[Optimizing the response to epidemics of meningococcal meningitis: report of a workshop of experts at CERMES (Niamey, Niger, 12th to 14th January 1998)].

Recent meningitis epidemics in West Africa have drawn attention to shortcomings in the response of the health services. The health ministries of the countries involved have identified particular requirements. Following WHO recommendations, OCCGE organized a meeting of experts at CERMES, Niamey, in January 1998. The aim of this workshop was to consider the problems common to these countries, identify their needs and to produce concrete recommendations defining the roles of OCCGE and CERMES. Difficulties in mobilization, as no procedure had been established, and a lack of resources limited the efficiency of the response to epidemics. There was also insufficient training of personnel and laboratory facilities were often inadequate. OCCGE could draft a procedure manual specifying tasks and responsibilities for the control of an epidemic. It was suggested that a sub-regional stock of drugs, vaccines and injection equipment should be set up at CERMES. This should improve the speed of the response and complement national and international distribution systems. The group stressed the importance of improving the surveillance of meningitis epidemics. This approach depends on a structured network based around a reference laboratory. CERMES plans to support government initiatives by training and by maintaining the network. Efforts will be made to report and make best use of epidemiological information at all levels of the "health pyramid". Some OCCGE institutes (e.g. IPR and CERMES) have computer tools such as the Geographical Information System, which can be made available to governments. Analysis of sub-regional epidemics demonstrated the limitations of an alert threshold of 15 cases per 100,000 people. The sensitivity and specificity of this threshold differs between climatic zones OCCGE recommends that each country carry out its own research to determine the most appropriate alert threshold for each zone. Epidemics are currently managed by treatment with short courses of chloramphenicol in oil (injected into muscle). This approach may change as ceftriaxone becomes more affordable. The systematic use of ceftriaxone in infants under the age of 1 year presenting with meningitis is justified by the frequency of non-meningococcal bacterial causes. A consensus was reached on the most appropriate vaccination strategies: Emergency vaccination implemented rapidly in response to an epidemic. The entire population of a district between the age of 6 months and 30 years are vaccinated. Prophylactic vaccination in high-risk zones. This is carried out in the zone itself or in neighboring regions where there was an epidemic the preceding year. There is evidence that those not infected during an epidemic are at high risk the following year. These vaccinations should be carried out as soon as possible, at least before the start of the next epidemic season. Systematic vaccination is currently limited to special groups (e.g. school children, military personnel and pilgrims). It is hoped that the conjugated vaccine will become available for integration into the infant vaccination program.