Abstract
BackgroundSeasonal epidemics of bacterial meningitis in the African Meningitis Belt carry a high burden of disease and mortality. Reactive mass vaccination is used as a control measure during epidemics, but the time taken to gain immunity from the vaccine reduces the flexibility and effectiveness of these campaigns. Targeted reactive antibiotic prophylaxis could be used to supplement reactive mass vaccination and further reduce the incidence of meningitis, and the potential effectiveness and efficiency of these strategies should be explored.Methods and findingsData from an outbreak of meningococcal meningitis in Niger, caused primarily by Neisseria meningitidis serogroup C, is used to estimate clustering of meningitis cases at the household and village level. In addition, reactive antibiotic prophylaxis and reactive vaccination strategies are simulated to estimate their potential effectiveness and efficiency, with a focus on the threshold and spatial unit used to declare an epidemic and initiate the intervention.There is village-level clustering of suspected meningitis cases after an epidemic has been declared in a health area. Risk of suspected meningitis among household contacts of a suspected meningitis case is no higher than among members of the same village. Village-wide antibiotic prophylaxis can target subsequent cases in villages: across of range of parameters pertaining to how the intervention is performed, up to 220/672 suspected cases during the season are potentially preventable. On the other hand, household prophylaxis targets very few cases. In general, the village-wide strategy is not very sensitive to the method used to declare an epidemic. Finally, village-wide antibiotic prophylaxis is potentially more efficient than mass vaccination of all individuals at the beginning of the season, and than the equivalent reactive vaccination strategy.ConclusionsVillage-wide antibiotic prophylaxis should be considered and tested further as a response against outbreaks of meningococcal meningitis in the Meningitis Belt, as a supplement to reactive mass vaccination.
Highlights
Epidemics of bacterial meningitis occur seasonally in the “Meningitis Belt” of sub-Saharan Africa, and are most commonly due to Neisseria meningitidis[1, 2]
The funders had no role in study design, data collection and Seasonal epidemics of bacterial meningitis in the African Meningitis Belt carry a high burden of disease and mortality
Household contacts of meningococcal meningitis cases are at higher risk of meningococcal meningitis than the general population, and the risk ratio has been reported to be as high as 1,000[8, 9]
Summary
Epidemics of bacterial meningitis occur seasonally in the “Meningitis Belt” of sub-Saharan Africa, and are most commonly due to Neisseria meningitidis[1, 2]. Individuals in close contact with meningitis cases are at higher risk for carriage of N. meningitidis and invasive disease, among epidemic and non-epidemic settings[6, 7]. In high-resource settings, the effectiveness of household chemoprophylaxis has been estimated to reduce the risk of meningitis by 84%[10]. Antibiotic prophylaxis of household members of meningococcal meningitis cases is recommended by the World Health Organisation (WHO) in sub-Saharan Africa outside of an epidemic only[11]. This is because meningitis burden and carriage prevalence are much higher during epidemics[12], so household chemoprophylaxis would be labor-intensive and could have minimal impact on overall carriage. Targeted reactive antibiotic prophylaxis could be used to supplement reactive mass vaccination and further reduce the incidence of meningitis, and the potential effectiveness and efficiency of these strategies should be explored
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