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Watle SV, Børud B, Laake I, Baranowska-Hustad M, Bryant-Bratlie D, Bekkevold T, Caugant DA, Tunheim G, Næss LM. Antibodies against Neisseria meningitidis serogroups A, C, W and Y in serum and saliva of Norwegian adolescents. Vaccine 2023; 41:6529-6537. [PMID: 37648606 DOI: 10.1016/j.vaccine.2023.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The incidence of invasive meningococcal disease (IMD) among Norwegian 16-19-year-olds was 1-7/100,000 in the decade before the COVID-19 pandemic, with serogroup Y (MenY) dominance. In contrast to many other European countries, meningococcal vaccines are not part of the national immunisation program (NIP) in Norway. This cross-sectional study aimed to measure the degree of natural immunity against Neisseria meningitidis among adolescents in Norway to evaluate the need for introducing tetravalent meningococcal conjugate vaccine (MCV4) in the NIP. MATERIALS AND METHODS Serum and saliva samples were collected from students in upper and lower secondary schools in Norway in 2018. Samples were analysed for meningococcal capsular polysaccharide (PS)-specific antibodies using a bead-based multiplex immunoassay. PS-specific antibody levels were linked to data on meningococcal carriage, vaccination status and risk factors for carriage (assessed with questionnaire) and analysed by linear regression of log transformed concentrations. A subset of samples from unvaccinated individuals was analysed for serum bactericidal antibodies (SBA). RESULTS A total of 1344 participants, median age 16 years (range 12-24), were included in the study. Overall, 60.9% of the participants were female and 1137 (84.6%) were not vaccinated with MCV4. PS-specific antibody concentrations in serum and saliva were low among unvaccinated individuals for all serogroups and only 6.7-20.0% of the subpopulation with high PS-specific antibodies assessed with SBA had protective levels. Unvaccinated MenY carriers had higher levels of MenY anti-PS IgG in serum and IgA in saliva than those not carrying MenY. Use of Swedish snus was associated with lower anti-PS IgG levels in serum and waterpipe use with lower anti-PS IgG levels in saliva. CONCLUSION Unvaccinated adolescents in Norway have a low degree of natural immunity against the serogroups of N. meningitidis predominating among cases of IMD in this age group. Therefore, introduction of MCV4 for adolescents in the NIP is recommended.
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Affiliation(s)
- Sara Viksmoen Watle
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway.
| | - Bente Børud
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Marta Baranowska-Hustad
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Diane Bryant-Bratlie
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Terese Bekkevold
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Dominique A Caugant
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway
| | - Gro Tunheim
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Lisbeth Meyer Næss
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
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Knowledge, beliefs and practices regarding prevention of bacterial meningitis in Burkina Faso, 5 years after MenAfriVac mass campaigns. PLoS One 2021; 16:e0253263. [PMID: 34260604 PMCID: PMC8279338 DOI: 10.1371/journal.pone.0253263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background To adapt communications concerning vaccine prevention, we studied knowledge, beliefs and practices around meningitis risk and prevention in a young adult population in Burkina Faso in 2016, 5 years after the MenAfriVac® mass campaign and one year before the vaccine’s inclusion in the infant immunization schedule. Methods In a representative sample of the population aged 15 to 33 years (N = 220) in Bobo-Dioulasso, Burkina Faso, study nurses administered a standardized paper questionnaire consisting of predominantly open questions, collecting information on meningitis risk factors and prevention, and on exposure to dry air and kitchen fire smoke. We identified themes and analyzed their frequency. We created a meningitis knowledge score (range 0 to 4) based on pre-defined best responses and analyzed the determinants of knowledge score levels ≥2 (basic score) and ≥3 (high score) using multivariate logistic regression. Results Biomedically supported facts and good practices were known by the majority of participants (eg vaccine prevention, 84.5%). Younger women aged 15–20 years had a higher frequency of low scores <2 (17.0%) compared to older women aged 21–33 years (6.3%) and men of both age groups (3.8%). Junior secondary School attendance explained the differences between the two groups of women, the gender gap for the older, but not the young women, and explained score differences among young women. Local understandings and practices for risk and prevention were commonly reported and used (risk from unripe mango consumption and prevention through nasal application of shea nut butter). Discussion This study shows a gender gap in knowledge of meningitis risk and prevention, largely due to education-level inequalities. Women below 21 years had particularly low levels of knowledge and may need interventions outside schools and perinatal care. Our study suggests a strong adherence to local understandings of and practices around meningitis risk and prevention, which should be taken into account by vaccination promotion.
