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2019
Defeating Meningitis by 2030 A global roadmap
DRAFT 26 JUNE 2019
DRAFT 26 June 2019
1
Defeating Meningitis by 2030 – a global roadmap
Meningitis – a call for action
Meningitis, a devastating disease with a high case fatality and serious after-effects remains a major
global public-health challenge(1-4). Cases and outbreaks are a threat in all countries of the world, with
the highest burden in Africa (Figure 1). Meningitis, an inflammation of the membranes that surround
the brain and spinal cord, can be caused by infection with bacteria, viruses, protozoa and fungi. There
were an estimated 300,000 deaths globally from meningitis in 2015(1). Meningitis and meningitis
related sepsis can lead to severe after-effects, such as hearing loss, visual impairment, brain damage
and limb loss, that have a considerable emotional, social and financial impact on individuals, families
and communities(5-7). Epidemics of meningitis present a major challenge for health systems, the
economy and society. Meningitis is a largely vaccine-preventable disease, but progress in defeating
meningitis lags behind other vaccine preventable diseases such as tetanus(8).
Figure 1: Age-standardized incidence of meningitis per 100 000 population by location for both sexes, 2016
Source:(1)
In May 2017, over 50 representatives from governments, global health organizations, public health
bodies, academia, private sector, and civil society called for a global vision to “defeat meningitis by
2030”(9). In September of that year, 200 representatives from the 26 countries of the African
meningitis belt amplified this call and highlighted the need for equitable and sustainable access to
meningitis vaccines(10).
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WHO is coordinating the response to this call to action. A Technical Task Force of major technical
partners historically invested in long-term meningitis control, with complementary focus and
expertise, was convened to develop the roadmap. A baseline situation analysis(4) was undertaken
and, in February 2019, experts in meningitis, health and disability met to advance the draft
roadmap(11). The Task Force has further developed the roadmap for wider consultation.
The global roadmap
Scope
This roadmap of the first global strategy on meningitis sets a path to tackle the main causes of acute
bacterial meningitis: Neisseria meningitidis (Nm, meningococcus), Streptococcus pneumoniae (Spn,
pneumococcus), Haemophilus influenzae (Hi) and Streptococcus agalactiae (group B streptococcus, or
GBS). This focus is based on (i) the worldwide burden of disease due to these organisms, which also
cause sepsis and pneumonia, and (ii) the impact that this global strategy could have to diminish the
burden by 2030. Other important causes of meningitis, such as tuberculosis (TB) and Cryptococcus,
are not forgotten, several goals directed at reducing the burden of disease are applicable to all causes
of meningitis, particularly in support, after-care, advocacy and engagement. In addition, the
meningitis roadmap will reinforce and complement other global strategies on infectious diseases and
wider initiatives relating to health systems strengthening, universal health coverage, global health
security, disability rights and disability inclusion (see Connection to Other Global initiatives). A global
fight against meningitis is fully aligned with WHO's new 13th General Programme of Work and
captures the essence of WHO’s three-fold mission: promoting health, keeping the world safe, serving
the vulnerable(12).
Vision
The roadmap vision is global, since meningitis affects all populations worldwide, and ambitious, to
harness the energy of the coalition that is assembling around meningitis.
Roadmap vision
Towards a world free of meningitis
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Visionary goals
The visionary goals set out three main aims to reduce the impact of meningitis worldwide by 2030, a
date that aligns with the Sustainable Development Goals (SDGs)(13). Achieving these goals will rely on
strong commitments from countries, partners, and donors to collectively engage in defeating
meningitis.
Visionary goals by 2030
➢ Eliminate bacterial meningitis epidemics ➢ Reduce cases and deaths from vaccine-preventable bacterial meningitis* ➢ Reduce disability and improve quality of life after all causes of meningitis
* Global and regional targets to be agreed.
The serious impairments caused by meningitis feature prominently in this strategy, reflecting a greater
awareness that meningitis has a spectrum of outcomes, not only whether someone lives or dies.
A theory of change (Figure 2) summarizes the overall framework of the roadmap.
Figure 2: Theory of change for global roadmap to defeat meningitis by 2030
Issu
es Meningitis causes 300,000 deaths a year
globally and carries a risk of epidemics, many cases
could be prevented by vaccination
Tools, supplies and facilities for diagnosis and treatment are insufficient
Surveillance systems are not strong enough to
document the numbers, causes and effects of
meningitis
Meningitis and sepsis are a major cause of disability but availability and access
to care are weak
Awareness of meningitis as a global problem is low
among policy makers
Inp
uts
Countries commit to implement plans to
defeat meningitis
Partners commit to providing oversight,
technical expertise and innovative development
Donors commit to supporting the global
plan
Civil society commits to endorsing the roadmap
and raising awareness
Ou
tpu
ts Achieve high vaccine
coverage, develop new vaccines, develop
prevention strategies and epidemic control
Ensure meningitis diagnostic tools available,
health workers trained, quality-assured treatment
Ensure surveillance of meningitis and sequelae
at all levels
Ensure management of sequelae and care for
people affected by meningitis
Ensure meningitis has high global priority with awareness of meningitis
and disability at all levels
Ou
tco
mes Enhanced access to
improved vaccines and effective strategies for
prevention and epidemic control
Improved tools and access to diagnosis and
treatment
Improved monitoring of meningitis epidemiology
through disease
surveillance
Improved access to support and care for people and families
affected by meningitis
Higher awareness through advocacy and
engagement
Imp
act
by 2030
Epidemics of bacterial meningitis are eliminated
Cases and deaths from vaccine-preventable
bacterial meningitis are reduced (by % to be
determined)
Risk of disability is
reduced and quality of life is improved after all
causes of meningitis
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Strategic goals
As shown in Figure 2, the three visionary goals (the outcomes) depend on achieving the SGs and
milestones structured/organized in 5 domains of action or pillars (outputs):
Pillar 1: Prevention and epidemic control
Pillar 2: Diagnosis and treatment
Pillar 3: Disease surveillance
Pillar 4: Support and care for people affected by meningitis
Pillar 5: Advocacy and engagement
Each pillar sets out strategic goals, key activities and specific milestones to be achieved in order to
reach these goals. While serving to organise action, it is clear that the five pillars are interconnected:
diagnosis is closely linked to surveillance, surveillance informs prevention and epidemic control,
support and care for patients and families should commence during treatment at the time of
diagnosis, and advocacy and engagement are necessary for the success of every pillar. Maintaining
these links will be essential to success.
