title: Expansion of syndromic vaccine preventable disease surveillance to include bacterial meningitis and Japanese encephalitis: evaluation of adapting polio and measles laboratory networks in Bangladesh, China and India, 2007-2008.
abstract: BACKGROUND
  Surveillance for acute flaccid paralysis with laboratory confirmation has been a key strategy in the global polio eradication initiative, and the laboratory platform established for polio testing has been expanded in many countries to include surveillance for cases of febrile rash illness to identify measles and rubella cases. Vaccine-preventable disease surveillance is essential to detect outbreaks, define disease burden, guide vaccination strategies and assess immunization impact. Vaccines now exist to prevent Japanese encephalitis (JE) and some etiologies of bacterial meningitis.
  
  
  METHODS
  We evaluated the feasibility of expanding polio-measles surveillance and laboratory networks to detect bacterial meningitis and JE, using surveillance for acute meningitis-encephalitis syndrome in Bangladesh and China and acute encephalitis syndrome in India. We developed nine syndromic surveillance performance indicators based on international surveillance guidelines and calculated scores using supervisory visit reports, annual reports, and case-based surveillance data.
  
  
  RESULTS
  Scores, variable by country and targeted disease, were highest for the presence of national guidelines, sustainability, training, availability of JE laboratory resources, and effectiveness of using polio-measles networks for JE surveillance. Scores for effectiveness of building on polio-measles networks for bacterial meningitis surveillance and specimen referral were the lowest, because of differences in specimens and techniques.
  
  
  CONCLUSIONS
  Polio-measles surveillance and laboratory networks provided useful infrastructure for establishing syndromic surveillance and building capacity for JE diagnosis, but were less applicable for bacterial meningitis. Laboratory-supported surveillance for vaccine-preventable bacterial diseases will require substantial technical and financial support to enhance local diagnostic capacity.
authors.affiliation: Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: KCavallaro@cdc.gov.
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Cavallaro
authors.affiliation: Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Hardeep S
authors.initials: HS
authors.lastname: Sandhu
authors.affiliation: Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Terri B
authors.initials: TB
authors.lastname: Hyde
authors.affiliation: Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Barbara W
authors.initials: BW
authors.lastname: Johnson
authors.affiliation: Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Division of Bacterial Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Leonard W
authors.initials: LW
authors.lastname: Mayer
authors.affiliation: Division of Bacterial Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Clark
authors.affiliation: Division of Viral Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pallansch
authors.affiliation: National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.
authors.forename: Zundong
authors.initials: Z
authors.lastname: Yin
authors.affiliation: World Health Organization, Beijing, People's Republic of China.
authors.forename: Shuyan
authors.initials: S
authors.lastname: Zuo
authors.affiliation: World Health Organization, Beijing, People's Republic of China.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hadler
authors.affiliation: World Health Organization, Dhaka, Bangladesh.
authors.forename: Serguey
authors.initials: S
authors.lastname: Diorditsa
authors.affiliation: World Health Organization, Male, Maldives.
authors.forename: A S M Mainul
authors.initials: AS
authors.lastname: Hasan
authors.affiliation: National Polio Surveillance Project, World Health Organization, New Delhi, India.
authors.forename: Anindya S
authors.initials: AS
authors.lastname: Bose
authors.affiliation: Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Vance
authors.initials: V
authors.lastname: Dietz
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D004660:Encephalitis / Q000453:epidemiology*; D062665:Epidemiological Monitoring; D006302:Health Services Research; D006801:Humans; D007194:India / Q000453:epidemiology; D008581:Meningitis / Q000453:epidemiology*; D018571:Sentinel Surveillance
keywords: Japanese encephalitis; Meningitis; Surveillance; VPD; Vaccine preventable diseases