Developing national meningitis plans: an operational manual

WHOManualCurrent editionCC BY-NC-SA 3.0 IGO

World Health Organization · 1st edition, 2024 · 61 pages

Step-by-step guide for Ministries of Health to design, budget, and implement multisectoral national plans to defeat bacterial meningitis by 2030.

In one sentenceAll countries should develop multisectoral national meningitis plans with high vaccine coverage (Hib, PCV, meningococcal), strengthened laboratory diagnosis (≥50% CSF sampling), timely antimicrobial treatment, and integrated services for sequelae (hearing, epilepsy, cognitive).

Issuer: World Health Organization
Edition: 1st edition, 2024
Audience: Ministries of Health, National Immunization Programme managers, surveillance officers, laboratory directors, public health planners, clinicians, civil society organizations
Evidence: Operational guidance based on WHO global road map and World Health Assembly resolution WHA73.9; expert consensus
Reviewed: 18 Oct 2026 · GMJ

Read the original on WHO Download PDF (61 pp)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 18 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This operational manual supports countries in translating the WHO Defeating Meningitis by 2030 global road map into context-specific national action plans. It guides Ministries of Health through three stages: preparation (epidemiological analysis, activity mapping, stakeholder engagement), activity planning across five pillars (prevention and epidemic control; diagnosis and treatment; disease surveillance; support and care for people affected by sequelae; advocacy and engagement), and roll-out mechanisms (leadership, financing, supply chain, monitoring and evaluation).

The manual emphasises country ownership, multidisciplinary coordination, and integration with primary health care and universal health coverage. It provides ready-to-use templates, considerations for contextual adaptation, and links to technical resources. Activities span introduction and maintenance of vaccines against Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, and future Group B streptococcus vaccines; strengthening lumbar puncture and laboratory diagnosis; ensuring access to antimicrobial treatment; and establishing services for long-term sequelae (hearing loss, epilepsy, cognitive impairment).

The manual stresses synergies with other programmes, engagement of civil society organisations and communities, and mobilisation of domestic and international resources. Countries are encouraged to monitor progress using ten core indicators and adjust plans regularly based on epidemiological trends and availability of new vaccines.

Key points

For clinicians — doses and thresholds as stated in the guideline

Conduct epidemiological analysis stratified by causative pathogen (Nm, Spn, Hib, GBS), age, gender, geography, and time to identify populations and areas at highest risk.
Introduce or maintain high coverage (≥90%) of Hib and pneumococcal conjugate vaccines in routine immunisation, integrated with efforts under Immunization Agenda 2030.
In African meningitis belt countries, introduce MenACV into routine immunisation with catch-up campaigns, and transition to multivalent meningococcal conjugate vaccine (MMCV) based on epidemic risk assessment.
Design national testing strategies ensuring lumbar puncture is performed across all levels of care, with clear pathways for cerebrospinal fluid transport to laboratories for culture, molecular testing, and antimicrobial susceptibility testing.
Develop and disseminate national guidelines on treatment for all age groups based on local epidemiology and resistance patterns; ensure continuous availability of antimicrobials (including cephalosporins, penicillin) and lumbar puncture kits at all health facilities.
Implement case-based or strengthened aggregate surveillance using standard case definitions and alert/epidemic thresholds; ensure laboratory confirmation with serogrouping/serotyping and data sharing via electronic platforms (DHIS-2, EWARS, SORMAS).
Establish services for early recognition and management of sequelae (hearing loss, epilepsy, cognitive impairment, focal neurological deficits) integrated into primary health care, including access to assistive technology (hearing aids, cochlear implants) and antiseizure medications.
Monitor implementation using ten core indicators, including vaccine coverage (PCV, Hib, Nm), proportion of suspected cases with CSF collected (target ≥50%), incidence and mortality rates for Nm/Spn/Hib/GBS meningitis, and availability of community-based support programmes for people with sequelae.

Suggested country-level indicators for monitoring and evaluation based on global indicators

