title: Response Strategies against Meningitis Epidemics after Elimination of Serogroup A Meningococci, Niger.
abstract: To inform epidemic response strategies for the African meningitis belt after a meningococcal serogroup A conjugate vaccine was introduced in 2010, we compared the effectiveness and efficiency of meningitis surveillance and vaccine response strategies at district and health area levels using various thresholds of weekly incidence rates. We analyzed reports of suspected cases from 3 regions in Niger during 2002-2012 (154,392 health area weeks), simulating elimination of serogroup A meningitis by excluding health area years with identification of such cases. Effectiveness was highest for health area surveillance and district vaccination (58-366 cases; thresholds 7-20 cases/100,000 doses), whereas efficiency was optimized with health area vaccination (5.6-7.7 cases/100,000 doses). District-level intervention prevented <6 cases (0.2 cases/100,000 doses). Reducing the delay between epidemic signal and vaccine protection by 2 weeks doubled efficiency. Subdistrict surveillance and response might be most appropriate for meningitis epidemic response after elimination of serogroup A meningitis.
authors.forename: Halima Boubacar
authors.initials: HB
authors.lastname: Maïnassara
authors.forename: Juliette
authors.initials: J
authors.lastname: Paireau
authors.forename: Issa
authors.initials: I
authors.lastname: Idi
authors.forename: Jean-Paul Moulia
authors.initials: JP
authors.lastname: Pelat
authors.forename: Odile Ouwe Missi
authors.initials: OO
authors.lastname: Oukem-Boyer
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
authors.forename: Judith E
authors.initials: JE
authors.lastname: Mueller
mesh_terms: D004196:Disease Outbreaks / Q000517:prevention & control*; D058872:Epidemics / Q000706:statistics & numerical data*; D006801:Humans; D008585:Meningitis, Meningococcal / Q000453:epidemiology* / Q000628:therapy; D038381:Neisseria meningitidis, Serogroup A; D009548:Niger / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*
keywords: Meningitis; Niger; bacteria; epidemics; surveillance; vaccines