Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.
World Health Organization: Inter-Country Support Team for West Africa, Ouagadougou, Burkina Faso.
J Glob Health. 2019 Jun;9(1):010409. doi: 10.7189/jogh.09.010409.
Meningococcal disease continues to be a global public health concern due to its epidemic potential, severity, and sequelae. The global epidemiological data on circulating meningococcal serogroups have never been reviewed concurrently with the laboratory capacity for meningococcal surveillance at the national level. We, therefore, aimed to conduct a country-level review of meningococcal surveillance, serogroup distribution, and vaccine use.
We conducted a systematic literature review across six databases to identify studies (published January 1, 2010 to October 16, 2017) and grey literature reporting meningococcal serogroup data for the years 2010-2016. We performed independent random effects meta-analyses for serogroups A, B, C, W, X, Y, and other. We developed and circulated a questionnaire-based survey to surveillance focal points in countries (N = 95) with known regional bacterial meningitis surveillance programs to assess their surveillance capacity and summarized using descriptive methods.
We included 173 studies from 59 countries in the final analysis. The distribution of meningococcal serogroups differed markedly between countries and regions. Meningococcal serogroups C and W accounted for substantial proportions of meningococcal disease in most of Africa and Latin America. Serogroup B was the predominant cause of meningococcal disease in many locations in Europe, the Americas, and the Western Pacific. Serogroup Y also caused many cases of meningococcal disease in these regions, particularly in Nordic countries. Survey responses were received from 51 countries. All countries reported the ability to confirm the pathogen in-country, while approximately 30% either relied on reference laboratories for serogrouping (N = 10) or did not serogroup specimens (N = 5). Approximately half of countries did not utilize active laboratory-based surveillance system (N = 22). Nationwide use of a meningococcal vaccine varied, but most countries (N = 36) utilized a meningococcal vaccine at least for certain high-risk population groups, in private care, or during outbreaks.
Due to the large geographical variations in circulating meningococcal serogroups, each country should continue to be monitored for changes in major disease-causing serogroups in order to inform vaccine and control policies. Similarly, laboratory capacity should be appropriately scaled up to more accurately understand local epidemiology and disease burden, as well as the impact of vaccination programs.
由于脑膜炎球菌病具有流行潜力、严重性和后遗症，因此仍然是全球公共卫生关注的问题。全球关于流行脑膜炎球菌血清群的流行病学数据从未与国家一级脑膜炎球菌监测的实验室能力同时进行审查。因此，我们旨在对脑膜炎球菌监测、血清群分布和疫苗使用情况进行国家级审查。
我们在六个数据库中进行了系统文献综述，以确定 2010 年至 2016 年期间发表的研究报告（2010 年 1 月 1 日至 2017 年 10 月 16 日）和灰色文献，报告脑膜炎球菌血清群数据。我们对血清群 A、B、C、W、X、Y 和其他进行了独立的随机效应荟萃分析。我们制定并向已知具有区域细菌性脑膜炎监测计划的国家的监测重点分发了一份基于问卷调查的调查，以评估其监测能力，并使用描述性方法进行总结。
我们最终分析包括来自 59 个国家的 173 项研究。脑膜炎球菌血清群的分布在国家和地区之间有很大差异。在大多数非洲和拉丁美洲，脑膜炎球菌血清群 C 和 W 占脑膜炎球菌病的很大比例。在欧洲、美洲和西太平洋的许多地方，血清群 B 是脑膜炎球菌病的主要原因。在这些地区，血清群 Y 也导致许多脑膜炎球菌病病例，特别是在北欧国家。收到了来自 51 个国家的调查答复。所有国家都报告说有能力在国内确认病原体，而大约 30%的国家要么依赖参考实验室进行血清群分类（N=10），要么不对标本进行血清群分类（N=5）。大约一半的国家没有利用基于实验室的主动监测系统（N=22）。全国范围内使用脑膜炎球菌疫苗的情况各不相同，但大多数国家（N=36）至少为某些高危人群、私人护理或暴发期间使用脑膜炎球菌疫苗。
由于流行的脑膜炎球菌血清群在地理上存在很大差异，因此每个国家都应继续监测主要致病血清群的变化，以便为疫苗和控制政策提供信息。同样，应适当扩大实验室能力，以更准确地了解当地流行病学和疾病负担，以及疫苗接种计划的影响。
