title: Meningococcal Meningitis Surveillance in the African Meningitis Belt, 2004-2013.
abstract: BACKGROUND
  An enhanced meningitis surveillance network was established across the meningitis belt of sub-Saharan Africa in 2003 to rapidly collect, disseminate, and use district weekly data on meningitis incidence. Following 10 years' experience with enhanced surveillance that included the introduction of a group A meningococcal conjugate vaccine, PsA-TT (MenAfriVac), in 2010, we analyzed the data on meningitis incidence and case fatality from countries reporting to the network.
  
  
  METHODS
  After de-duplication and reconciliation, data were extracted from the surveillance bulletins and the central database held by the World Health Organization Inter-country Support Team in Burkina Faso for countries reporting consistently from 2004 through 2013 (Benin, Burkina Faso, Chad, Democratic Republic of Congo, Ghana, Côte d'Ivoire, Mali, Niger, Nigeria, Togo).
  
  
  RESULTS
  The 10 study countries reported 341 562 suspected and confirmed cases over the 10-year study period, with a marked peak in 2009 due to a large epidemic of group A Neisseria meningitidis (NmA) meningitis. Case fatality was lowest (5.9%) during this year. A mean of 71 and 67 districts annually crossed the alert and epidemic thresholds, respectively. The incidence rate of NmA meningitis fell >10-fold, from 0.27 per 100,000 in 2004-2010 to 0.02 per 100,000 in 2011-2013 (P < .0001).
  
  
  CONCLUSIONS
  In addition to supporting timely outbreak response, the enhanced meningitis surveillance system provides a global overview of the epidemiology of meningitis in the region, despite limitations in data quality and completeness. This study confirms a dramatic fall in NmA incidence after the introduction of PsA-TT.
authors.affiliation: Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso.
authors.forename: Clément
authors.initials: C
authors.lastname: Lingani
authors.affiliation: Université de Montréal, Canada.
authors.forename: Cassi
authors.initials: C
authors.lastname: Bergeron-Caron
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: James M
authors.initials: JM
authors.lastname: Stuart
authors.affiliation: Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Katya
authors.initials: K
authors.lastname: Fernandez
authors.affiliation: Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso.
authors.forename: Mamoudou H
authors.initials: MH
authors.lastname: Djingarey
authors.affiliation: Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Ronveaux
authors.affiliation: Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Schnitzler
authors.affiliation: Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: William A
authors.initials: WA
authors.lastname: Perea
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D062665:Epidemiological Monitoring; D006801:Humans; D015994:Incidence; D008585:Meningitis, Meningococcal / Q000453:epidemiology*; D009026:Mortality; D009345:Neisseria meningitidis / Q000145:classification* / Q000302:isolation & purification*
keywords: Africa; meningitis; surveillance