WHO Collaborating Centre for Reference and Research on Meningococci
The World Health Organization (WHO) is committed to eliminating meningococcal disease as a public health problem.
Meningococcal disease constitutes an enormous public health burden, especially in sub-Saharan Africa where large-scale epidemics still occur.
The Norwegian Institute of Public Health (NIPH), which has been an appointed WHO Collaborating Centre for Reference and Research on Meningococci since 1991, contributes to the task of eliminating meningococcal disease worldwide.
Meningococcal disease is caused by the bacterium Neisseria meningitidis (the meningococcus). There are two predominant clinical forms of meningococcal disease, septicaemia (or blood stream infection) and meningitis which is a serious infection affecting the brain membranes. The disease can lead to severe disability, including hearing loss, mental retardation and epilepsy, and case-fatality rates are around 10 per cent, even with optimal patient care. The meningococcus is the only bacterium which causes large meningitis epidemics. In the so-called meningitis belt of sub-Saharan Africa, a region encompassing all or part of 26 countries from Senegal in the West to Ethiopia in the East, large epidemics of meningococcal meningitis recur every few years.
The disease is transmitted by air-borne droplets from people who have the bacterium in their throat, but are without symptoms (asymptomatic carriers). Twelve groups of the Neisseria meningitidis have been identified, five of which (A, B, C, W, and X) can cause epidemics. The large epidemics in the meningitis belt were mainly caused by strains of serogroup A, until an affordable monovalent protein-conjugate polysaccharide vaccine against group A meningococci (MenAfriVac®) was introduced in mass vaccination campaigns, starting in 2010. The vaccine is now given to small children in most countries in the meningitis belt through the Expanded Program on Immunization. Following this extremely successful vaccine implementation, serogroup A meningococcal disease is now basically absent from the meningitis belt. However, serogroups C, W and X are circulating in the region and, while giving raise to smaller epidemics, are still a significant public health problem. Multivalent protein-conjugate polysaccharide vaccines are being developed, and a pentavalent (A, C, W, Y and X) should soon be WHO prequalified.
In 2017, representatives from governments, global health organizations, public health bodies, academia, private sector, and civil societies called for a global vision of a world free of meningitis. WHO took up the call to action and, with global partners, has developed a roadmap to defeat meningitis by 2030. The road map focuses on the four major meningitis-causing bacterial pathogens, one of which is N. meningitidis. The visionary goals of the road map are to: (i) eliminate epidemics of bacterial meningitis; (ii) reduce cases of vaccine-preventable bacterial meningitis by 50 % and deaths by 70 %; and (iii) reduce disability and improve quality of life after meningitis of any cause. To achieve these goals, the road map has key activities across five pillars: prevention and epidemic control; diagnosis and treatment; disease surveillance; support and care for people affected by meningitis, and advocacy and engagement.
The Norwegian Institute of Public Health was designated as a WHO Collaborating Centre 30 years ago due to the expertise and engagement of its employees in the study of meningococcal meningitis globally. Through the years the Centre has supported WHO in contributing to diagnostic and outbreak detection in other countries, in monitoring worldwide spread of virulent strains using molecular methods, and with capacity building, particularly in Africa. The Centre’s director is currently engaged as an individual expert in the Technical Task Force of the road map for defeating meningitis by 2030.
Responsibilities of the WHO Collaborating Centre
- Collection of all systemic meningococci isolates from Norway’s medical microbiological laboratories.
- Reference studies of meningococcal strains from Norway and abroad (serogroup determination, resistance characterization and whole genome sequencing).
- Performance of meningococcal carriage studies around cases/epidemics and in particular population groups.
- Monitoring of N. meningitidis strains from various geographical areas and epidemiological situations using whole genome sequencing and various schemes for characterization. Collection & analysis of information are disseminated through WHO-HQ & WHO-RO to the interested countries by an annual report and, if needed, by other means.
- Genetic studies of culture-negative cerebrospinal fluids and sera from meningitis patients.
- Monitoring variations and extent of virulence properties and antimicrobial resistance among meningococci.
- Studies of the population genetics and evolution of Neisseria species.
- Research related to meningococcal vaccines: characterization of meningococcal antigens and study antibody response after vaccination and disease.
- Maintain a meningococcal strain bank.
- Contribute to diagnostic and outbreak detection in other countries (particularly in Africa).
- Support development of new rapid diagnostic tests.
- Support implementation of new genetic-based typing methods in other countries.
- Help to establish quality control of laboratory methods.
- Provide reference strains, clinical isolates and other material (e.g. DNA) upon request for eligible parties like: the National reference laboratories in the allocated countries; European and North American laboratories that are part of the Global Laboratory Network on Meningococcal Diseases.
- Production of material for transport (e.g. Trans-Isolate medium) of clinical samples and isolates within and between countries.
- Open to requests to strengthen diagnostic functions in other countries on site.
- Report results to international collaboration partners.
- Responsibility for presenting, together with the other WHO Collaborating Centres for Reference and Research on Meningococci, an annual joint analysis of the meningococcal situation with conclusions and possibilities/problems for the future.
About WHO Collaborating Centres
The WHO Collaborating Centres are institutions, such as research institutes, parts of universities or academies, which are designated by the WHO’s Director-General to carry out activities in support of the Organization's programmes. Currently there are over 800 WHO collaborating centres in over 80 Member States working with WHO on areas, such as nursing, occupational health, communicable diseases, nutrition, mental health, chronic diseases and health technologies. (Source: WHO).
Prof. Dominique A. Caugant - Director of the Centre
Division for Infection Control
Norwegian Institute of Public Health
P.O. Box 222 Skøyen
0213 Oslo, Norway
Tel: (+47) 93863188
For a list of publications from the Centre, see References below.