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Abstract
Meningococcal carriage dynamics drive patterns of invasive disease. The distribution of carriage by age has been well described in Europe, but not in the African meningitis belt, a region characterised by frequent epidemics of meningitis. We aimed to estimate the age-specific prevalence of meningococcal carriage by season in the African meningitis belt. We searched PubMed, Web of Science, the Cochrane Library and grey literature for papers reporting carriage of Neisseria meningitidis in defined age groups in the African meningitis belt. We used a mixed-effects logistic regression to model meningococcal carriage prevalence as a function of age, adjusting for season, location and year. Carriage prevalence increased from low prevalence in infants (0.595% in the rainy season, 95% CI 0.482–0.852%) to a broad peak at age 10 (1.94%, 95% CI 1.87–2.47%), then decreased in adolescence. The odds of carriage were significantly increased during the dry season (OR 1.5 95% CI 1.4–1.7) and during outbreaks (OR 6.7 95% CI 1.6–29). Meningococcal carriage in the African meningitis belt peaks at a younger age compared to Europe. This is consistent with contact studies in Africa, which show that children 10–14 years have the highest frequency of contacts. Targeting older children in Africa for conjugate vaccination may be effective in reducing meningococcal transmission.
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Yaro S, Njanpop Lafourcade BM, Ouangraoua S, Ouoba A, Kpoda H, Findlow H, Tall H, Seanehia J, Martin C, Ouedraogo JB, Gessner B, Meda N, Borrow R, Trotter C, Mueller JE. Antibody Persistence at the Population Level 5 Years After Mass Vaccination With Meningococcal Serogroup A Conjugate Vaccine (PsA-TT) in Burkina Faso: Need for a Booster Campaign? Clin Infect Dis 2020; 68:435-443. [PMID: 30481265 DOI: 10.1093/cid/ciy488] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/06/2018] [Indexed: 01/10/2023] Open
Abstract
Background In Burkina Faso, serogroup A meningococcal (NmA) conjugate vaccine (PsA-TT, MenAfriVac) was introduced through a mass campaign in children and adults in December 2010. Similar to a serological survey in 2011, we followed population-level antibody persistence for 5 years after the campaign and estimated time of return to previously-published pre-vaccination levels. Methods We conducted 2 cross-sectional surveys in 2013 and early 2016, including representative samples (N = 600) of the general population of Bobo-Dioulasso, Burkina Faso. Serum bactericidal antibody titers (rabbit complement) were measured against NmA reference strain F8236 (SBA-ref), NmA strain 3125 (SBA-3125), and NmA-specific immunoglobulin G (IgG) concentrations. Results During the 2016 survey, in different age groups between 6 and 29 years, the relative changes in geometric means compared to 2011 values were greater among younger age groups. They were between -87% and -43% for SBA-ref; -99% and -78% for SBA-3125; and -89% and -63% for IgG. In linear extrapolation of age-specific geometric means from 2013 to 2016, among children aged 1-4 years at the time of the PsA-TT campaign, a return to pre-vaccination levels should be expected after 12, 8, and 6 years, respectively, according to SBA-ref, SBA-3125, and IgG. Among older individuals, complete return to baseline is expected at the earliest after 11 years (SBA-ref and SBA-3125) or 9 years (IgG). Conclusions Based on SBA-3125, a booster campaign after 8 years would be required to sustain direct immune protection for children aged 1-4 years during the PsA-TT campaign. Antibodies persisted longer in older age groups.