Targets for visionary and strategic goals will be set in the monitoring and evaluation framework, and
adapted to regional and local context. The roadmap should be adapted by countries into locally
relevant, evidence-based meningitis action plans with regional guidance/objectives for
implementation.
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Pillar 1: Prevention and epidemic control
Achieved through development and enhanced access to affordable vaccines, effective prophylactic measures and targeted control interventions
Enhanced efforts are needed to advocate for immunization. These include (i) encouraging vaccine
introduction, achieving and maintaining sufficient vaccine coverage, especially in lower- and middle-
income countries (LMICs) where the burden of meningitis is greatest, (ii) promoting the development
of vaccines to address the residual disease burden due to GBS, and Hi, Nm and Spn serogroups or
serotypes not covered by existing vaccines, (iii) reinforcing policy and improving strategies to enhance
the impact of vaccination and (iv) ensuring equitable access to affordable vaccines. Polysaccharide-
conjugate vaccines are dramatically reducing the global burden of disease caused by Nm, Spn and Hi
but their global uptake and impact needs to be enhanced. However, not all serogroups are presently
covered by these vaccines. Novel protein-based vaccines against NmB disease are now being used at
public health scale in high income countries (HICs). No vaccine exists for the prevention of GBS disease,
but GBS conjugate vaccine candidates are in development. Several Nm and Spn conjugate vaccine
candidates are also in late stage development including multivalent products with broader
serogroup/type coverage than existing vaccines. In addition, protein vaccine candidates against Nm,
Spn and GBS are in various stages of development. Also, as high usage of antibiotics in the treatment
of suspected meningitis can lead to the development of antimicrobial resistance (AMR), enhanced and
sustained vaccination programmes will have an increasingly important role in strategies for mitigating
the negative impact of AMR.
Chemoprophylaxis is generally used for close contacts of cases of meningococcal meningitis, but needs
further evaluation, particularly in the context of epidemics in the African meningitis belt. Policies for
prevention of GBS transmission from pregnant mothers to children using intravenous antibiotics are
implemented in many HICs but need evaluation before recommending for use in low and middle
income countries (LMICs).
The most important challenges in the control of Nm or Spn meningitis epidemics include weak
laboratory capacity to confirm the epidemic pathogen and lack of timely access to sufficient quantities
of affordable vaccines for outbreak response. For Spn meningitis outbreaks, guidance on response is
needed. And ultimately, evidence-based policy adjustment followed by high uptake of adequate
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preventive vaccination strategies using appropriate vaccines would ideally prevent the occurrence of
epidemics.
The aims of this pillar are to (i) introduce new vaccines, achieve and maintain high coverage of current
and new vaccines, against Nm, Spn, Hi and GBS in all countries, as required (ii) develop and
license/WHO prequalify effective and affordable new vaccines targeting Nm, Spn, Hi and GBS (ii)
develop evidence-based policy on vaccination strategies that result in optimal individual protection
and, where feasible, herd protection (iv) develop and implement context-specific strategies to prevent
GBS infection in infants (v) develop and improve strategies for outbreak prevention and response
including vaccination, chemoprophylaxis and risk communication, inclusive of mass gatherings and
humanitarian emergencies.
