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Meningococcal disease in the Middle East: A report from the Global Meningococcal Initiative
Seif S Al-Abri1, Musallam Yunus Abuhasan2, Soha Shawqi A Albayat3
1Royal Hospital, Sultanate of Oman.
Abstract:
This review details recent findings from the Global Meningococcal Initiative's (GMI) recent meeting on the surveillance and control strategies for invasive meningococcal disease in the Middle East. The nature of case reporting and notification varies across the region, with many countries using bacterial meningitis as an IMD case definition in lieu of meningitis and septicaemia. This may overlook a significant burden associated with IMD leading to underreporting or misreporting of the disease. Based on these current definitions, IMD reported incidence remains low across the region, with historical outbreaks mainly occurring due to the Hajj and Umrah mass gatherings. The use of case confirmation techniques also varies in Middle Eastern countries. While typical microbiological techniques, such as culture and Gram staining, are widely used for characterisation, polymerase chain reaction (PCR) testing is utilised in a small number of countries. PCR testing may be inaccessible for several reasons including sample transportation, cost, or a lack of laboratory expertise. These barriers, not exclusive to PCR use, may impact surveillance systems more broadly. Another concern throughout the region is potentially widespread ciprofloxacin resistance since its use for chemoprophylaxis remains high in many countries.
Insights
Invasive meningococcal disease (IMD) surveillance in the Middle East faces challenges due to varied reporting and diagnostic methods. Addressing these issues is crucial for accurate disease burden assessment and effective control strategies.
Area of Science:
- Public Health
- Epidemiology
- Microbiology
Background:
- Invasive meningococcal disease (IMD) surveillance and control strategies in the Middle East were discussed at a Global Meningococcal Initiative (GMI) meeting.
- Current IMD case definitions in many Middle Eastern countries may lead to underreporting or misreporting of the disease burden.
Purpose of the Study:
- To review recent findings on IMD surveillance and control in the Middle East.
- To highlight challenges in case reporting, notification, and diagnostic techniques.
- To identify concerns regarding antimicrobial resistance.
Main Methods:
- Review of recent findings and discussions from the GMI meeting.
- Analysis of variations in case reporting, notification, and diagnostic methods (culture, Gram staining, PCR) across Middle Eastern countries.
- Assessment of factors affecting PCR accessibility and surveillance system impact.
Main Results:
- Reported IMD incidence remains low, with historical outbreaks linked to mass gatherings like Hajj and Umrah.
- Variability exists in case confirmation techniques, with limited PCR utilization due to accessibility barriers.
- Potential widespread ciprofloxacin resistance is a concern due to high chemoprophylaxis use.
Conclusions:
- Inconsistent case definitions and diagnostic methods hinder accurate IMD surveillance in the Middle East.
- Barriers to advanced diagnostics like PCR need to be addressed to improve surveillance.
- Antimicrobial resistance, particularly to ciprofloxacin, requires careful monitoring and management.
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