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Affiliation(s)
| | | | | | | | | | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester, United Kingdom
| | - Haoua Tall
- Agence de Medecine Preventive, Paris, France
| | - Joy Seanehia
- EHESP French School of Public Health, Sorbonne Paris Cité, France et Institut Pasteur, Paris
| | | | | | | | | | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester, United Kingdom
| | | | - Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, France et Institut Pasteur, Paris
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Greenwood BM, Aseffa A, Caugant DA, Diallo K, Kristiansen PA, Maiden MCJ, Stuart JM, Trotter CL. Narrative review of methods and findings of recent studies on the carriage of meningococci and other Neisseria species in the African Meningitis Belt. Trop Med Int Health 2019; 24:143-154. [PMID: 30461138 PMCID: PMC7380001 DOI: 10.1111/tmi.13185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review the findings of studies of pharyngeal carriage of Neisseria meningitidis and related species conducted in the African meningitis belt since a previous review published in 2007. METHODS PubMed and Web of Science were searched in July 2018 using the terms 'meningococcal OR Neisseria meningitidis OR lactamica AND carriage AND Africa', with the search limited to papers published on or after 1st January 2007. We conducted a narrative review of these publications. RESULTS One hundred and thirteen papers were identified using the search terms described above, 20 of which reported new data from surveys conducted in an African meningitis belt country. These papers described 40 surveys conducted before the introduction of the group A meningococcal conjugate vaccine (MenAfriVacR ) during which 66 707 pharyngeal swabs were obtained. Carriage prevalence of N. meningitidis varied substantially by time and place, ranging from <1% to 24%. The mean pharyngeal carriage prevalence of N. meningitidis across all surveys was 4.5% [95% CI: 3.4%, 6.8%] and that of capsulated N. meningitidis was 2.8% [95% CI: 1.9%; 5.2%]. A study of households provided strong evidence for meningococcal transmission within and outside households. The introduction of MenAfriVac® led to marked reductions in carriage of the serogroup A meningococcus in Burkina Faso and Chad. CONCLUSIONS Recent studies employing standardised methods confirm the findings of older studies that carriage of N. meningitidis in the African meningitis belt is highly variable over time and place, but generally occurs with a lower prevalence and shorter duration than reported from industrialised countries.
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Affiliation(s)
| | | | | | - Kanny Diallo
- Department of BacteriologyNoguchi Memorial Research InstituteUniversity of LegonAccraLegon
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Woringer M, Martiny N, Porgho S, Bicaba BW, Bar-Hen A, Mueller JE. Atmospheric Dust, Early Cases, and Localized Meningitis Epidemics in the African Meningitis Belt: An Analysis Using High Spatial Resolution Data. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:97002. [PMID: 30192160 PMCID: PMC6375477 DOI: 10.1289/ehp2752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Bacterial meningitis causes a high burden of disease in the African meningitis belt, with regular seasonal hyperendemicity and sporadic short, but intense, localized epidemics during the late dry season occurring at a small spatial scale [i.e., below the district level, in individual health centers (HCs)]. In addition, epidemic waves with larger geographic extent occur every 7-10 y. Although atmospheric dust load is thought to be an essential factor for hyperendemicity, its role for localized epidemics remains hypothetic. OBJECTIVES Our goal was to evaluate the association of localized meningitis epidemics in HC catchment areas with the dust load and the occurrence of cases in the same population early in the dry season. METHODS We compiled weekly reported cases of suspected bacterial meningitis at the HC resolution for 14 districts of Burkina Faso for the period 2004-2014. Using logistic regression, we evaluated the association of epidemic HC-weeks with atmospheric dust [approximated by the aerosol optical thickness (AOT) satellite product] and with the observation of early meningitis cases during October-December. RESULTS Although AOT was strongly associated with epidemic HC-weeks in crude analyses across all HC-weeks during the meningitis season [odds ratio (OR) [Formula: see text]; 95% CI: 4.90, 9.50], the association was no longer apparent when controlling for calendar week (OR [Formula: see text]; 95% CI: 0.60, 1.50). The number of early meningitis cases reported during October-December was associated with epidemic HC-weeks in the same HC catchment area during January-May of the following year (OR for each additional early case [Formula: see text]; 95% CI: 1.06, 1.21). CONCLUSIONS Spatial variations of atmospheric dust load do not seem to be a factor in the occurrence of localized meningitis epidemics, and the factor triggering them remains to be identified. The pathophysiological mechanism linking early cases to localized epidemics is not understood, but their occurrence and number of early cases could be an indicator for epidemic risk. https://doi.org/10.1289/EHP2752.