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Strategic goals Key activities Landmark goals (milestones)
SG 1: Introduce new vaccines, achieve and maintain high coverage of current and new vaccines, against Nm, Spn, Hi and GBS in all countries as appropriate (see SG18, SG20)
Implement locally appropriate tailored immunization strategies to achieve and maintain high vaccination coverage against Nm, Spn, Hib (and GBS when a vaccine is available) in all countries, reinforcing and complementing existing immunization strategies Ensure proper linkages and synergies with WHO, UNICEF, Gavi and other global or regional initiatives aiming to reduce costs and increase access to vaccines for Lower-Middle Income Countries (LMICs), e.g. the Measles & Rubella Initiative, and the planned WHO Immunization Agenda 2030. Ensure vaccines preventing bacterial meningitis are affordable, accessible and easy to use (e.g. regimen and number of doses, simple vaccination schedule, thermostable, product labelling and packaging) for every country where they are needed
Spn, Hib. By 2025, Spn and Hib conjugate vaccines introduced in all countries with locally relevant strategies, including new vaccine introduction By 2030, >90% vaccine coverage for complete series maintained or achieved in all countries Nm (meningitis belt) By 2021, introduction of preventive vaccination against Nm serogroup A in routine immunization programmes completed in >= 20 meningitis belt countries By 2023, introduction of preventive vaccination against Nm serogroups ACWXY in routine immunization programmes started in >=5 meningitis belt countries; By 2030, preventive vaccination against MenACWXY started in all countries in the meningitis belt as appropriate and with >90% coverage in the groups targeted for vaccination Nm (other countries) By 2025, locally relevant meningococcal disease vaccination strategies introduced in all countries with moderate/high incidence GBS By 2030, GBS vaccine introduced, if available and with Gavi support where needed, in >=10 countries with an established burden of GBS in line with WHO policy
Define regulatory pathways for licensure of GBS vaccines By 2022, regulatory pathways for licensure of GBS vaccines
defined, based on consultations with National Regulatory
Authorities and WHO PQT
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SG2: Develop and license/WHO prequalify affordable new vaccines targeting Nm, Spn, Hi and GBS
Develop and license/WHO prequalify affordable vaccines: additional multivalent meningococcal conjugate vaccines, additional MenB vaccines, additional pneumococcal, Hi and GBS vaccines
Nm By 2020, WHO TPP for multivalent meningococcal conjugate vaccine published, including thermostability considerations By 2021, WHO Technical Report Series (TRS) for multivalent meningococcal conjugate vaccine published By 2022, at least one affordable multivalent (ACWXY) meningococcal conjugate vaccine licensed and WHO prequalified By 2026, at least one affordable MenB vaccine and sufficient sources of affordable multivalent meningococcal conjugate vaccines to ensure security of supply Spn By 2021, WHO TRS for PCVs updated By 2020, at least one, and by 2025 at least three, additional affordable PCVs, with coverage consistent with emerging data on serotypes causing invasive disease in LMICs, licensed and WHO prequalified By 2026, at least one new Spn vaccine with broader coverage – either higher valency PCV or protein containing vaccine - licensed and WHO prequalified GBS By 2022, regulatory pathways for licensure of GBS vaccines
defined, based on consultations with National Regulatory
Authorities and WHO Prequalification Team
By 2026, at least one affordable vaccine against GBS licensed and WHO prequalified (for maternal immunization during pregnancy to prevent GBS-related stillbirth and invasive GBS disease in infants)
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Hia By 2028, at least one vaccine against Hia licensed to address high burden of disease in some communities, e.g. indigenous peoples in N. America and Australia
Improve access to affordable vaccines through provision of support -including tech transfer, to vaccine manufacturers in their efforts to develop, license/WHO prequalify new vaccines and ensure diversification of quality-assured sufficient vaccine production capacity in more countries, including LMICS
By 2030, sufficient sources of affordable Spn and Nm multivalent
conjugate vaccines to ensure security of supply
By 2030, quality-assured sufficient vaccine production capacity
diversified into >=5 LMICs for Hib, Spn and Nm multivalent
conjugate vaccines
SG3: Develop evidence-based policy on vaccination strategies that result in optimal individual protection and, where feasible, herd protection
Evaluate vaccination strategies for use of multivalent meningococcal conjugate vaccines to achieve herd protection
By 2022, modeling research studies on multivalent meningococcal conjugate vaccination strategy completed and results disseminated with open access to support vaccine introduction strategies By 2024, cluster randomized studies and/or carriage studies on multivalent meningococcal conjugate to inform vaccination strategy completed and published
Develop global policy for use of MenB and multivalent meningococcal conjugate vaccines
By 2022, global policy available for use of MenB and multivalent meningococcal conjugate vaccines By 2030, global policy updated as new vaccines and evidence become available
Assess the overall vaccine impact, duration of protection, serotype replacement and indirect effects induced with different pneumococcal conjugate vaccine (PCV) schedules to inform vaccination strategies for use of PCVs in order to maintain immunity in populations and
By 2025, vaccine effects and duration of protection induced with different PCV schedules documented, including feasibility of new dosing schedules and catch-up campaigns
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to prevent/control vaccine-preventable pneumococcal disease among unvaccinated individuals (older children, adolescents and adults)
By 2026, global policy on PCV schedules updated and implemented based on these findings
Establish immune correlates of protection (serogroup
