Abstract
BackgroundIn 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.MethodsWe reviewed epidemiological and laboratory World Health Organization data after MACV introduction in 20 countries. Information from the International Coordinating Group documented reactive vaccination.ResultsIn 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).ConclusionOutbreaks 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.
Highlights
In 2010–2017, meningococcal serogroup A conjugate vaccine (MACV) was introduced in 21 African meningitis belt countries
Reactive vaccination was conducted during 14 outbreaks (5.7 million people vaccinated, median response time 36 days)
We present here a description and analysis of N. meningitidis epidemics that have occurred after MACV introduction through 2017, including an analysis of the reactive vaccination
Summary
We reviewed epidemiological and laboratory World Health Organization data after MACV introduction in 20 countries. The WHO enhanced meningitis surveillance (ES) network was established across the African meningitis belt in 2003, initially in 8 countries [2]. Standard methods were developed to detect and notify cases, including standard operating procedures, standard case definitions, intervention thresholds (see Table 1), laboratory standards, and data collection tools. We excluded data from the Democratic Republic of Congo as the majority of the country is considered to be outside the meningitis belt and the intervention thresholds are not considered applicable [5, 11]
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