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Affiliation(s)
| | - Nadège Martiny
- 2 UMR6282 BIOGEOSCIENCES, University of Burgundy , Dijon, France
| | - Souleymane Porgho
- 3 Direction de la lutte contre la maladie, Ministry of Health , Ouagadougou, Burkina Faso
| | - Brice W Bicaba
- 3 Direction de la lutte contre la maladie, Ministry of Health , Ouagadougou, Burkina Faso
| | - Avner Bar-Hen
- 4 Conservatoire national d'arts et métiers (CNAM) , Paris, France
| | - Judith E Mueller
- 5 French School of Public Health (EHESP), Sorbonne Paris Cité , Paris, France
- 6 Institut Pasteur, Paris, France
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Norheim G, Mueller JE, Njanpop-Lafourcade BM, Delrieu I, Findlow H, Borrow R, Xie O, Nagaputra J, Ramasamy R, Dold C, Tamekloe TA, Rollier CS, Watt H, Kere AB, Næss LM, Pollard AJ. Natural immunity against capsular group X N. meningitidis following an outbreak in Togo, 2007. Vaccine 2018; 36:1297-1303. [DOI: 10.1016/j.vaccine.2018.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 12/12/2022]
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Mueller JE, Woringer M, Porgho S, Madec Y, Tall H, Martiny N, Bicaba BW. The association between respiratory tract infection incidence and localised meningitis epidemics: an analysis of high-resolution surveillance data from Burkina Faso. Sci Rep 2017; 7:11570. [PMID: 28912442 PMCID: PMC5599514 DOI: 10.1038/s41598-017-11889-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/30/2017] [Indexed: 12/03/2022] Open
Abstract
Meningococcal meningitis epidemics in the African meningitis belt consist of localised meningitis epidemics (LME) that reach attack proportions of 1% within a few weeks. A meningococcal serogroup A conjugate vaccine was introduced in meningitis belt countries from 2010 on, but LME due to other serogroups continue to occur. The mechanisms underlying LME are poorly understood, but an association with respiratory pathogens has been hypothesised. We analysed national routine surveillance data in high spatial resolution (health centre level) from 13 districts in Burkina Faso, 2004–2014. We defined LME as a weekly incidence rate of suspected meningitis ≥75 per 100,000 during ≥2 weeks; and high incidence episodes of respiratory tract infections (RTI) as the 5th quintile of monthly incidences. We included 10,334 health centre month observations during the meningitis season (January-May), including 85 with LME, and 1891 (1820) high-incidence episodes of upper (lower) RTI. In mixed effects logistic regression accounting for spatial structure, and controlling for dust conditions, relative air humidity and month, the occurrence of LME was strongly associated with high incidence episodes of upper (odds ratio 23.9, 95%-confidence interval 3.1–185.3), but not lower RTI. In the African meningitis belt, meningitis epidemics may be triggered by outbreaks of upper RTI.
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Affiliation(s)
- Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, Paris, France. .,Institut Pasteur, Paris, France.
| | | | - Souleymane Porgho
- Direction de la lutte contre la maladie, Ministry of Health, Ouagadougou, Burkina Faso
| | | | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | - Nadège Martiny
- UMR6282 BIOGEOSCIENCES, University of Burgundy, Dijon, France
| | - Brice W Bicaba
- Direction de la lutte contre la maladie, Ministry of Health, Ouagadougou, Burkina Faso
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Agier L, Martiny N, Thiongane O, Mueller JE, Paireau J, Watkins ER, Irving TJ, Koutangni T, Broutin H. Towards understanding the epidemiology of Neisseria meningitidis in the African meningitis belt: a multi-disciplinary overview. Int J Infect Dis 2016; 54:103-112. [PMID: 27826113 DOI: 10.1016/j.ijid.2016.10.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/21/2016] [Accepted: 10/29/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Neisseria meningitidis is the major cause of seasonal meningitis epidemics in the African meningitis belt. In the changing context of a reduction in incidence of serogroup A and an increase in incidence of serogroups W and C and of Streptococcus pneumoniae, a better understanding of the determinants driving the disease transmission dynamics remains crucial to improving bacterial meningitis control. METHODS The literature was searched to provide a multi-disciplinary overview of the determinants of meningitis transmission dynamics in the African meningitis belt. RESULTS Seasonal hyperendemicity is likely predominantly caused by increased invasion rates, sporadic localized epidemics by increased transmission rates, and larger pluri-annual epidemic waves by changing population immunity. Carriage likely involves competition for colonization and cross-immunity. The duration of immunity likely depends on the acquisition type. Major risk factors include dust and low humidity, and presumably human contact rates and co-infections; social studies highlighted environmental and dietary factors, with supernatural explanations. CONCLUSIONS Efforts should focus on implementing multi-country, longitudinal seroprevalence and epidemiological studies, validating immune markers of protection, and improving surveillance, including more systematic molecular characterizations of the bacteria. Integrating climate and social factors into disease control strategies represents a high priority for optimizing the public health response and anticipating the geographic evolution of the African meningitis belt.
