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

Andre Arsene Bita Fouda

doi:10.11648/j.iji.20190701.13

Abstract

Bacterial meningitis disease is a burden in the African meningitis belt. Before 2010, Neisseria meningitidis serogroup A (Neisseria meningitidis A) was the predominant pathogen causing about 90 percent of meningitis epidemics in Africa. The meningococcal A conjugate vaccine (MACV) protecting against Neisseria meningitidis A was introduced since 2010. The purpose of this quantitative study was to determine the magnitude and fatality of meningitis bacterial disease in Africa following the introduction of MACV from 2010 and 2017. An interrupted time series design and nonprobability sampling were used. Secondary data issued of meningitis enhanced surveillance were retrieved from World Health Organization database. The binomial negative regression and Pearson’s Chi-Square tests were used. The study found that after the MACV introduction there was a 39% decline of incidence rate of meningitis suspected cases (IRR 0.61, 95% CI 0.48 – 0.79, p < .001) and 99% decline of the risk of Neisseria meningitidis A (RR 0.01, 95% CI 0.08-0.013). There was a difference in the meningitis CFR before and after MACV introduction in 21 out of the 26 countries of African meningitis belt. After the introduction of MACV, there was a 46% decline in risk to report high CFR (>10%) after the MACV immunization (RR 0.547, 95% CI 0.40 – 0.74). There was a 49% decline of fatal meningitis (IRR 0.51, 95% CI 0.41 – 0.68, p < .001). After 2010, Neisseria meningitidis A declined and S. Pneumoniae, Neisseria meningitidis W135, Neisseria meningitidis C, Neisseria meningitidis X, and Hib became predominant. Between 2010 and 2017 Neisseria meningitidis all serogroups concerned remained higher the other pathogens 15,885 (62.06%) Vs 25,596. The study showed that following the MACV introduction despite the dramatic reduction of Neisseria meningitidis A, meningococcal meningitis bacterial disease remains a major public health problem.

Highlights

Meningitis remains a burden for the 26 countries of the African meningitis belt, stretching from Senegal in the west to Ethiopia in the east [1, 2]
There is a difference in incidence rate of the suspected cases of meningitis disease before and after meningococcal A conjugate vaccine (MACV) introduction in 21 out of the 26 countries of African meningitis belt between 2010 and 2017
The study found 39% decline of incidence rate of meningitis suspected cases (IRR 0.61, 95% CI 0.48 – 0.79, p < .001) after the introduction of MACV®, with heterogeneity observed by country

Summary

Introduction

Meningitis remains a burden for the 26 countries of the African meningitis belt, stretching from Senegal in the west to Ethiopia in the east [1, 2]. The bacterial is a serious infection of the meninges, thin fibrous tissue that covers the brain and spinal cord. It can cause severe brain damage and is fatal in 50% of cases if left untreated. The findings showed that meningococcal meningitis has the greatest incidence with large epidemics in Africa in the dry season. N. meningitidis is transmitted from person-to-person through droplets of respiratory or throat secretions from carriers. Ten percent to 20% of the population carries N. meningitidis in their throat at any given time [3]

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