Meningococcal Meningitis Surveillance in the African Meningitis Belt, 2004-2013.

BACKGROUND: An enhanced meningitis surveillance network was established across the meningitis belt of sub-Saharan Africa in 2003 to rapidly collect, disseminate, and use district weekly data on meningitis incidence. Following 10 years' experience with enhanced surveillance that included the introduction of a group A meningococcal conjugate vaccine, PsA-TT (MenAfriVac), in 2010, we analyzed the data on meningitis incidence and case fatality from countries reporting to the network. METHODS: After de-duplication and reconciliation, data were extracted from the surveillance bulletins and the central database held by the World Health Organization Inter-country Support Team in Burkina Faso for countries reporting consistently from 2004 through 2013 (Benin, Burkina Faso, Chad, Democratic Republic of Congo, Ghana, Côte d'Ivoire, Mali, Niger, Nigeria, Togo). RESULTS: The 10 study countries reported 341 562 suspected and confirmed cases over the 10-year study period, with a marked peak in 2009 due to a large epidemic of group A Neisseria meningitidis (NmA) meningitis. Case fatality was lowest (5.9%) during this year. A mean of 71 and 67 districts annually crossed the alert and epidemic thresholds, respectively. The incidence rate of NmA meningitis fell >10-fold, from 0.27 per 100,000 in 2004-2010 to 0.02 per 100,000 in 2011-2013 (P < .0001). CONCLUSIONS: In addition to supporting timely outbreak response, the enhanced meningitis surveillance system provides a global overview of the epidemiology of meningitis in the region, despite limitations in data quality and completeness. This study confirms a dramatic fall in NmA incidence after the introduction of PsA-TT.

A systematic review of cigarette smoking trajectories in adolescents.

Trajectory analyses differentiate subgroups of smokers based on early patterns of cigarette use, but no study has summarized this literature. We systematically reviewed the literature on adolescent cigarette smoking trajectories to document the number and shapes of trajectories identified, assess if certain study characteristics influence the number or shapes of trajectories identified, summarize factors associated with and outcomes of trajectory group membership, and assess whether the results of trajectory analyses help identify windows of opportunity for intervention. We searched PubMed and EMBASE (1/1/1980 to 1/11/2018) and identified 1695 articles. Forty-three articles with data from 37 unique datasets were retained. Each trajectory was categorized into one of three groups (i.e., low-stable, increasing, other). Number of trajectories ranged from 2 to 6 (mode = 4); 44-76% of participants were low-stable cigarette consumers, 11-21% increased consumption, and 3-11% were categorized as "other." Number of data points, smoking indicator used, and time axis influenced the number of trajectories identified. Only two articles depicted the natural course of smoking since onset. Factors associated with trajectory membership included age, sex/gender, race/ethnicity, parental education, behavior problems, depression, academic performance, baseline cigarette use, parental and friends smoking, alcohol use, and cannabis use. Outcomes included illicit drug and alcohol use. Beyond parsimoniously describing cigarette smoking patterns, it is not clear whether trajectory analyses offer increased insight into the natural course, determinants or outcomes of cigarette smoking in ways that inform the development of intervention.