/type specific) for Nm, Spn, and GBS
By 2025, studies to establish further immune correlates of
protection in different transmission settings conducted and
published for Nm, Spn and GBS
Quantify the potential benefits of vaccines on
decreasing overall antibiotic use for invasive infections
or for prophylaxis and on reducing antimicrobial
resistance
By 2024, potential benefits of meningitis vaccines quantified on decreasing overall antibiotic use and reducing antimicrobial resistance
SG4: Develop and implement
context-specific strategy to
prevent GBS infection in infants
(see SG7, SG11)
Conduct research to further document transmission
patterns of GBS and risk factors for early/late onset GBS
disease
By 2023, study completed on transmission of GBS and risk factors for early/late onset GBS disease
Develop and implement global strategy on preventing
GBS transmission to infants considering evidence, needs
and feasibility, with consideration for potential impact
on antimicrobial resistance, linking with other sepsis,
maternal and child health initiatives
By 2025, global policy available on GBS prevention in infants
By 2030, recommended prevention policies implemented in
countries where appropriate, unless superseded by a vaccination
programme
SG5: Develop and improve
strategies for outbreak
prevention and response
including vaccination,
chemoprophylaxis and risk
Review and establish WHO definitions for outbreaks of
meningococcal and pneumococcal meningitis, and late
onset GBS disease in all Regions to guide investigation
and control measures
By 2021, WHO definitions updated or established for
meningococcal and pneumococcal meningitis and late onset GBS
disease outbreaks in all Regions
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communication, inclusive of
mass gatherings and
humanitarian emergencies
(see SG20)
Develop and update strategies on surveillance,
preparedness and response to meningitis epidemics,
including consideration of mass gathering issues
Update strategies on vaccination during and after humanitarian emergencies for preventing epidemics among refugees and displaced persons
By 2023, guidelines on surveillance, preparedness and response
to meningitis epidemics updated, including updating of reactive
vaccination strategies
Develop strategies to ensure sufficient vaccine stockpile
and gradually transition from polysaccharide to
affordable multivalent meningococcal conjugate
vaccines to respond to outbreaks
By 2021, the ICG stockpile of meningococcal vaccines
appropriately replenished (quantity, composition, timeliness),
building on predictive modeling research, to enable an early
response to outbreaks in the meningitis belt
By 2023, sufficient affordable multivalent meningococcal
conjugate vaccines available globally to respond to outbreaks in
all Regions without ICG intervention, allowing to plan for gradual
phasing out of the meningitis ICG, as well as to address
preventive vaccination needs for mass gatherings
Define strategies to prevent / respond to pneumococcal
meningitis outbreaks
By 2021, WHO strategy for pneumococcal meningitis outbreak prevention and response available, possibly including catch up and/or response vaccination campaigns if appropriate
Conduct research and review policy for use of antibiotic
prophylaxis as a control measure during meningococcal
meningitis outbreaks in the African meningitis belt, with
consideration for potential impact on antimicrobial
resistance
By 2021, additional study completed on the potential risks and
benefits of this strategy of using antibiotic prophylaxis during
meningococcal meningitis outbreaks in the African meningitis belt
By 2022, revised policy (if necessary) published on antibiotic
prophylaxis during meningococcal meningitis outbreaks in the
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African meningitis belt, with possibly time-limit considerations (in
consideration and coordination with introduction/ availability of
multivalent Nm conjugate vaccines)
Prepare and implement context-appropriate community
engagement and risk communication messaging on
severity of disease to maximise reach during outbreaks
through traditional and innovative/digital approaches
e.g. radio, newspaper, community outreach, social
media, SMS mass messaging
Monitor secondary communication of messages and
rumours via monitoring and accountability mechanisms
(including social media monitoring)
By 2020, social and communication channels mapping completed
in all high-risk countries
By 2020, guidance for monitoring secondary communication of
messages and community rumours on meningitis outbreaks
available and used globally
By 2021, risk communications with mixed methods of messaging
available and used in meningitis outbreaks globally
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Pillar 2: Diagnosis and treatment
Achieved through access to appropriate diagnostic tests at all levels of care,
enhanced surveillance and prompt and effective treatment
Laboratory confirmation is well defined for the main bacterial pathogens (culture and real time PCR
being the gold standards), but health workers, especially in LMICs, may not be trained or resourced to
identify cases of meningitis, cerebrospinal fluid (CSF) samples are often not collected, and laboratory
capacity is often weak. There is a lack of quality assured, affordable, high performance rapid diagnostic
tests (RDTs). Antibiotic treatment regimens are well established, but WHO guidelines for treatment of
adults with bacterial meningitis are not currently available and recommended antibiotics are not
always available. A review of adjunctive therapies in LMICs is needed.
The aims of this pillar are (i) to make meningitis diagnostic tools available at the appropriate level of
care to increase confirmation of bacterial meningitis and antimicrobial susceptibility testing (AST), (ii)
to develop and implement a diagnosis, treatment and care policy for maternal/infant GBS,
particularly for use in low-resource settings, (iii) to ensure community health workers can recognize
and refer patients with meningitis, and that peripheral primary care workers can diagnose and
initiate treatment (iv) to provide appropriate quality assured treatment and supportive care for
every patient to reduce sequelae and deaths.