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Affiliation(s)
- Lydiane Agier
- Combining Health Information, Computation and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK.
| | - Nadège Martiny
- Centre de Recherches de Climatologie (CRC), UMR 6282 CNRS Biogeosciences, Université de Bourgogne, Dijon, France
| | - Oumy Thiongane
- Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Antenne IRD Bobo Dioulasso, Bobo, Burkina Faso
| | - Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France; Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Juliette Paireau
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France; Department of Ecology and Evolutionary Biology, Princeton Environmental Institute, Princeton University, Princeton, New Jersey, USA
| | | | - Tom J Irving
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Thibaut Koutangni
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France; Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Hélène Broutin
- MIVEGEC, UMR 590CNRS/224IRD/UM, Montpellier, France; Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop, Fann, Dakar, Senegal
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Maïnassara HB, Paireau J, Idi I, Jusot JF, Moulia Pelat JP, Ouwe Missi Oukem-Boyer O, Fontanet A, Mueller JE. Serogroup-Specific Characteristics of Localized Meningococcal Meningitis Epidemics in Niger 2002-2012 and 2015: Analysis of Health Center Level Surveillance Data. PLoS One 2016; 11:e0163110. [PMID: 27657530 PMCID: PMC5033479 DOI: 10.1371/journal.pone.0163110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/04/2016] [Indexed: 11/18/2022] Open
Abstract
To compare dynamics of localized meningitis epidemics (LE) by meningococcal (Nm) serogroup, we analyzed a surveillance database of suspected and laboratory-confirmed Nm cases from 373 health areas (HA) of three regions in Niger during 2002-2012 and one region concerned by NmC epidemics during 2015. We defined LE as HA weekly incidence rates of ≥20 suspected cases per 100,000 during ≥2 weeks and assigned the predominant serogroup based on polymerase chain reaction testing of cerebrospinal fluid. Among the 175 LE, median peak weekly incidence rate in LE due to NmA, W, X and C were 54, 39, 109 and 46 per 100,000, respectively. These differences impacted ability of the epidemic to be detected at the district level. While this analysis is limited by the small number of LE due to NmX (N = 4) and NmW (N = 5), further research should explore whether strategies for prevention and response to meningitis epidemics need to be adapted according to predominant meningococcal serogroups.
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Affiliation(s)
- Halima Boubacar Maïnassara
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
- * E-mail:
| | - Juliette Paireau
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, United States of America
| | - Issa Idi
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | | | | | - Arnaud Fontanet
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
| | - Judith E. Mueller
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
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Tall H, Yaro S, Kpoda HBN, Ouangraoua S, Trotter CL, Njanpop Lafourcade BM, Findlow H, Bai X, Martin C, Nwakamma I, Ouedraogo JB, Gessner BD, Borrow R, Mueller JE. Meningococcal Seroepidemiology 1 Year After the PsA-TT Mass Immunization Campaign in Burkina Faso. Clin Infect Dis 2016; 61 Suppl 5:S540-6. [PMID: 26553686 PMCID: PMC4639492 DOI: 10.1093/cid/civ519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background. A group A meningococcal (MenA) conjugate vaccine, PsA-TT (MenAfriVac), was introduced in Burkina Faso via mass campaigns between September and December 2010, targeting the 1- to 29-year-old population. This study describes specific antibody titers in the general population 11 months later and compares them to preintroduction data obtained during 2008 using the same protocol. Methods. During October–November 2011, we recruited a representative sample of the population of urban Bobo-Dioulasso aged 6 months to 29 years, who underwent standardized interviews and blood draws. We assessed anti-MenA immunoglobulin G (IgG) concentrations (n = 200) and, using rabbit complement, serum bactericidal antibody (SBA) titers against 2 group A strains: reference strain F8238 (SBAref) (n = 562) and strain 3125 (SBA3125) (n = 200). Results. Among the 562 participants, 481 (86%) were aged ≥23 months and had been eligible for the PsA-TT campaign. Among them, vaccine coverage was 86.3% (95% confidence interval [CI], 82.7%–89.9%). Prevalence of putatively protective antibodies among vaccine-eligible age groups was 97.3% (95% CI, 95.9%–98.7%) for SBAref titers ≥128, 83.6% (95% CI, 77.6%–89.7%) for SBA3125 ≥128, and 84.2% (95% CI, 78.7%–89.7%) for anti-MenA IgG ≥2 µg/mL. Compared to the population aged 23 months to 29 years during 2008, geometric mean titers of SBAref were 7.59-fold higher during 2011, 51.88-fold for SBA3125, and 10.56-fold for IgG. Conclusions. This study shows high seroprevalence against group A meningococci in Burkina Faso following MenAfriVac introduction. Follow-up surveys will provide evidence on the persistence of population-level immunity and the optimal vaccination strategy for long-term control of MenA meningitis in the African meningitis belt.
