Surveillance and control of meningococcal meningitis epidemics in refugee populations.

Epidemics of communicable diseases pose a direct threat to refugee and internally displaced populations, and could lead to high mortality rates and a disruption of basic health care services. Several large refugee populations live in regions of high meningococcal disease endemicity and their camps are at risk for outbreaks of meningococcal meningitis. Surveillance in these camps allows early detection and control of impending outbreaks. Confirmation of meningococcal disease can be performed under field conditions using simple techniques, such as latex agglutination. Isolates should be obtained for serogroup confirmation and antibiotic sensitivity studies at reference laboratories. Serogroup information is used to determine the risk of widespread epidemic disease and the utility of available vaccines. During epidemics, treatment regimens should be standardized, preferably with an effective single-dose antibiotic. Mass vaccination campaigns should be initiated, the populations at high risk being targeted for vaccination as quickly as possible. When the risk of epidemic disease is deemed to be high, preemptive vaccination may be warranted. Daily surveillance using a simple case definition is essential during an epidemic to determine the effectiveness of control measures and to delineate high-risk groups for vaccination or chemoprophylaxis. Many of these recommendations can be applied also to other populations in developing countries.