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Strategic goals Key activities Landmark goals (milestones)
SG6: Make meningitis diagnostic tools available at the appropriate level of care to increase confirmation of bacterial meningitis and antimicrobial susceptibility testing (AST)
Increase use of diagnostic lumbar punctures (LPs) and other specimen sampling by ensuring availability of sterile kits, supporting national policies and training to enable staff other than doctors to do LPs, and increasing community acceptance of LPs
By 2024, CSF and other samples (e.g. blood) as required collected in all countries from >50% of suspected meningitis cases
Evaluate role of blood tests (culture, PCR) as an alternative to CSF
By 2022, studies published on evaluaton of blood testing in the diagnosis of meningitis/sepsis in at least two settings, including the African meningitis belt
Establish innovative (pooled) funding mechanisms to enable development of rapid diagnostic tests
By 2022, funding mechanisms established to enable development of RDTs and deployment into the field at scale
Support research into identification of biomarkers (preferably based on blood or urine) to be used in a point of care (POC) test suitable for use in LMICs, to rapidly detect invasive bacterial vs viral infection
By 2026, quality assured, affordable and accessible, point of care (POC) diagnostic tests developed based on a specific biomarker(s) to rapidly detect invasive bacterial vs viral infection and that are appropriate for use in LMICs By 2030, tests used in 50 LMICs
Develop target product profiles (TPPs) for diagnostic tests that identify the main pathogens of suspected meningitis cases (bacterial, viral, fungal), determine market needs, and develop diagnostic tests according to TPP
By 2026, quality assured and affordable syndromic (multiplex) diagnostic test available to identify and distinguish the main pathogens responsible for meningitis (bacterial, viral, fungal) By 2030, tests used in 50 LMICs
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SG7: Develop and implement diagnosis, treatment and care policy for infant GBS, particularly for low-resource settings (see SG4)
Develop affordable POC diagnostic tests, suitable for low resource settings, for (i) maternal GBS carriage (ii) invasive GBS disease in infants
By 2026, a quality assured, affordable and accessible POC diagnostic tests available to identify (i) maternal GBS carriage and (ii) invasive GBS disease
Develop and implement diagnosis, treatment and care policies/strategies for infant GBS, particularly for low resource settings
By 2026, infant GBS diagnosis, treatment and care strategy available for all countries By 2030, recommended strategy implemented in >50% of countries
SG8: Ensure community/peripheral level health workers are trained and provided with suitable resources to enable them to appropriately identify, diagnose, and treat people with meningitis (see SG14, SG15)
Ensure appropriate training and supervision for each level of care on timely identification, diagnosis, referral and treatment of meningitis so that community health workers can recognize and refer, and so that peripheral primary care workers can diagnose and initiate treatment
By 2026, a training and supervision programme on identification, diagnosis, referral and treatment of meningitis patients (including potential sequelae) from peripheral level to hospital level established and integrated into existing training >80% of countries
Ensure a mechanism for timely procurement and distribution of recommended antimicrobials and medical supplies needed for supportive care at country level as part of essential medicine supplies
By 2024, established mechanism for timely antimicrobials and supplies for supportive care integrated into national procurement in >80% of countries
SG9: Provide appropriate quality-assured treatment and supportive care for every patient to reduce sequelae and deaths (see SG3, SG12)
Review the potential benefit of adjunctive therapies for bacterial meningitis e.g. mannitol, steroids in LMICs
By 2024, potential benefit of adjunctive therapies in LMICs evaluated by systematic review
Develop and disseminate comprehensive, regionally adapted, patient management guidance and treatment packages for all ages and causes of meningitis, specifically
By 2025, evidence-based package of treatment and care that addresses all causes of meningitis and tailored to all resource settings made available for all Regions
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addressing current gaps (e.g. neonatal meningitis and sepsis, WHO antibiotic treatment guidance for adults and use of adjunctive therapies or other strategies for prevention and management of sequelae) and antimicrobial resistance evidence
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Pillar 3 Disease Surveillance
Achieved by encompassing all main causes of bacterial meningitis and their
sequelae to guide meningitis control policies and accurately monitor progress
toward goals
Guidelines for national surveillance of meningitis pathogens are not uniformly implemented, and
there are no recommended guidelines for GBS surveillance. In many countries, weak surveillance
systems hamper prompt outbreak detection and response and decisions about vaccine introduction.
Laboratory capacity for diagnostic testing, including molecular characterization, needs strengthening
for effective surveillance. Disease data reporting to the international level and whole genome
sequence (WGS) repositories are needed to strengthen global surveillance. There is very limited
guidance and implementation of surveillance of sequelae in all regions.
The aims of this pillar are to (i) set standards for bacterial meningitis surveillance systems and ensure
that they are in place in each country (ii) develop and implement global guidance, including for low-
resource settings, on surveillance of infant GBS disease (iii) develop and implement a strategy for
surveillance of sequelae from meningitis (iv) improve disease data reporting to the international level
to strengthen regional and global monitoring and estimation of the disease burden.
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Strategic goals Key activities Landmark goals (milestones)
SG10: Ensure effective bacterial meningitis surveillance systems are in place in each country
Review regional surveillance strategy for main bacterial meningitis pathogens in each region and elaborate guidelines as needed. (SG11 covers GBS surveillance)
By 2021, regional surveillance guidance available in all regions for main bacterial meningitis pathogens
Develop, adopt and implement a minimum package of surveillance for the main bacterial meningitis pathogens at country level, with standards for epidemiology, laboratory capacity (including microbiology and antimicrobial resistance), data management making use of innovative tools
By 2025, minimum package of main bacterial meningitis pathogens surveillance implemented in >80% of countries
Perform global surveillance of emerging resistance patterns of main pathogens, linking with antibiotic resistance networks and control strategies
By 2023, a global mechanism to monitor the antibiotic resistance pattern of main meningitis pathogens is functional
SG11: Develop and implement global guidance, including for low-resource settings, on surveillance of infant GBS disease
Conduct situation analysis on surveillance of infant GBS invasive disease (including stillbirths, pre-term births due to GBS) world-wide
By 2021, situation analysis completed on infant GBS disease surveillance world-wide
Develop regional and international guidelines and tools for surveillance of infant GBS disease, including standardized case definitions and ascertainment methodologies
By 2020, international and regional guidelines for surveillance of infant GBS disease developed for all Regions
Establish surveillance systems for infant GBS (including stillbirths, pre-term births), according to guidelines and as regionally appropriate
By 2024, surveillance of infant GBS implemented in high burden regions, and by 2028 in medium/low burden regions.
