title: Strong Public Health Recommendations from Weak Evidence? Lessons Learned in Developing Guidance on the Public Health Management of Meningococcal Disease.
abstract: The evidence underpinning public health policy is often of low quality, leading to inconsistencies in recommended interventions. One example is the divergence in national policies across Europe for managing contacts of invasive meningococcal disease. Aiming to develop consistent guidance at the European level, a group of experts reviewed the literature and formulated recommendations. The group defined eight priority research questions, searched the literature, and formulated recommendations using GRADE methodology. Five of the research questions are discussed in this paper. After taking into account quality of evidence, benefit, harm, value, preference, burden on patient of the intervention, and resource implications, we made four strong recommendations and five weak recommendations for intervention. Strong recommendations related not only to one question with very low quality of evidence as well as to two questions with moderate to high quality of evidence. The weak recommendations related to two questions with low and very low quality of evidence but also to one question with moderate quality of evidence. GRADE methodology ensures a transparent process and explicit recognition of additional factors that should be considered when making recommendations for policy. This approach can be usefully applied to many areas of public health policy where evidence quality is often low.
authors.affiliation: Consultant Epidemiologist (Independent), 1081 Brussels, Belgium ; Department of Vaccinology, University of Antwerp, 2000 Antwerp, Belgium.
authors.forename: Germaine
authors.initials: G
authors.lastname: Hanquet
authors.affiliation: Division of Epidemiology, Norwegian Institute of Public Health, 0403 Oslo, Norway ; National Institute of Public Health-National Institute of Hygiene, 400-791 Warsaw, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Stefanoff
authors.affiliation: Department of Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, 13086 Berlin, Germany.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Hellenbrand
authors.affiliation: Meningococcal Reference Laboratory, Austrian Agency for Food and Health Safety, 8010 Graz, Austria.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Heuberger
authors.affiliation: Vaccine-Preventable Diseases Programme, European Centre for Disease Prevention and Control, 171 83 Stockholm, Sweden.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Lopalco
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK ; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
authors.forename: James M
authors.initials: JM
authors.lastname: Stuart
mesh_terms: D005060:Europe; D019317:Evidence-Based Medicine; D006801:Humans; D008589:Meningococcal Infections / Q000453:epidemiology* / Q000473:pathology; D011634:Public Health; D062486:Public Health Surveillance