Project

Bacterial meningitis is an infection of the meninges, the thin lining that surrounds the brain and spinal cord, which is caused by the bacterium Neisseria meningitidis. This infection poses life-threatening risk to infants, children, and young adults in particular. The disease (especially caused by the serogroup A form of the bacterium) is most prevalent in the sub-Saharan "meningitis belt", from Senegal in the West to Ethiopia in the East with an at-risk population estimated to be about 430 million. The size of epidemics can be enormous and can place an immense burden on affected countries immediately.
With most of its land lying within the meningitis belt, Niger is an endangered country and is severely attacked by the meningitis epidemic every year. In the 2009 epidemic season alone, 13,440 people were infected and 564 died. Twenty out of 42 districts within Niger were at the severe alert level in this period. The WHO Regional Office for Africa, in partnership with other organizations, has recommended member states affected by the disease to vaccinate the target population aged 1-29 years.

The current approach taken by the public health authorities of Niger for prevention and control of meningitis epidemics focuses on early detection of the disease via surveillance, and on the campaign for emergency mass vaccination using the bivalent A/C polysaccharide vaccine. Unfortunately, most emergency mass vaccinations are conducted only after the epidemic wave has already passed, and thus have limited public health impact, and rather act as a financial drain on public health economics. Furthermore, the polysaccharide vaccines used in these reactive campaigns are ineffective towards infants under 2 years of age, and because the effects generally last only for 2-3 years these vaccines are not appropriate as long term preventative measures against meningitis.

In order to overcome the above mentioned limitations of the polysaccharide vaccine, a novel group A meningococcal conjugate vaccine has finally been developed for the African regions. The main purpose of our project, 'Strengthening Epidemiologic Surveillance and Response against Meningitis in Niger,' is to introduce this new conjugate vaccine to Niger, it being the country most affected by epidemic meningitis, and help them break free from this danger imposed upon them.

The new vaccine is expected to provide a long-term protection of about 10 years for people of all ages including infants, and by conferring a herd immunity effect, it appears to be far better suited for prevention of meningococcal epidemics in Africa. WHO and PATH have been working on the development of the new vaccine since 2001, and in June 2010 the group A meningococcal conjugate vaccine, MenAfriVac™ received prequalification by the WHO. The introduction of this vaccine has been planned to begin in Niger, Mali, and Burkina Faso and move on to sub-Saharan regions of Africa lying within the "meningitis belt". In the 4th quarter of 2010, mass immunization campaigns took place in the Nigerien districts of Tillaberi, Niameri and Doso, and as a result 3 million local residents were vaccinated. Another mass immunization campaign has been planned for the second half of 2011 to vaccinate 8 million people in other regions of Niger. This immunization project to vaccinate the target group of 1 to 29 year olds with MenAfriVac™ will act as a cornerstone in the fight for eradication of the group A meningococcal epidemics in Africa.

Expected effects

This project has not only supported the introduction of the new vaccine, but also the initiative of the Nigerien Ministry of Health (MOH) in its efforts towards disease control. This has consequently led to successful mass immunization campaigns; in 2010 one hundred thousand local residents of the Tillaberi district hit by meningococcal epidemics were vaccinated, and in the following year a second mass immunization took place in the Maradi area targeting one hundred thousand people who were not vaccinated in the prior Maradi campaign. Furthermore, to strengthen the disease surveillance system and management capacity of the Nigerien Ministry of Health, there are other projects running parallel involved in the expansion of the vaccine cold storage facilities, improvement in waste disposal ability and the evaluation of the immunization campaigns. These measures when combined are expected to ready the Nigerien Ministry of Health to respond to the meningitis epidemics in a rapid and efficient manner.

Reference:

Meningitis Investment Case, GAVI Alliance and Fund Board Meeting, 25 June 2008

Niger MOPH, Action Plan for Men A introduction, 2010