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SG12: Develop and implement the surveillance of sequelae from meningitis (see SG14, SG15, SG19)
Develop a global strategy for surveillance of sequelae from meningitis and sepsis (routine surveillance, sentinel sites, surveys). Develop tools/SOPs/protocols for surveillance of sequelae and training materials
By 2026, global strategy and tools for surveillance of sequelae developed
Map institutions, and civil society organizations (CSOs)/ Organizations of Persons with Disabilities (including parent and patient groups, self- help groups), providing services to persons with disabilities, engage with them and include them in surveillance networks of sequelae (coordinate activity with SG15)
By 2025, institutions and CSOs, providing services to persons with disabilities mapped and included in surveillance of sequelae
Adapt the global strategy to be region specific and implement surveillance of sequelae at country-level Support training of health-care workers (including staff of audiology, neurology, physiotherapy, orthopaedic and prosthetic departments), teachers, community members, CSO members on the collection of information on sequelae from meningitis and sepsis
By 2030, regionally adapted strategies for meningitis sequelae implemented
Encourage Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) to collect data on disabilities
By 2022, variables on disabilities will be integrated in the standard DHS and MICS indicator list
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SG13: Ensure disease data reporting to the international level to strengthen regional and global monitoring and estimation of the disease burden
Refine and improve estimates of regional and global burden from meningitis due to Nm, Spn, Hi and GBS, including risk and impact of sequelae
By 2022, estimates of global and regional disease burden of main pathogens refined, including risk and impact of sequelae
Establish regional or international mechanism/network for molecular surveillance, of bacterial meningitis pathogens allowing for timely strain identification and sharing of information
By 2025, representative proportion (minimum 10%)) of strains characterized for Nm, Spn, Hi and GBS meningitis pathogens strains characterized in a globally coordinated mechanism in all Regions
In collaboration with the WHO collaborating centres and reference laboratories, establish a global genome library for meningitis pathogens (Nm, Spn, Hi, GBS), and associated clinical and epidemiological data with clear governance and guidelines for access and use of strains
By 2025, global genome library functional for each of the four pathogens
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Pillar 4: Support and care for people affected by meningitis
Achieved by ensuring that effective systems for identification and management
of sequelae are implemented and that people and families/carers affected by
meningitis can access appropriate support and care services that meet their
needs.
It is estimated that at least one third of people surviving an episode of bacterial meningitis have
enduring after-effects. Impairments caused by meningitis are wide-ranging and often severe.
Common sequelae include seizures, hearing and vision loss, cognitive impairment, neuromotor
disability, memory and behavior changes, as well as scarring and limb amputations after
meningococcal sepsis. Aftercare has a high cost and may not be affordable for families. Policies and
services for assessment of sequelae, treatment, rehabilitation and follow up including in communities
are often absent or insufficient with inequitable access, especially in LMICs. Training on disability and
bereavement for health care professionals and community workers is limited, with inadequate
numbers of trained staff at all levels of care from community to hospital. Given the global burden of
bacterial meningitis, it is essential to build and strengthen health systems to provide the necessary
care and programmatic support for everyone who needs it.
The aims of this pillar are to (i) strengthen early recognition and management of sequelae in health
care and community settings (ii) increase availability and access to appropriate care for people
affected by meningitis including those with sequelae from meningitis and for families/carers of those
who have either recovered or died.
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Strategic goals Key activities Landmark goals (milestones)
SG14: Strengthen early recognition and management of sequelae after meningitis in health care and community settings (see SG8, SG12)
Conduct primary and secondary research on
epidemiology and impact of sequelae on children
and adults to determine extent of service needs in
different settings
By 2023, studies completed on impact of sequelae and service needs
Develop and implement best practice guidelines for
detection, monitoring and management of
meningitis sequelae before and after discharge
from hospital, at all levels of health care and in
community settings e.g. schools
By 2025, global guidelines for systematic detection, monitoring and management of sequelae after meningitis developed; and by 2028, adapted and implemented in >50% of countries
Promote community-based programmes to (i) identify sequelae and disabilities, based on UN (Washington Group) and WHO instruments, and refer for assessment and appropriate care (ii) to provide care, support and aftercare to individuals, families and communities affected by meningitis e.g. psychosocial support
By 2028, system of community-based identification of sequelae and disabilities, and referral for assessment and care established in >50% of countries By 2028, community based programmes available in >50% of countries to provide routine comprehensive support to those affected by meningitis
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SG15: Increase availability and access to appropriate care (i) for people affected by meningitis and (ii) for their families/carers
(see SG12, SG17)
Map out existing services and support systems
available by country for (i) people with disabilities,
including those with meningitis sequelae and (ii) for
families/carers of people affected by meningitis,
identifying barriers to access, availability, and use
(informal and formal) (coordinate activity with
SG12)
By 2023, services and support systems mapped out
for (i) people with disabilities including meningitis
sequelae and (ii) families /carers of people with
meningitis who have recovered or died, in >80% of
countries including barriers to access, availability,
and use
Strengthen partnerships between government and
CSOs, including disabled people organizations and
other networks, so that people with sequalae or
disabilities due to meningitis and their
families/carers have access to quality and effective
services that are in line with international human
rights standards and frameworks
By 2025, guidelines to facilitate access for people
affected by meningitis to services on community-
based rehabilitation (CBR) developed; and by 2028,
in place in >50% of countries
Provide up-to-date relevant information to people and carers affected by meningitis about access to services for managing sequelae through varied channels e.g. media, social media, schools, community-based mechanisms etc
By 2027, up-to-date relevant information provided by media, social media, schools, community-based mechanisms etc to people affected by meningitis on access to services and support
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Pillar 5: Advocacy and Engagement
To raise public and political awareness of meningitis and around disability, to
improve health-seeking and access to control measures
Advocacy can drive lasting change and makes the case for that change. Advocacy goals for meningitis
include better protection against meningitis, better diagnosis and treatment, and better support and
aftercare for those who have experienced meningitis and their families. Provision of general
information about meningitis to the overall population, at-risk groups and health workers, as well as
specific information for people who have directly been affected by meningitis, their families and
communities, can play an important role in defeating meningitis, but such information is often lacking.
