Overview

Until recently, most meningitis epidemics in the meningitis belt of sub-Saharan Africa were due to Neisseria meningitidis serogroup A (NmA), such that the existing WHO guidelines have been directed mainly at the control of these epidemics. However, since 2010, countries in the meningitis belt have started to introduce a new serogroup A meningococcal conjugate vaccine conferring individual protection and herd immunity. Following the successful roll-out of this vaccine, epidemics due to NmA are disappearing, but other serogroups (e.g. NmW, NmX and NmC) still cause epidemics, albeit at a lower frequency and of a smaller size.

Due to these changes, WHO organized the review of the evidence to provide recommendations for epidemic control, related to operational thresholds for investigation and response to outbreaks, the use of rapid diagnostic tests, antibiotic regimens in epidemics, and prophylaxis for household contacts of cases.

Contents

• Definitions and abbreviations
• Executive summary
• Background
  • Epidemiology
  • Current strategy
  • Need for review of strategy
• Methods
  • Process and scope
  • Evidence retrieval and synthesis
  • Evidence to recommendations
  • Decision-making
  • Declaration of interest
• Operational thresholds
  • Evidence
  • From evidence to recommendations
  • Question
  • Remarks
  • Implications
  • Evaluation and research
• Rapid diagnostic tests
  • Evidence
  • From evidence to recommendations
  • Question
  • Remarks
  • Implications
  • Evaluation and research
• Antibiotic regimens during epidemics
  • Evidence
  • From evidence to recommendations
  • Question
  • Remarks
  • Implications
  • Evaluation and research
• Prophylaxis for household contacts
  • Evidence
  • From evidence to recommendations
  • Question
  • Implications
  • Evaluation and research
• Publication and dissemination
• Quality evaluation, usefulness and impact
• Funding
• Acknowledgements
• References
• Annex 1 Guideline groups
• Annex 2 PICO questions
• Annex 3 Declarations of interest
• Annex 4 GRADE profiles
• Annex 5 Flow diagrams of searches in systematic reviews
• Web Annexes - Evidence
  • Intervention Threshold
  • Use of Rapid Diagnostic Tests
  • Antibiotic Regimens in Epidemics
  • Prophylaxis for Household Contacts

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