Meningococcal meningitis in Mali: a long-term study of persistence and spread.
OBJECTIVE
Meningococcal meningitis (MM) is still a huge threat in the African meningitis belt. To fight against epidemics, a strengthened health information system, based upon weekly collected data, was set up in Mali. We aimed to study the spatio-temporal dynamics of MM in this country between 1992 and 2003.


METHODS
We were first interested in the impact of population size on the disease persistence. We then used cross-correlation analysis to study the spread of the disease on three different spatial scales, i.e., inter-region (global) and inter-district and intra-district (local) levels.


RESULTS
We found no persistence of MM at district level in Mali during the whole of the study period. However, we found persistence on a nationwide scale after the 1997 big epidemics, as opposed to the 1992-1996 time periods. In terms of spread, two main regions seem to lead MM dynamics in Mali, even if on a local scale the 'cities-villages' diffusion pattern was not systematically observed.


CONCLUSIONS
This study improves knowledge on the spread and persistence of MM in Mali in recent years. It constitutes a first spatial study describing persistence and spread of MM in an African meningitis belt country. The next step should be the integration of vaccination and genetic variability data to clarify the route of spread of the disease in the human population.
Philippon
Solenne
S
PRODIG, UMR 8586 - CNRS, Université Paris I, Paris, France.
Broutin
Hélène
H
Constantin de Magny
Guillaume
G
Toure
Kandioura
K
Diakite
Cheick Hamala
CH
Fourquet
Nicole
N
Courel
Marie-Françoise
MF
Sultan
Benjamin
B
Guégan
Jean-François
JF
D004196:Disease Outbreaks; D006801:Humans; D008137:Longitudinal Studies; D008302:Mali / Q000453:epidemiology; D008585:Meningitis, Meningococcal / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D009345:Neisseria meningitidis; D011156:Population Density; D011159:Population Surveillance / Q000379:methods; D012424:Rural Population; D014505:Urban Population