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Affiliation(s)
- Haoua Tall
- Agence de Médecine Préventive, Paris, France
| | | | | | | | - Caroline L Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge
| | | | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - Xilian Bai
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | | | - Ikenna Nwakamma
- Ecole des Hautes Etudes en Santé Publique French School of Public Health, Sorbonne Paris Cité, France
| | | | | | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - Judith E Mueller
- Ecole des Hautes Etudes en Santé Publique French School of Public Health, Sorbonne Paris Cité, France Institut Pasteur, Paris, France
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Maïnassara HB, Paireau J, Idi I, Pelat JPM, Oukem-Boyer OOM, Fontanet A, Mueller JE. Response Strategies against Meningitis Epidemics after Elimination of Serogroup A Meningococci, Niger. Emerg Infect Dis 2016. [PMID: 26196461 PMCID: PMC4517723 DOI: 10.3201/eid2108.141361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Surveillance and epidemic vaccine response would be most effective at the health area level. To inform epidemic response strategies for the African meningitis belt after a meningococcal serogroup A conjugate vaccine was introduced in 2010, we compared the effectiveness and efficiency of meningitis surveillance and vaccine response strategies at district and health area levels using various thresholds of weekly incidence rates. We analyzed reports of suspected cases from 3 regions in Niger during 2002–2012 (154,392 health area weeks), simulating elimination of serogroup A meningitis by excluding health area years with identification of such cases. Effectiveness was highest for health area surveillance and district vaccination (58–366 cases; thresholds 7–20 cases/100,000 doses), whereas efficiency was optimized with health area vaccination (5.6–7.7 cases/100,000 doses). District-level intervention prevented <6 cases (0.2 cases/100,000 doses). Reducing the delay between epidemic signal and vaccine protection by 2 weeks doubled efficiency. Subdistrict surveillance and response might be most appropriate for meningitis epidemic response after elimination of serogroup A meningitis.
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Manigart O, Trotter C, Findlow H, Assefa A, Mihret W, Moti Demisse T, Yeshitela B, Osei I, Hodgson A, Quaye SL, Sow S, Coulibaly M, Diallo K, Traore A, Collard JM, Moustapha Boukary R, Djermakoye O, Mahamane AE, Jusot JF, Sokhna C, Alavo S, Doucoure S, Ba EH, Dieng M, Diallo A, Daugla DM, Omotara B, Chandramohan D, Hassan-King M, Nascimento M, Woukeu A, Borrow R, Stuart JM, Greenwood B. A Seroepidemiological Study of Serogroup A Meningococcal Infection in the African Meningitis Belt. PLoS One 2016; 11:e0147928. [PMID: 26872255 PMCID: PMC4752490 DOI: 10.1371/journal.pone.0147928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/11/2016] [Indexed: 12/31/2022] Open
Abstract
The pattern of epidemic meningococcal disease in the African meningitis belt may be influenced by the background level of population immunity but this has been measured infrequently. A standardised enzyme-linked immunosorbent assay (ELISA) for measuring meningococcal serogroup A IgG antibodies was established at five centres within the meningitis belt. Antibody concentrations were then measured in 3930 individuals stratified by age and residence from six countries. Seroprevalence by age was used in a catalytic model to determine the force of infection. Meningococcal serogroup A IgG antibody concentrations were high in each country but showed heterogeneity across the meningitis belt. The geometric mean concentration (GMC) was highest in Ghana (9.09 μg/mL [95% CI 8.29, 9.97]) and lowest in Ethiopia (1.43 μg/mL [95% CI 1.31, 1.57]) on the margins of the belt. The force of infection was lowest in Ethiopia (λ = 0.028). Variables associated with a concentration above the putative protective level of 2 μg/mL were age, urban residence and a history of recent vaccination with a meningococcal vaccine. Prior to vaccination with the serogroup A meningococcal conjugate vaccine, meningococcal serogroup A IgG antibody concentrations were high across the African meningitis belt and yet the region remained susceptible to epidemics.