Table extracted from the guideline

Indicator code	Global level	Country level	Comment
Impact 2	Incidence of meningitis due to Nm, Spn, Hib and GBS (global) per 100 000 population	Epidemiological surveillance data from reported cases of Nm, Spn, Hib and GBS	Estimated at global level from surveillance data complemented with models; country data feeds the estimate
Impact 3	Mortality rate of meningitis due to Nm, Spn, Hib and GBS (global) per 100 000 population	Epidemiological surveillance data from reported deaths due to Nm, Spn, Hib and GBS	Estimated at global level from surveillance data complemented with models; country data feeds the estimate
Outcome 1	Vaccine coverage rates for Spn, Hib and multivalent Nm vaccines in targeted groups, and GBS when available	Vaccine coverage for PCV (all doses), Hib (DTP3), Nm vaccine and GBS (pregnant women – when available)	Combines coverage from routine immunisation, preventive campaigns and emergency response campaigns monitored by WHO
Output 1.1	Percentage of countries with routine immunisation programmes against Nm, Spn, Hib, and GBS (when available)	Presence and actual implementation of vaccination in National Immunization Programme against Spn, Hib, Nm and GBS	Nm: target is children and/or adolescents; GBS: target is pregnant women
Outcome 2	Percentage of countries that collected CSF (or blood samples) in at least 50% of suspected meningitis cases	Percentage of CSF (or blood samples) collected among suspected meningitis cases
Output 3.1	Percentage of countries submitting specimens and data from at least X% of confirmed cases to global network for molecular surveillance	Percentage of collected specimens submitted to regional or global network for molecular surveillance of Nm, Spn, Hib and GBS	Can be completed by number of specimens
Outcome 4	Percentage of people affected by meningitis who received care and support to manage sequelae	Number of people affected by meningitis who received care and support to manage sequelae	Additional qualitative data
Output 4.2	Percentage of countries with community-based programmes to support people affected by meningitis	Availability of community-based programmes	Should specify whether programmes are nationwide or in specific settings
Output 5.2	Percentage of countries that conducted meningitis awareness campaigns	Number of meningitis awareness campaigns conducted during the implementation cycle	Campaigns and sensitization activities can be listed

Source: World Health Organization, Developing national meningitis plans: an operational manual. Reproduced in summary form.

From the guideline

Verbatim

“Bacterial meningitis represents one of the deadliest and incapacitating forms of disease. It can lead to death in less than 24 hours, and leaves one-fifth of people surviving the acute episode with lifelong disabilities.”

— World Health Organization, Developing national meningitis plans: an operational manual, Chapter 1. Introduction, page 1 (2024)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As Chair of the Public Health Institute of Georgia, I see this manual as a timely tool for our region. Georgia has made progress with Hib and PCV introduction, but meningococcal vaccination remains absent from our schedule despite sporadic outbreaks, and surveillance with laboratory confirmation is incomplete in many districts. I would stress to Georgian clinicians the manual's emphasis on lumbar puncture across all levels of care and timely antimicrobial treatment—delay of even hours can be fatal or lead to permanent disability. One realistic caveat: mobilising domestic financing for the full spectrum of activities, especially long-term rehabilitation services for survivors with hearing loss and cognitive sequelae, will require sustained high-level political commitment and innovative integration with our existing UHC and disability programmes.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 18 Oct 2026

Applicability

Georgia and the South Caucasus

Georgia and neighbouring South Caucasus countries lie outside the African meningitis belt but face sporadic cases and occasional outbreaks of bacterial meningitis. The manual’s framework is directly applicable: Georgia introduced Hib vaccine in 2006 and PCV13 in 2013, yet coverage gaps remain in some regions. Strengthening surveillance with laboratory confirmation (culture and molecular methods) is essential to guide decisions on meningococcal vaccine introduction—currently not in the national schedule—and to monitor pneumococcal serotype replacement. The manual’s emphasis on integration with primary health care aligns with Georgia’s UHC programme (launched 2013) and ongoing health system reforms. National planners should prioritise establishing referral pathways for lumbar puncture and CSF transport, training community health workers in early recognition of meningitis, and building partnerships with civil society organisations (including disability advocacy groups) to support survivors with hearing loss, epilepsy, and cognitive sequelae. Mobilising domestic financing and leveraging synergies with immunisation, antimicrobial stewardship, and disability programmes will be critical for sustainable implementation.

Questions this guideline answers

Quick answers

Which countries must develop a national meningitis plan?

All WHO Member States committed at the 73rd World Health Assembly (resolution WHA73.9) to develop multidisciplinary national meningitis prevention and control plans. Plans can be stand-alone or embedded within broader health initiatives and should be tailored to local epidemiology, resources, and priorities.

What are the three visionary goals of Defeating Meningitis by 2030?

Eliminate epidemics of bacterial meningitis; reduce cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%; and reduce disability and improve quality of life after meningitis of any cause.

Which vaccines should be prioritised in national plans?

Hib vaccine and pneumococcal conjugate vaccine (PCV) for routine immunisation with high coverage (≥90%). For meningococcal disease, countries outside the African meningitis belt should assess burden and serogroup distribution to guide introduction of conjugate vaccines targeting infants, adolescents, or high-risk groups. African meningitis belt countries should introduce MenACV into routine schedules with catch-up campaigns and transition to MMCV. A Group B streptococcus vaccine for pregnant women should be introduced once available.

What is the target for cerebrospinal fluid (CSF) sampling in suspected meningitis cases?

At least 50% of suspected meningitis cases should have CSF (or blood) collected for laboratory testing. National testing strategies should ensure lumbar puncture is performed across all levels of care, with clear pathways for specimen transport to reference laboratories for culture, molecular testing (including molecular surveillance), serogrouping/serotyping, and antimicrobial susceptibility testing.

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Developing national meningitis plans: an operational manual

What this guideline says

Key points

Suggested country-level indicators for monitoring and evaluation based on global indicators

From the guideline