Meningococcal Meningitis Outbreaks in the African Meningitis Belt After Meningococcal Serogroup A Conjugate Vaccine Introduction, 2011-2017

Overview

Journal J Infect Dis

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2019 Nov 1

PMID 31671449

Citations 27

Authors

Katya Fernandez

Clement Lingani

Olaolu Moses Aderinola

Kadade Goumbi

Brice Bicaba

Zewdu Assefa Edea

Clement Glele

Badu Sarkodie

Agbeko Tamekloe

Armelle Ngomba

Mamoudou Djingarey

Ado Bwaka

William Perea

Olivier Ronveaux

Affiliations

Soon will be listed here.

Abstract

Background: In 2010-2017, meningococcal serogroup A conjugate vaccine (MACV) was introduced in 21 African meningitis belt countries. Neisseria meningitidis A epidemics have been eliminated here; however, non-A serogroup epidemics continue.

Methods: We reviewed epidemiological and laboratory World Health Organization data after MACV introduction in 20 countries. Information from the International Coordinating Group documented reactive vaccination.

Results: In 2011-2017, 17 outbreaks were reported (31 786 suspected cases from 8 countries, 1-6 outbreaks/year). Outbreaks were of 18-14 542 cases in 113 districts (median 3 districts/outbreak). The most affected countries were Nigeria (17 375 cases) and Niger (9343 cases). Cumulative average attack rates per outbreak were 37-203 cases/100 000 population (median 112). Serogroup C accounted for 11 outbreaks and W for 6. The median proportion of laboratory confirmed cases was 20%. Reactive vaccination was conducted during 14 outbreaks (5.7 million people vaccinated, median response time 36 days).

Conclusion: Outbreaks due to non-A serogroup meningococci continue to be a significant burden in this region. Until an affordable multivalent conjugate vaccine becomes available, the need for timely reactive vaccination and an emergency vaccine stockpile remains high. Countries must continue to strengthen detection, confirmation, and timeliness of outbreak control measures.

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References

Yen C, Hyde T, Costa A, Fernandez K, Tam J, Hugonnet S . The development of global vaccine stockpiles. Lancet Infect Dis. 2015; 15(3):340-7. PMC: 4712379. DOI: 10.1016/S1473-3099(14)70999-5. View

Mbaeyi S, Lingani C, Diallo A, Bicaba B, Ouedraogo-Traore R, Acyl M . Improving Case-Based Meningitis Surveillance in 5 Countries in the Meningitis Belt of Sub-Saharan Africa, 2015-2017. J Infect Dis. 2019; 220(220 Suppl 4):S155-S164. DOI: 10.1093/infdis/jiz303. View

Boisier P, Nicolas P, Djibo S, Taha M, Jeanne I, Mainassara H . Meningococcal meningitis: unprecedented incidence of serogroup X-related cases in 2006 in Niger. Clin Infect Dis. 2007; 44(5):657-63. DOI: 10.1086/511646. View

Sanogo Y, Guindo I, Diarra S, Retchless A, Abdou M, Coulibaly S . A New Sequence Type of Neisseria meningitidis Serogroup C Associated With a 2016 Meningitis Outbreak in Mali. J Infect Dis. 2019; 220(220 Suppl 4):S190-S197. DOI: 10.1093/infdis/jiz272. View

. Meningitis in Chad, Niger and Nigeria: 2009 epidemic season. Wkly Epidemiol Rec. 2010; 85(8):47-63. View

Greenwood B . Manson Lecture. Meningococcal meningitis in Africa. Trans R Soc Trop Med Hyg. 2000; 93(4):341-53. DOI: 10.1016/s0035-9203(99)90106-2. View

. Delivering at the country level: the International Coordinating Group on Vaccine Provision and its impact in 2016 and 2017. Wkly Epidemiol Rec. 2018; 93(10):105-16. View

Lingani C, Bergeron-Caron C, Stuart J, Fernandez K, Djingarey M, Ronveaux O . Meningococcal Meningitis Surveillance in the African Meningitis Belt, 2004-2013. Clin Infect Dis. 2015; 61 Suppl 5:S410-5. PMC: 4639499. DOI: 10.1093/cid/civ597. View

Leake J, Kone M, Yada A, Barry L, Traore G, Ware A . Early detection and response to meningococcal disease epidemics in sub-Saharan Africa: appraisal of the WHO strategy. Bull World Health Organ. 2002; 80(5):342-9. PMC: 2567794. View

10.

