Table 1. Rationale for integrated meningoencephalitis surveillance in Asia.
| Rationale | Comments | |
|---|---|---|
| Increasing case detection through a syndromic approach to overlapping clinical syndromes | In patients with CNS infections, there is a clear overlap between those that meet the case definition for “acute encephalitis syndrome” and for “bacterial meningitis”. Initial assignment of patients for reporting through one particular system could result in incomplete case detection and an inaccurate representation of disease burden. | |
| Consistency with routine clinical management procedures | The approach to investigation of a patient with suspected meningitis or encephalitis is the same – a lumbar puncture is routinely recommended for collection of cerebrospinal fluid to assist diagnosis and guide treatment. Samples can be collected at the same time for treatment and public health purposes. | |
| Streamlining of surveillance systems | Low-income countries frequently lack operational expenses for basic health services, so the best use of resources is essential and an integrated system can help reduce programmatic duplication and streamline staff time. It also provides an operational system for surveillance for other diseases that may become public health priorities (e.g. mumps and enterovirus infection) and for newly emerging infectious neurological diseases. | |
| Facilitation of decision-making and evaluation of new vaccine introduction programmes | Integrated surveillance has the potential to provide disease burden data on several vaccine-preventable CNS diseases of public health importance in a comprehensive and coordinated way. The same system can be used for both decision-making (burden of disease) and evaluation of vaccine introduction programmes. | |
| Highlighting the impact of childhood neurological disease | Meningoencephalitis surveillance with collection of clinical outcome data will demonstrate the impact of CNS infections and reinforce the need to strengthen capacity for good clinical case management to improve outcomes. It will also focus attention on the need to support children disabled from disease, consistent with the 2005 World Health Assembly resolution to improve outcomes for persons with disabilities.9 |
CNS, central nervous system.