Bacterial meningitis epidemiology and return of Neisseria meningitidis serogroup A cases in Burkina Faso in the five years following MenAfriVac mass vaccination campaign

Abstract

BackgroundHistorically, Neisseria meningitidis serogroup A (NmA) caused large meningitis epidemics in sub-Saharan Africa. In 2010, Burkina Faso became the first country to implement a national meningococcal serogroup A conjugate vaccine (MACV) campaign. We analyzed nationwide meningitis surveillance data from Burkina Faso for the 5 years following MACV introduction.MethodsWe examined Burkina Faso’s aggregate reporting and national laboratory-confirmed case-based meningitis surveillance data from 2011–2015. We calculated incidence (cases per 100,000 persons), and described reported NmA cases.ResultsIn 2011–2015, Burkina Faso reported 20,389 cases of suspected meningitis. A quarter (4,503) of suspected meningitis cases with cerebrospinal fluid specimens were laboratory-confirmed as either S. pneumoniae (57%), N. meningitidis (40%), or H. influenzae (2%). Average adjusted annual national incidence of meningococcal meningitis was 3.8 (range: 2.0–10.2 annually) and was highest among infants aged <1 year (8.4). N. meningitidis serogroup W caused the majority (64%) of meningococcal meningitis among all age groups. Only six confirmed NmA cases were reported in 2011–2015. Five cases were in children who were too young (n = 2) or otherwise not vaccinated (n = 3) during the 2010 MACV mass vaccination campaign; one case had documented MACV receipt, representing the first documented MACV failure.ConclusionsMeningococcal meningitis incidence in Burkina Faso remains relatively low following MACV introduction. However, a substantial burden remains and NmA transmission has persisted. MACV integration into routine childhood immunization programs is essential to ensure continued protection.

Combined testing for herpes simplex virus and Mycobacterium tuberculosis DNA in cerebrospinal fluid of patients with aseptic meningitis in Burkina Faso, West Africa

“…In Burkina Faso, meningitis accounts for 4% of all death representing the 7th most frequent cause of death . Only a quarter of suspected meningitis cases with CSF were laboratory‐confirmed as either S. pneumoniae , N. meningitidis, or H. influenza . Rapid and accurate diagnosis is mandatory for allowing prompt and appropriate care improving the clinical prognosis and minimizing debilitating sequelae.…”

“…In countries located in the “meningitis belt” such as Burkina Faso, CSF samples are generally tested for the three main causative bacteria Neisseria meningitidis , Streptococcus pneumoniae , and Haemophilus influenzae by culture, antigen detection, and PCR . However, only about a quarter of suspected cases are laboratory‐confirmed with these tests . Little is known about the prevalence of HSV and MTB as agents responsible for severe but potentially curable aseptic meningoencephalitis in sub‐Saharan Africa .…”

“…10,11 However, only about a quarter of suspected cases are laboratory-confirmed with these tests. 12 Little is known about the prevalence of HSV and MTB as agents responsible for severe but potentially curable aseptic meningoencephalitis in sub-Saharan Africa. 13,14 Identification of MTB and HSV in CSF is important since a specific chemotherapy is required for these pathogens.…”

Protecting the most vulnerable age group: a review of MenACWY-TT immunogenicity and safety in infants

“…However, we acknowledge that sufficient correlates of protection against MenA disease and carriage are not yet known. Some data are available from Burkina Faso showing a dramatic reduction of MenA disease incidence occurred after the introduction of a national MenA-TT vaccination campaign; however, more recent evidence showed an increase in MenA transmission, suggesting an increase in the number of susceptible people after years without routine vaccination against MenA disease or a catch-up campaign [73], allowing pathogen transmission to be reestablished in the general population as herd protection was diminished.…”

Epidemiological Status of Bacterial Meningitis Disease Following the Introduction of the Meningococcal A Conjugate Vaccine in the African Meningitis Belt

“…The reduction of the incidence of bacterial meningitis cases, epidemics and deaths following the introduction of MACV into meningtis belt was demonstrated [1,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Novak et al showed 71% decline in risk of meningitis (suspected cases) in Burkina Faso 1 year after the introduction of MACV [11].…”