Elimination of Epidemic Meningitis in the African Region: Progress and Challenges:2010-2016

Abstract

Background Epidemics of meningococcal disease constitute a major public health challenge in Africa, affecting mostly the 24 countries of the meningitis belt. These epidemics led to a call for a call for a safe, effective and affordable conjugate vaccine against the major serogroup responsible for recent epidemics by leaders of the region. Objective This paper documents experiences with efforts at eliminating epidemic meningitis in the African Region. Method The meningoccocal serogroup A conjugate vaccine was developed, licensed and offered to more than 235 million people through mass vaccination campaigns in 16 countries since 2010. Future plans include providing the vaccine to the remaining countries in the African Meningitis Belt and, to implement the vaccine into routine national infant immunization programme and to organise catch-up immunization campaigns every 5 years for unvaccinated <5 year-olds who had missed their routine vaccinations. Results The success of the project is evidenced by the large declines in cases of group A meningococcal disease since 2010, with no cases reported in vaccinated persons across the 16 countries, reflecting the highly effective nature of the vaccine. The successful control of serogroup A meningococcal disease has highlighted the need to tackle other meningococcal serogroups through development of polyvalent conjugate vaccines with the aim of eliminating epidemics of meningococcal meningitis in the African region.

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

“…The study found the decline of N. meningitidis A after 2010 with the introduction of MACV and the predominance of other meningitis pathogens (N. meningitidis W135, N. meningitidis C, N. meningitidis X, and Streptococcus pneumoniae) with the near disappearance of N. meningitidis A cases and epidemics in African meningitis belt countries [18,21,[24][25][26][27][28]. The results of the study confirmed those found in the literature.…”

“…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].…”

“…Findings also showed the signifcant reduction of NmA incidence and carriage following the immunization with MACV [3,12,14]. Following the introduction of MACV authors found the change of bacterial meningitis profile with the predominance of N. meningitidis C, N. meningitidis W, N. meningitidis X, S. pneumoniae, and Hbi [9,18,[21][22][23][24][25][26][27][28].…”

Encephalitis and meningitis in Western Africa: a scoping review of pathogens

“…No cases of Neisseria meningitidis serogroup A have been identified in the vaccinated population [21, 24]. Such concerted efforts showcase the pivotal role that understanding the aetiology of CNS infections can play in preventing future neurological infectious outbreaks [25, 26].…”

“…There is a need to assess the landscape of CNS pathogens affecting the West African region beyond our initial synthesis. Having already translated research on neurological infections into successful policy in this region in the cases of meningitis and also poliomyelitis, a model for future action exists [26]. Many other pathogenic causes of CNS infections pose significant risks for outbreaks and necessitate increased attention [21].…”