Meningitis poses specific information challenges. Its rapid onset leaves little time to act, increasing
the need for good, targeted information. It is frequently confused with other fever-causing diseases,
such as malaria, increasing the need for health worker resources and training. Disability is a common
feature of life after meningitis, meaning good aftercare information is essential.
Effective information can make people aware of the need to seek help based on awareness of the
signs and symptoms of meningitis and to increase demand from populations for vaccination.
Clinical guidelines are often not available to help ensure that health workers and clinicians are trained
and resourced to respond. Information is generally lacking to help signposting of patients to support
services.
The aims of this pillar are to (i) improve recognition among funders and policymakers at national,
regional and global level that meningitis and the roadmap to defeat meningitis should be prioritized
as a health issue at every level, (ii) increase awareness and sensitization of communities around
disability and the services available to manage disabilities, (iii) ensure awareness among all
populations of meningitis signs, symptoms and consequences so that they seek appropriate
healthcare, (iv) ensure that people and communities are aware of their right to meningitis prevention
and support services, and that they value and demand them, and (v) maintain high vaccine confidence.
25
Strategic goals Key activities Landmark goals (milestones)
SG16: Ensure recognition among funders and
policymakers at national, regional and global level
that meningitis and the roadmap to defeat
meningitis should be prioritized as a health issue
at every level
Raise awareness of meningitis as a health priority
among funders and policy makers through national
and international champions, community
engagement, CSOs, advocacy groups and health
care providers
By 2021, meningitis and related disability included
in all relevant WHO (Global and Regional) and
donors’ strategic and operational plans and
budgets
Build a business case for investment prevention,
surveillance, diagnosis, and treatment of
meningitis, and for prevention and management of
sequelae, targeted for use by policymakers,
decision makers and funders at global, regional and
national levels
By 2020, a business case available and promoted at
global, regional and national level
Countries undertake baseline needs assessment on
meningitis and then create national action plans
that address gaps and are aligned to the global
roadmap
By 2022, >80% of countries have undertaken a
meningitis baseline needs assessment.
By 2024, >80% of countries have a context
appropriate meningitis action plan and monitoring
framework aligned to their national health strategy,
budget and global roadmap through to 2030
Improve global recognition of and activities around
World Meningitis Day (WMD) and other global
health dates (e.g. sepsis, cerebral palsy, disability),
adapt messaging to policy makers as well as the
general public, and raise funding for promoting
activities that support the roadmap
By 2022, WMD and related global health dates
visibly endorsed by global policy makers/funders
and used by >80% of countries to assess/promote
roadmap progress and share learning through
personal stories and best practice around the world
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SG17. Ensure awareness and sensitization of
communities around disability and available
services
(see SG15)
Support global and national campaigns on
International Day of Persons with Disabilities to
increase awareness and sensitization of
communities on disability, and to address
significant attitudinal barriers that lead to stigma
and undignified treatment of people with
disabilities
Raise awareness of new systems for data collection
on sequelae/disability and of available support
services
By 2025 awareness raised on International Day of
Persons with Disabilities in >80% of countries to
increase sensitization of communities on disability
and awareness of available services
SG18: Ensure awareness among all populations of
the symptoms, signs and consequences of
meningitis so that they seek appropriate
healthcare
(see SG6, SG8)
Undertake communication programmes and
activities that increase population awareness of the
symptoms, signs and consequences of meningitis
and of the recommended health seeking response,
based on strategies used to promote recognition of
other diseases (HIV, malaria and TB), including
social media, champions, community leaders, and
frontline workers
By 2023, meningitis awareness campaigns
conducted in >80% of countries appropriate to
national burden and integrated with existing health
awareness activities
Study the factors that facilitate or act as barriers to
health seeking behaviours for meningitis and
integrate actions into country plans to address the
issues identified
By 2025, region specific research published into
factors that facilitate or act as barriers to health
seeking behaviours for meningitis.
