Control of Epidemic Group A Meningococcal Meningitis in Nepal

Abstract

During the first six months of 1983, an epidemic of serogroup A meningococcal meningitis occurred in the Kathmandu valley of Nepal, resulting in 875 cases and 95 deaths. The annual attack rate was 103 cases per 100,000 population, with a peak attack rate occurring in April. Epidemic meningococcal disease had not been recognized previously in Nepal. Early in 1984, a review of hospital-based data on pyogenic meningitis in Kathmandu showed three times as many cases per month compared with the same period the previous year, suggesting that a recurrent epidemic was unfolding. Beginning in February 1984, a vaccination campaign directed at a high-risk target population of people aged 1-24 years was launched; over 329,000 doses of bivalent A/C meningococcal vaccine were given, achieving approximately 64% coverage of the target population. A dramatic decline in the number of new meningitis cases occurred coincident with the initiation of the mass vaccination campaign. This experience demonstrates that it is possible, with appropriate surveillance efforts, to detect an evolving epidemic of meningococcal disease early in its course and to institute control measures in advance of the expected epidemic peak.

Impact of a mass vaccination campaign against a meningitis epidemic in a refugee camp

“…Some previous reports attributed such immediate decreases to preceding mass vaccination campaigns (Binkin & Band 1982;Cochi et al 1987;Spiegel et al 1993). But our data show that a synchronous decline in incidence occurred in Katale independently of any vaccination.…”

“…Prevaccination attack rates were similar ( 1988, unpublished observations). In developing countries, CFR between 3.5 and 34% are described during meningococcal meningitis epidemics (Binkin & Band 1982;Bosmans et al 1980;Cochi et al 1987;Moore 1992;Peltola 1983;Tikhomirov 1987). In comparing CFR and attack rates, case definitions should be taken into account.…”

“…the immunity it confers is of limited duration; in young children it lasts less than 3 years (Reingold et al 1985) and protection is poor in infants (Galazka 1982; Schwartz et al 1989). For these reasons, meningococcal vaccine has not been added to routine childhood immunization programmes (Galazka 1982; Reingold et d., 1985;Wright 1989). curtail epidemics (Binkin & Band 1982;Cadoz 1984; Cochi et al 1987;Greenwood 1984; Mohammed & Zaruba 1981; Spiegel et al 1993) Mass vaccination campaigns seem to be able to Tropical Medicine and International Health E. Haelterman et of.. VOLUME I NO. 3 PP 385-392 JUNE 1996 Meningitis epidemic in refugee camps and may be cost-effective (Cochi et al 1987).…”

“…For these reasons, meningococcal vaccine has not been added to routine childhood immunization programmes (Galazka 1982; Reingold et d., 1985;Wright 1989). curtail epidemics (Binkin & Band 1982;Cadoz 1984; Cochi et al 1987;Greenwood 1984; Mohammed & Zaruba 1981; Spiegel et al 1993) Mass vaccination campaigns seem to be able to Tropical Medicine and International Health E. Haelterman et of.. VOLUME I NO. 3 PP 385-392 JUNE 1996 Meningitis epidemic in refugee camps and may be cost-effective (Cochi et al 1987). However, to be effective, mass vaccination campaigns need to start early in the course of the epidemic (Cadoz 1984;Greenwood 1984).…”

Prevention and Control of Meningococcal Disease: Recommendations for Use of Meningococcal Vaccines in Pediatric Patients

“…Serogroup A and C polysaccharide vaccines have demonstrated estimated clinical efficacies of more than 85% in school-aged children and adults and are useful in controlling outbreaks. 16,17 Serogroup Y and W-135 polysaccharide vaccines are safe and immunogenic in children older than 2 years and adults, and although clinical efficacy has not been documented, immunization with these polysaccharide vaccines induces high titers of serum bactericidal antibodies, a correlate of protection. The antibody responses to each of the 4 polysaccharides in the tetravalent polysaccharide vaccine are serogroup-specific and independent.…”