A Review of the Epidemiology of Invasive Meningococcal Disease and Vaccination Strategies in North Africa

Taha, Muhamed‐Kheir; Serra, Lidia

doi:10.1016/j.ijid.2020.11.162

Cited by 9 publications

(12 citation statements)

References 29 publications

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“…Improved surveillance systems could help improve disease monitoring. The Global Burden of Disease Study showed that six of the ten countries with the highest number of meningitis deaths (all-causes) are in the African meningitis belt region; though data for older adults from these countries are lacking, suggesting a potential underreporting of cases in older adults in this region [ 41 , 91 , 92 ]. Since we restricted our search to English langauge papers only we decided to exclude date from outside North American and Europe but it is interesting to note that we identified only eleven English language published studies of IMD in older adults from countries outside Europe or North America, which appers to be consistent with previous research highlighting the lack of regional data, particularly from South-East Asia and the Eastern Mediterranean [ 3 ] in non-native languages.…”

Section: Discussionmentioning

confidence: 99%

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Guedes

Bertrand-Gerentes

Evans³

et al. 2022

BMC Public Health

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Background Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD. Methods A comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information. Results There were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults. Conclusions The use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities’ decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.

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Section: Discussionmentioning

confidence: 99%

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Guedes

Bertrand-Gerentes

Evans³

et al. 2022

BMC Public Health

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“…One important point is that some level of underreporting for IMD in KSA may exist, a feature also apparent in other surveillance studies in the MENA regions [ 25 , 48 , 49 ]. We suggest this for two reasons.…”

Section: Discussionmentioning

confidence: 71%

“…Most global reviews, including regional reviews from the Global Meningococcal Initiative, highlight limited recent epidemiological data available from many countries in Asia, and from the Middle East and North African (MENA) regions. [ 1 , 2 , 23 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

The Epidemiology of Invasive Meningococcal Disease in the Kingdom of Saudi Arabia: A Narrative Review with Updated Analysis

Badur¹,

Dabbagh

Shibl

et al. 2021

Infect Dis Ther

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Reducing invasive meningococcal disease (IMD) through MenACWY immunization is a critical healthcare strategy in the Kingdom of Saudi Arabia (KSA). Robust IMD surveillance is essential to help assess the need for additional immunization initiatives in target populations. This is particularly important in KSA, where mass gatherings accompanying Hajj/Umrah pilgrimages have been associated with IMD outbreaks within the local KSA population, and subsequent intercontinental spread via returning pilgrims. This narrative review of the published literature describes the changing epidemiology of IMD in KSA to provide a perspective on the impact of current immunization strategies and potential gaps. As recent published surveillance data are lacking, we also evaluated publicly reported data from the KSA Ministry of Health (MoH) for 2012–2019 to inform more recent IMD trends. Between 1995 and 2011, national surveillance data indicate that 1103 IMD cases were reported in KSA: 60% in 2000–2001, involving two (mainly MenW) outbreaks involving KSA citizens/residents and pilgrims focused in Mecca and Medina. Across 2002–2011, 184 cases of IMD were reported, with a higher proportion occurring in KSA citizens/residents, and with less focus within pilgrimage centers than apparent in previous years. Our analysis of MoH data found that, between 2012 and 2019, 44 IMD cases were reported, all in KSA citizens/residents, and chiefly in children or infants. No pilgrimage-associated outbreaks have occurred since 2001. Serogroup data were available for 62.5% of all cases for 2002–2011; MenW (40.0%), MenA (35.7%), and MenB (16.5%). Serogroup data for 2012–2019 remain incompletely reported, and the existing surveillance system could be improved, as some element of underestimation/underreporting of IMD may exist. While existing MenACWY immunization strategies for KSA citizens/residents and visiting pilgrims have been successful in reducing IMD due to specific serogroups, disease due to MenB remains a potential risk, and additional immunization strategies should be considered. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00467-x.

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“…In South Africa, the distribution of IMD by serogroup is W (42%), B (21%), "not defined" (15%), and Y (13%) (44). In Morocco, IMD is considered endemic with estimated incidence and death rates for meningococcal meningitis as 13.24/100,000 and 0.22/100,000, respectively (18). While, Tunisia has relatively lower incidence and death rates estimated to be 6.80/100,000 and 0.08/100,000, respectively (18).…”

Section: Meningococcal Infectionmentioning

confidence: 99%

“…In Morocco, IMD is considered endemic with estimated incidence and death rates for meningococcal meningitis as 13.24/100,000 and 0.22/100,000, respectively (18). While, Tunisia has relatively lower incidence and death rates estimated to be 6.80/100,000 and 0.08/100,000, respectively (18). Meningococcal serogroup B (MenB) is highly prevalent in most of North Africa (45).…”

Section: Meningococcal Infectionmentioning

confidence: 99%

Trends in Adult and Elderly Vaccination: Focus on Vaccination Practices in Tunisia and Morocco

Abouqal

Béji

Chakroun

et al. 2022

Front. Public Health

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Vaccine preventable diseases (VPDs) are a prevailing concern among the adult population, despite availability of vaccines. Unlike pediatric vaccination programs, adult vaccination programs lack the required reach, initiative, and awareness. Clinical studies and real-world data have proven that vaccines effectively reduce the disease burden of VPDs and increase life expectancy. In Tunisia and Morocco, the national immunization program (NIP) focuses more on pediatric vaccination and have limited vaccination programs for adults. However, some vaccination campaigns targeting adults are organized. For example, influenza vaccination campaigns prioritizing at risk adults which includes healthcare professionals, elderly, and patients with comorbidities. Women of childbearing age who have never been vaccinated or whose information is uncertain are recommended to receive tetanus vaccination. Tunisia NIP recommends rubella vaccine mainly for women of childbearing age, while in Morocco, national vaccination campaigns were organized for girls and women (up to 24 years of age) to eliminate rubella. Further, travelers from both countries are recommended to follow all requirements and recommendations in the travel destination. The objective of this manuscript is to provide an overview of the global disease burden of common VPDs including (but not limited to) meningococcal diseases, pneumococcal diseases, hepatitis, and influenza. The review also provides an overview of clinical data and guidelines/recommendations on adult vaccination practices, with special focus on Tunisia and Morocco. Some European and North American countries have concrete recommendations and strategies for adult vaccination to keep the VPDs in check. In Morocco and Tunisia, although, there are sporadic adult vaccination initiatives, the efforts still need upscaling and endorsements to boost vaccination awareness and uptake. There is a need to strengthen strategies in both countries to understand the disease burden and spread awareness. Additional studies are needed to generate economic evidence to support cost-effectiveness of vaccines. Integration of private and public healthcare systems may further improve vaccination uptake in adults.

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A Review of the Epidemiology of Invasive Meningococcal Disease and Vaccination Strategies in North Africa

Cited by 9 publications

References 29 publications

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

The Epidemiology of Invasive Meningococcal Disease in the Kingdom of Saudi Arabia: A Narrative Review with Updated Analysis

Trends in Adult and Elderly Vaccination: Focus on Vaccination Practices in Tunisia and Morocco

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