By 2028, recommended actions included in national
plans in >80% of countries
DRAFT 26 June 2019
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SG19: Ensure that people and communities are
aware of their right to meningitis prevention and
support services, and that they value and demand
them
(see SG1, SG3, SG16)
Identify, encourage and support civil society
organizations that do or could promote the
interests of those affected by meningitis, including
those with sequelae, and invite involvement in
delivering the goals of the roadmap through their
communities, engagement with national and
regional authorities and international networks of
CSOs
By 2025, citizen representation and input to
national meningitis annual plans in >30% of
countries
Improve community understanding of existing and
new vaccination platforms (e.g. maternal
immunization when available for GBS) by
Knowledge, Attitude and Practice (KAP) studies,
and social anthropological research
By 2025, KAP studies and social anthropological
research conducted and by 2028 (depending on
vaccine availability) GBS maternal vaccination
promoted
SG20: Maintain high vaccine confidence
(see SG1, SG5)
Communicate widely through social media,
community platforms, and media engagement on
the safety and impact data of meningitis vaccines
and leverage the story of MenAfriVac to emphasize
that other causes of meningitis remain but are
potentially addressable with new vaccines
Develop risk and crisis communication plans for
new and existing vaccines in order to address
potential inaccurate communication of adverse
events
By 2023, communication plans promoting vaccine
confidence developed and implemented in >50% of
countries; and by 2026, in > 80% of countries
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Connection to other global initiatives
The multi-pathogen, multidisciplinary nature of the Defeating Meningitis roadmap provides
opportunities for linkage with other global projects and initiatives, which can drive accelerated
progress towards mutual or complementary goals. The Defeating Meningitis technical task force is
actively working to identify potentially complementary initiatives and will establish and maintain
linkages with these initiatives to ensure alignment of goals and integrated approaches wherever
possible.
Initiatives with potential synergy with the Defeating Meningitis roadmap fall into several categories:
Maintain active collaboration:
• WHO Sepsis programme
• Group B Streptococcus Vaccine Development Technology Roadmap
• Global Antimicrobial Resistance Surveillance System
• WHO Vaccines for AMR project (no website yet)
• WHO Rehabilitation Support Package
• WHO Deafness and Hearing Loss programme
Maintain communication to identify potential future opportunities:
• Global roadmap for advancing development of vaccines against sexually transmitted
infections
Share information to promote visibility of the Defeating Meningitis roadmap or our goals/targets:
• Immunization Agenda 2030 (draft 0, no website yet)
o Successor to the Global Vaccine Action Plan
• WHO Global Observatory on Health Research and Development
• Global Action Plan for Healthy Lives and Wellbeing For All
• IMPRINT – Immunising Pregnant Women and Infants Network
TBD (we are working to contact these groups/initiatives to identify how we can synergize)
• Global Action Plan for Pneumonia and Diarrhoea
• Japanese Encephalitis Prevention and Control programs (WPRO, SEARO)
• Cryptococcal disease component of the WHO HIV programme
• The End TB Strategy
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• Pocket Book of Hospital Care for Children (next edition)
• WHO Universal Health Coverage Package
• Global Strategy for Women’s, Children’s, and Adolescents’ Health
• Every Newborn Action Plan
• Africa Health Strategy 2016-30
• WHO Global Strategy on Human Resources for Health
• Convention on the rights of persons with disabilities
• BactiVac Network
Timelines for roadmap development WHO is hosting a web-based public consultation from June to July 2019 and will convene a global
stakeholder consultation in September 2019. At this meeting, 120-150 delegates from around the
world will be invited to give feedback on the roadmap: the priority for this meeting will be to align
with country perspectives and ensure that people affected by meningitis have a voice. Regional
meetings will be held to tailor the strategy to regional issues. The draft roadmap will be submitted to
the WHO Executive Board and the World Health Assembly for review and endorsement in 2020.
Roadmap sections to be developed include:
Implementation
Communication plan
Monitoring and Evaluation framework
Critical path/ risk management
Financing
Business plan/value proposition
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Key references
1. Zunt JR, Kassebaum NJ, Blake N, Glennie L, Wright C, Nichols E, et al. Global, regional, and national burden of meningitis, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2018;17(12):1061-82. 2. van de Beek D. Progress and challenges in bacterial meningitis. Lancet. 2012;380(9854):1623-4. 3. McIntyre PB, O'Brien KL, Greenwood B, van de Beek D. Effect of vaccines on bacterial meningitis worldwide. The Lancet. 2012;380(9854):1703-11. 4. WHO. Defeating meningitis by 2030: baseline situation analysis Geneva WHO; 2019 [Available from: https://www.who.int/immunization/research/BSA_20feb2019.pdf?ua=1. 5. Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(5):317-28. 6. Edmond K, Dieye Y, Griffiths UK, Fleming J, Ba O, Diallo N, et al. Prospective cohort study of disabling sequelae and quality of life in children with bacterial meningitis in urban Senegal. Pediatr Infect Dis J. 2010;29(11):1023-9. 7. Kohli-Lynch M, Russell NJ, Seale AC, Dangor Z, Tann CJ, Baker CJ, et al. Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis. 2017;65(suppl_2):S190-s9. 8. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151-210. 9. Park W. A global vision for meningitis by 2030 and how to get there. Wilton Park, UK; 2017. 10. WHO. 14th Annual meeting on surveillance, preparedness, and response to meningitis outbreaks in Africa & 4th Annual MenAfriNet partners’ meeting: Ouagadougou, Burkina Faso - 12 – 15 September 2017 2017 [ 11. Park W. Defeating meningitis by 2030: developing a global roadmap 2019. 12. WHO. Thirteenth general programme of work 2019−2023 2018 [Available from: http://origin.who.int/about/what-we-do/gpw-thirteen-consultation/en/. 13. UN. Sustainable development goals [Available from: https://www.un.org/sustainabledevelopment/sustainable-development-goals/.
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