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Affiliation(s)
- Olivier Manigart
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Medical Research Council Unit, Fajara, The Gambia
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Helen Findlow
- Public Health England Vaccine Evaluation Unit, Manchester, United Kingdom
| | - Abraham Assefa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Wude Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | - Isaac Osei
- Navrongo Health Research Centre, Navrongo, Ghana
| | | | | | - Samba Sow
- Centre pour les Vaccins en Développement, Bamako, Mali
| | | | - Kanny Diallo
- Centre pour les Vaccins en Développement, Bamako, Mali
| | - Awa Traore
- Centre pour les Vaccins en Développement, Bamako, Mali
| | | | | | | | | | | | - Cheikh Sokhna
- Institut de Recherche pour le Développement, Dakar, Senegal
| | - Serge Alavo
- Institut de Recherche pour le Développement, Dakar, Senegal
| | | | - El Hadj Ba
- Institut de Recherche pour le Développement, Dakar, Senegal
| | - Mariétou Dieng
- Institut de Recherche pour le Développement, Dakar, Senegal
| | | | | | - Babatunji Omotara
- Department of Community Medicine, University of Maiduguri, Maiduguri, Nigeria
| | - Daniel Chandramohan
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Musa Hassan-King
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maria Nascimento
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Arouna Woukeu
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ray Borrow
- Public Health England Vaccine Evaluation Unit, Manchester, United Kingdom
| | - James M. Stuart
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Brian Greenwood
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Karachaliou A, Conlan AJK, Preziosi MP, Trotter CL. Modeling Long-term Vaccination Strategies With MenAfriVac in the African Meningitis Belt. Clin Infect Dis 2015; 61 Suppl 5:S594-600. [PMID: 26553693 PMCID: PMC4639487 DOI: 10.1093/cid/civ508] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The introduction of MenAfriVac in campaigns targeting people aged 1-29 years across the African meningitis belt has successfully reduced meningitis incidence and carriage due to Neisseria meningitidis group A (MenA). It is important to consider how best to sustain population protection in the long term. METHODS We created a mathematical model of MenA transmission and disease to investigate the potential impact of a range of immunization strategies. The model is age structured; includes classes of susceptible, carrier, ill, and immune people (who may be vaccinated or unvaccinated); and incorporates seasonal transmission and a stochastic forcing term that models between year variation in rates of transmission. Model parameters were primarily derived from African sources. The model can describe the typical annual incidence of meningitis in the prevaccine era, with irregular epidemics of varying size. Parameter and structural uncertainty were explored in sensitivity analyses. RESULTS Following MenAfriVac introduction at high uptake, the model predicts excellent short-term disease control. With no subsequent immunization, strong resurgences in disease incidence were predicted after approximately 15 years (assuming 10 years' average vaccine protection). Routine immunization at 9 months of age resulted in lower average annual incidence than regular mass campaigns of 1- to 4-year-olds, provided coverage was above approximately 60%. The strategy with the lowest overall average annual incidence and longest time to resurgence was achieved using a combination strategy of introduction into the Expanded Programme on Immunization at 9 months, 5 years after the initial mass campaigns, with a catch-up targeting unvaccinated 1- to 4-year-olds. CONCLUSIONS These results can be used to inform policy recommendations for long-term vaccination strategies with MenAfriVac.
