Containing epidemics and managing cases largely depends on the existence of adequate national epidemiological and laboratory surveillance, which enables early detection of epidemics.

A regional network for surveillance of bacterial meningitis among children less than 5 years of age with an emphasis on Haemophilus influenzae type B (Hib), Streptococcus pneumoniae (the pneumococcus) and Neisseria meningitidis as causative organisms was established in the WHO Eastern Mediterranean Region in 2005. In late 2007, the network was expanded to include other invasive bacterial diseases (pneumonia and sepsis).

Based on the regional standard operational procedures of menengitis in the Region, the case description of meningitis is:

Suspected cases of meningitis are persons who present with the following:

sudden onset of fever (> 38.5°C rectal or > 38°C axillary) and at least one of the following signs:

neck stiffness

bulging fontanel

altered or reduced level of consciousness

convulsions

up to 6 years: any seizure

up to 6 months: 2 generalized brief convulsions within a 24-hour period

poor sucking and irritability (> 2 months old)

prostration or lethargy

toxic appearance

petechial or purpuric rash. 

For children confirmed case is a case that is laboratory-confirmed as meningococcus in the cerebrospinal fluid (CSF) or from the blood.

The regional surveillance of meningitis includes:

case-based reporting form that is filled out for all suspected cases of bacterial meningitis

specimen collection and reporting form that is completed for all specimens forwarded to laboratory investigation

suspected bacterial meningitis log book for all suspected cases of meningitis that includes the minimum data required for surveillance purposes

laboratory log book for CSF and blood specimens that is used to record information on all patients with suspected meningitis, severe pneumonia and sepsis and for whom CSF has been collected.

Any positive Gram stain CSF and positive blood culture results are reported to clinicians within 1 hour after receiving the CSF specimens in the laboratory. 

Recommended case classifications of pertussis

Clinically-confirmed

A clinically-confirmed case is diagnosed as pertussis by a physician of a person with a cough lasting at least two weeks with at least one of the following symptoms: paroxysms (i.e. fits) of coughing; inspiratory whooping; post-tussive vomiting (i.e. vomiting immediately after coughing) without another apparent cause. The case is not laboratory-confirmed.

Laboratory-confirmed

A laboratory-confirmed case meets the clinical case definition and is laboratory-confirmed by isolation of Bordetella pertussis or detection of genomic sequences by means of the polymerase chain reaction (PCR) or positive paired serology.

Laboratory confirmation is not readily available in most countries. Therefore, disease surveillance is based mainly on clinical diagnosis of cases. Monitoring the number of infants who have received the third dose of diphtheria toxoid-containing vaccine (DPT3) is important.

Surveillance of pertussis consists of a routine monthly report of aggregated data on clinical cases in countries with DPT3 coverage less than 90%. Reported data should be stratified by age. In countries with DPT3 coverage equal to or higher than 90%, case-based surveillance is recommended. Immediate investigation of all pertussis outbreaks with collection of case-based data is also recommended. In addition, sentinel surveillance is recommended in a few major hospitals to collect more in-depth information than that obtained through routine surveillance.

Global and regional data and statistics

WHO-recommended surveillance standard of pertussis