Routine immunization against Meningococcal meningitis due to Neisseria meningitidis is not generally recommended following disasters because of its lack of efficacy in young children and its short duration of protection. However, in areas such as Africa's "meningitis belt" where epidemic Meningococcal meningitis is known to occur, surveillance for meningitis using a standard case definition should be part of any post-emergency surveillance system. An incidence rate of meningitis exceeding 15/100,000/week in for example the African meningitis belt for a period of two consecutive weeks has been shown to be predictive of an outbreak in an open populations >100,000. In refugee camps where the population is unknown or is usually less than 100,000, a rough indicator of an outbreak is a doubling of the baseline number of meningitis cases from one week to the next over a period of three weeks. Even one case in a camp situation should alert officials to monitor new cases with extreme care, and mass immunization of a camp may be appropriate with only two cases having occurred if it appears the disease is being transmitted within the camp population. Immunization against types A or C should be done if the following criteria are met:

• The presence of Neisseria meningitidis type A or C is confirmed by the laboratory. Note: type B does not usually cause large outbreaks.

• Surveillance data indicate that persons older than 1 year of age (for type A) or 2 years of age (for type C) are affected.

The age groups to immunize depend on the age groups affected, although the immunization of children and young adults between 1 to 25 years of age will usually protect most of the population at risk. Priority should be given to the areas or populations with the highest incidence rates.

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