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© 1987 Oxford University Press

research-article

Control of Epidemic Group A Meningococcal Meningitis in Nepal

STEPHEN L COCHI, LAURI E MARKOWITZ, D JOSHI, RICHARD C OWENS, JR, DON H STENHOUSE, WARAKA N REGMI, RANENDRA P B SHRESTHA, I L ACHARYA, MUKUNDA MANANDHAR, VIJAY L GURUBACHARYA, DOUGLAS OWENS and AND ARTHUR L REINGOLD

Meningitis and Special Pathogens Branch. Division of Bacterial Diseases, Center for Infectious Diseases, Centers for Disease Control Atlanta, Georgia 30333, USA
Ministry of Health Nepal
Integrated Rural Health/Family Planning Services Project Nepal
Division of Immunization, Center for Prevention Services, Centers for Disease Control

During the first six months of 1983, an epidemic of serogroup A meningococcal meningitis occurred in the Kathmandu valley of Nepal, resulting in 875 cases and 95 deaths. The annual attack rate was 103 cases per 100000 population, with a peak attack rate occurring in April. Epidemic meningococcal disease had not been recognized previously in Nepal. Early in 1984, a review of hospital-based data on pyogenic meningitis in Kathmandu showed three times as many cases per month compared with the same period the previous year, suggesting that a recurrent epidemic was unfolding. Beginning in February 1984, a vaccination campaign directed at a high-risk target population of people aged 1–24 years was launched; over 329000 doses of bivalent A/C meningococcal vaccine were given, achieving approximately 64% coverage of the target population. A dramatic decline in the number of new meningitis cases occurred coincident with the initiation of the mass vaccination campaign. This experience demonstrates that it is possible, with appropriate surveillance efforts, to detect an evolving epidemic of meningococcal disease early in its course and to institute control measures in advance of the expected epidemic peak.

Received 1 January 1986


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