. Meningococcal disease in countries of the African meningitis belt, 2012 - emerging needs and future perspectives. Wkly Epidemiol Rec. 2013; 88(12):129-36. View

11.

Mounkoro D, Nikiema C, Maman I, Sakande S, Bozio C, Tall H . Neisseria meningitidis Serogroup W Meningitis Epidemic in Togo, 2016. J Infect Dis. 2019; 220(220 Suppl 4):S216-S224. PMC: 6822970. DOI: 10.1093/infdis/jiz330. View

12.

Feagins A, Vuong J, Fernandez K, Njanpop-Lafourcade B, Mwenda J, Sanogo Y . The Strengthening of Laboratory Systems in the Meningitis Belt to Improve Meningitis Surveillance, 2008-2018: A Partners' Perspective. J Infect Dis. 2019; 220(220 Suppl 4):S175-S181. DOI: 10.1093/infdis/jiz337. View

13.

. Meningitis control in countries of the African meningitis belt, 2015. Wkly Epidemiol Rec. 2016; 91(16):209-16. View

14.

Trotter C, Cibrelus L, Fernandez K, Lingani C, Ronveaux O, Stuart J . Response thresholds for epidemic meningitis in sub-Saharan Africa following the introduction of MenAfriVac®. Vaccine. 2015; 33(46):6212-7. DOI: 10.1016/j.vaccine.2015.09.107. View

15.

Trotter C, Lingani C, Fernandez K, Cooper L, Bita A, Tevi-Benissan C . Impact of MenAfriVac in nine countries of the African meningitis belt, 2010-15: an analysis of surveillance data. Lancet Infect Dis. 2017; 17(8):867-872. DOI: 10.1016/S1473-3099(17)30301-8. View

16.

Cooper L, Ronveaux O, Fernandez K, Lingani C, Goumbi K, Ihekweazu C . Spatiotemporal Analysis of Serogroup C Meningococcal Meningitis Spread in Niger and Nigeria and Implications for Epidemic Response. J Infect Dis. 2019; 220(220 Suppl 4):S244-S252. PMC: 6822969. DOI: 10.1093/infdis/jiz343. View

17.

. Preparedness for outbreaks of meningococcal meningitis due to Neisseria meningitidis serogroup C in Africa: recommendations from a WHO expert consultation. Wkly Epidemiol Rec. 2015; 90(47):633-6. View

18.

Delrieu I, Yaro S, Tamekloe T, Njanpop-Lafourcade B, Tall H, Jaillard P . Emergence of epidemic Neisseria meningitidis serogroup X meningitis in Togo and Burkina Faso. PLoS One. 2011; 6(5):e19513. PMC: 3098835. DOI: 10.1371/journal.pone.0019513. View

19.

Novak R, Ronveaux O, Bita A, Ake H, Lessa F, Wang X . Future Directions for Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Sub-Saharan Africa. J Infect Dis. 2019; 220(220 Suppl 4):S279-S285. PMC: 6822967. DOI: 10.1093/infdis/jiz421. View

20.

Agier L, Martiny N, Thiongane O, Mueller J, Paireau J, Watkins E . Towards understanding the epidemiology of Neisseria meningitidis in the African meningitis belt: a multi-disciplinary overview. Int J Infect Dis. 2016; 54:103-112. DOI: 10.1016/j.ijid.2016.10.032. View