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Wednesday 15 March 2017
Meningococcal disease in Latin America

WAidid suggests this week "The current situation of meningococcal disease in Latin America and updated Global Meningococcal Initiative (GMI) recommendations", the article published on Vaccine at the end of 2015 

Neisseria meningitidis (N. meningitidis) remains a major cause of invasive bacterial disease worldwide and is associated with substantial morbidity and overall case fatality rates of around 10%. In Latin America, incidence rates and serogroup distribution of meningococcal disease (MD) are highly variable and very limited data are available from different countries. The Global Meningococcal Initiative (GMI) is a multidisciplinary group, which aims to help to prevent MD worldwide through education, research, international cooperation, and to develop recommendations.
The reporting of MD is mandatory in Latin America, but surveillance systems and reporting systems are not standardized across countries. In addition, there is limited access to hospital care in some countries, as well as differences in the diagnostic methods and MD case definitions.
In order to help improve and standardize reporting of MD in Latin America, the GMI has proposed a number of recommendation, including a clear definition of a suspected case, the use of molecular diagnostic techniques in routine surveillance, an expanding use of culture methods, to establish well-equipped sentinel and reference laboratories with highly trained staff, and the adoption of a single case definition in all Latin American countries. Nevertheless, the GMI recognizes that some countries have resource and financial constraints, which prevent them from taking up all recommendations, and it therefore encourages alliances to be formed with other supportive organizations.
Monitoring phenotypic and genotypic characteristics of circulating N. meningitidis strains is of fundamental importance in understanding MD in each country. Six serogroups (A, B, C, W, X, and Y) cause nearly all cases of MD globally. Most cases of MD in Latin America are sporadic and caused by serogroups B and C, with emergence of serogroup W in Southern Cone countries. In contrast, serogroup A has virtually disappeared from Latin America.
Information about the carriage of N. meningitidis is essential in understanding the transmission dynamics of meningococcal infection, and for assessing the extent and potential that exists for vaccination strategies to induce herd protection.
The Chilean experience provides a unique opportunity to learn more about serogroup W disease and about the importance of an integrated surveillance system, a rapid response, and transparent dissemination of data to the public.
In late 2010, Brazil became the first Latin American country to introduce Meningococcal C conjugate (MCC), providing an immediate reduction in incidence rates of MD in children aged <2 years, but no early impact was observed in unvaccinated age groups.
The authors highlighted that, although notification of MD is compulsory in Latin America, surveillance is inconsistent and that the only countries where there is evidence of routine use of the molecular diagnostic test are Brazil and Chile. The authors concluded that the introduction of meningococcal vaccines across Latin America represents an important achievement in the control of MD, however there remain significant challenges in ensuring that the best strategies, both in terms of public health impact and cost-effectiveness, are being implemented. Finally, they highlighted the importance of vaccine affordability, and consequently, access, and they stressed the marked imbalance existing in the infrastructures and available resources, among the different States.

AUTHORS: Sáfadi M. A., O'Ryan M., Valenzuela Bravo M. T., Brandileone M. C., Gorla M. C., de Lemos A. P., Moreno G., Vazquez J. A., López E. L., Taha M. K., Borrow R.; Global Meningococcal Initiative.