2monthsofage
7dayscedriaxonerecommendedØ Inlargeepidemics-confirmedNm-challengingthehealthsystem,
singledoseceAriaxonecanbeused§ follow-upandevalua/onofcasesader24hours
Ø OilychloramphenicolnotrecommendedanymoreØ Importanttomaintainapolicyoffreetreatmentduring
meningococcalmeningi/sepidemics
Prophylaxis:2014Recommenda)on
Nochangefrompreviousguidelines:
(i) An/bio/csrecommendedasaprophylac/cmeasureforhouseholdcontactsofallagesinnon-epidemicperiods,butnotduringepidemics
(ii)Ciprofloxacinpreferred,withcedriaxoneasanalterna/ve
Niger2015NmCepidemic:Casehouseholdsathigherriskthanothers(Epicentre)
Ø research study to test the effectiveness of chemoprophylaxis (2016)
3.Responsevaccina)onØ Recommendedasearlyaspossiblewithin4weeksofcrossingthethreshold
Ø Recommendedwiththedifferentvaccinesavailablefor2016– ACYWpolysaccharide– ACWpolysaccharide– MonovalentCconjugate
• hyporesponsivenessnotanissue• recommendedincaseofNmCepidemic
– propor/onofNmWshouldbelessthan30%
• registra/onandlogis/calchallenges– ACpolysaccharide
Indica'vedecisiontreeformeningi'svaccinechoice
MonovalentCconjugateanop)on
Vaccina)on
TheunexpectedNmCre-emergence2013-2015
Ø onepar/cularareawithexpandingtendency
Source:WHO2015
2016:NmCexpansionriskishigh
HighriskoffurtherCepidemicsin2016andader• Uniqueclone,gene/callydis/nctfrompreviousdisease
strains,foundrarelyincarrierisolates• LowimmunitytoCexpected• Increasingnumberseachyear2013to2014to2015,rela/vely
localisedinNWNigeriaun/l2014,rapidexpansiontoNigerin2015
• SimilarepidemicpaIerntoNmAepidemics
0
500
1000
1500
2000
2500
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Meningi/scases,Niger-sourceMenAfrinet
Enhancedsurveillance,2016(weeks1-5)
Source:WHO2016
Allcountriesinthebeltshouldworry
Butinpar/cular:• NigerandNigeria
– Districtspar/allyvaccinatedin2015– Districtswithreportedcasesin2015,notcrossingthethreshold
• BurkinaFaso,Mali,Côted’IvoireandBenin• Otherneighbouringcountries
– Chad,Cameroon
Arecountriesprepared?• Niamey,December2015:workshopwith12countries
Ø SpecificpreparednessandresponseplansØ AwarenessonnewguidelinesandstrategiesØ ICGupdates
• 2016:goodsignsØ ICGrequestfromTogo(NmW):fastandwelldocumentedØ NigeriaearlyresponseinYauri(NmC)
• Mainchallenge:laboratoryconfirma/onØ Mobiliza/onofLabmobileinNigeria?Ø Confirma/oncapacityinCôted’Ivoire?Ø PneumococcalserotypinginGhana?
1.Preparednessandresponseplanvalidated 2.Fundingsourcesiden/fied
3.Guidancedocuments/toolsavailableatalllevels?
4.Flowfortheconfirma/onofsamplesfunc/onal?
5.Na/onalReferenceLaboratoryfunc/onal?
6.Surveillancematerialsandlumbarpuncturekitsdistributed?7.TImediaavailableinthedistricts?
8.Trainingconducted
9.Placeandpersonneldefinedforlumbarpunctures? 10.Mechanismforthetransportofsamplesopera/onal? 11.Mechanismforinterna)onaltransferofstrainstoWHOCentresopera/onal?
12.Dataflowopera/onal
13.Inves/ga/onofcasesandepidemicmanagementopera/onal?14.Ce^riaxoneavailableandpre-posi/oned?15.ICGmechanismandvaccinerequestprocessmastered16.Canvaccinesavailableinthe2016ICGstockpilebedeployed?
Preparednesschecklist
Merci-Thankyou!
TOMORROW Wednesday24FebruaryDEMAIN Mercredi24févrierSidemee)ngforCountrystaff:Stateofpreparednessformeningi)sepidemicsin201614.30–16.30,AfricanUnionConference
Ques)onaboutreplacement…Expertgroup,December2015• NmCre-emergenceinAfricaisnotlinkedtotheelimina/onofNmA
epidemics,followingMenAfrivacintroduc/on• Noserogroupreplacement
– N.mAcarriageoutsideepidemicsbeforetheintroduc/onofMenAfriVacwasusuallynotdetectableoratverylowlevels,leavingliIleopportunityforreplacementofthebacteriuminitsecologicalniche;
– largeandrapidfluctua/onsinserogroup/straindistribu/onareknowntooccurinabsenceofvaccineinterven/on;
– theN.mCoutbreakstrainisacompletelynewclone.• Probablylinkedtothenaturalevolu/onofserogroups
– NmWexample– Meningococcusisunfortunatelyunpredictable…
