{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:38:36Z","timestamp":1782365916308,"version":"3.54.5"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"Supplement_4","license":[{"start":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T00:00:00Z","timestamp":1572480000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MenAfriNet consortium"},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1084298"],"award-info":[{"award-number":["OPP1084298"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Meningococcal serogroup A conjugate vaccine (MACV) was introduced in Chad during 2011\u20132012. Meningitis surveillance has been conducted nationwide since 2003, with case-based surveillance (CBS) in select districts from 2012. In 2016, the MenAfriNet consortium supported Chad to implement CBS in 4 additional districts and real-time polymerase chain reaction (rt-PCR) at the national reference laboratory (NRL) to improve pathogen detection. We describe analysis of bacterial meningitis cases during 3 periods: pre-MACV (2010\u20132012), pre-MenAfriNet (2013\u20132015), and post-MenAfriNet (2016\u20132018).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>National surveillance targeted meningitis cases caused by Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae. Cerebrospinal fluid specimens, inoculated trans-isolate media, and\/or isolates from suspected meningitis cases were tested via culture, latex, and\/or rt-PCR; confirmed bacterial meningitis was defined by a positive result on any test. We calculated proportion of suspected cases with a specimen received by period, and proportion of specimens with a bacterial meningitis pathogen identified, by period, pathogen, and test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The NRL received specimens for 6.8% (876\/12813), 46.4% (316\/681), and 79.1% (787\/995) of suspected meningitis cases in 2010\u20132012, 2013\u20132015, and 2016\u20132018, respectively, with a bacterial meningitis pathogen detected in 33.6% (294\/876), 27.8% (88\/316), and 33.2% (261\/787) of tested specimens. The number of N. meningitidis serogroup A (NmA) among confirmed bacterial meningitis cases decreased from 254 (86.4%) during 2010\u20132012 to 2 (2.3%) during 2013\u20132015, with zero NmA cases detected after 2014. In contrast, proportional and absolute increases were seen between 2010\u20132012, 2013\u20132015, and 2016\u20132018 in cases caused by S. pneumoniae (5.1% [15\/294], 65.9% [58\/88], and 52.1% [136\/261]), NmX (0.7% [2\/294], 1.1% [1\/88], and 22.2% [58\/261]), and Hib (0.3% [1\/294], 11.4% [10\/88], and 14.9% [39\/261]). Of specimens received at the NRL, proportions tested during the 3 periods were 47.7% (418), 53.2% (168), and 9.0% (71) by latex; 81.4% (713), 98.4% (311), and 93.9% (739) by culture; and 0.0% (0), 0.0% (0), and 90.5% (712) by rt-PCR, respectively. During the post-MenAfriNet period (2016\u20132018), 86.1% (678) of confirmed cases were tested by both culture and rt-PCR, with 12.5% (85) and 32.4% (220) positive by culture and rt-PCR, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>CBS implementation was associated with increased specimen referral. Increased detection of non-NmA cases could reflect changes in incidence or increased sensitivity of case detection with rt-PCR. Continued surveillance with the use of rt-PCR to monitor changing epidemiology could inform the development of effective vaccination strategies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiz366","type":"journal-article","created":{"date-parts":[[2019,7,19]],"date-time":"2019-07-19T15:28:16Z","timestamp":1563550096000},"page":"S182-S189","source":"Crossref","is-referenced-by-count":6,"title":["Implementation of Case-Based Surveillance and Real-time Polymerase Chain Reaction to Monitor Bacterial Meningitis Pathogens in Chad"],"prefix":"10.1093","volume":"220","author":[{"given":"Marietou F","family":"Paye","sequence":"first","affiliation":[{"name":"Centers for Disease Control and Prevention Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadidja","family":"Gamougame","sequence":"additional","affiliation":[{"name":"H\u00f4pital G\u00e9n\u00e9ral de R\u00e9f\u00e9rence Nationale, N\u2019Djamena, Chad"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah K","family":"Payamps","sequence":"additional","affiliation":[{"name":"IHRC Inc"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia R","family":"Feagins","sequence":"additional","affiliation":[{"name":"IHRC Inc"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daugla Doumagoum","family":"Moto","sequence":"additional","affiliation":[{"name":"Centre de Support en Sant\u00e9 Internationale, N\u2019Djamena, Chad"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronelngar","family":"Moyengar","sequence":"additional","affiliation":[{"name":"Centre de Support en Sant\u00e9 Internationale, N\u2019Djamena, Chad"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Na\u00efbe\u00ef","sequence":"additional","affiliation":[{"name":"Centre de Support en Sant\u00e9 Internationale, N\u2019Djamena, Chad"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeni","family":"Vuong","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alpha Oumar","family":"Diallo","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Tate","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi M","family":"Soeters","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahamat Ali","family":"Acyl","sequence":"additional","affiliation":[{"name":"Service de Surveillance \u00c9pid\u00e9miologique Int\u00e9gr\u00e9e, Minist\u00e8re de la Sant\u00e9 Publique, N\u2019Djamena, Chad"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,31]]},"reference":[{"key":"2019110101095167700_CIT0001","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S0035-9203(99)90106-2","article-title":"Meningococcal meningitis in Africa","volume":"93","author":"Greenwood","year":"1999","journal-title":"Trans R Soc Trop Med 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