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Affiliation(s)
- Andromachi Karachaliou
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
| | - Andrew J. K. Conlan
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
| | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
- Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Caroline L. Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
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The Diversity of Meningococcal Carriage Across the African Meningitis Belt and the Impact of Vaccination With a Group A Meningococcal Conjugate Vaccine. J Infect Dis 2015; 212:1298-307. [PMID: 25858956 PMCID: PMC4577048 DOI: 10.1093/infdis/jiv211] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/25/2015] [Indexed: 12/27/2022] Open
Abstract
Background. Study of meningococcal carriage is essential to understanding the epidemiology of Neisseria meningitidis infection. Methods. Twenty cross-sectional carriage surveys were conducted in 7 countries in the African meningitis belt; 5 surveys were conducted after introduction of a new serogroup A meningococcal conjugate vaccine (MenAfriVac). Pharyngeal swab specimens were collected, and Neisseria species were identified by microbiological and molecular techniques. Results. A total of 1687 of 48 490 participants (3.4%; 95% confidence interval [CI], 3.2%–3.6%) carried meningococci. Carriage was more frequent in individuals aged 5–14 years, relative to those aged 15–29 years (adjusted odds ratio [OR], 1.41; 95% CI, 1.25–1.60); in males, relative to females (adjusted OR, 1.17; 95% CI, 1.10–1.24); in individuals in rural areas, relative to those in urban areas (adjusted OR, 1.44; 95% CI, 1.28–1.63); and in the dry season, relative to the rainy season (adjusted OR, 1.54; 95% CI, 1.37–1.75). Forty-eight percent of isolates had genes encoding disease-associated polysaccharide capsules; genogroup W predominated, and genogroup A was rare. Strain diversity was lower in countries in the center of the meningitis belt than in Senegal or Ethiopia. The prevalence of genogroup A fell from 0.7% to 0.02% in Chad following mass vaccination with MenAfriVac. Conclusions. The prevalence of meningococcal carriage in the African meningitis belt is lower than in industrialized countries and is very diverse and dynamic, even in the absence of vaccination.
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Koutangni T, Boubacar Maïnassara H, Mueller JE. Incidence, carriage and case-carrier ratios for meningococcal meningitis in the African meningitis belt: a systematic review and meta-analysis. PLoS One 2015; 10:e0116725. [PMID: 25658307 PMCID: PMC4319942 DOI: 10.1371/journal.pone.0116725] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 12/12/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To facilitate the interpretation of meningococcal meningitis epidemiology in the "African meningitis belt", we aimed at obtaining serogroup-specific pooled estimates of incidence, carriage and case-carrier ratios for meningococcal meningitis in the African meningitis belt and describe their variations across the endemic, hyperendemic and epidemic context. METHODS We conducted a systematic review and meta-analysis of studies reporting serogroup-specific meningococcal meningitis monthly incidence and carriage in the same population and time period. Epidemiological contexts were defined as endemic (wet season, no epidemic), hyperendemic (dry season, no epidemic), and epidemic (dry season, epidemic). FINDINGS Eight studies reporting a total of eighty pairs of serogroup-specific meningococcal meningitis incidence and carriage estimates were included in this review. For serogroup A, changes associated with the transition from endemic to hyperendemic incidence and from hyperendemic to epidemic incidence were 15-fold and 120-fold respectively. Changes in carriage prevalence associated with both transitions were 1-fold and 30-fold respectively.
For serogroup W and X, the transition from endemic to hyperendemic incidence involved a 4-fold and 1•1-fold increase respectively. Increases in carriage prevalence for the later transition were 7-fold and 1•7-fold respectively. No data were available for the hyperendemic-epidemic transition for these serogroups. Our findings suggested that the regular seasonal variation in serogroup A meningococcal meningitis incidence between the rainy and the dry season could be mainly driven by seasonal change in the ratio of clinical cases to subclinical infections. In contrast appearance of epidemic incidences is related to a substantial increase in transmission and colonisation and to lesser extent with changes in the case-carrier ratio. CONCLUSION Seasonal change in the rate of progression to disease given carriage together with variations in frequency of carriage transmission should be considered in models attempting to capture the epidemiology of meningococcal meningitis and mainly to predict meningitis epidemics in the African meningitis belt.
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Affiliation(s)
- Thibaut Koutangni
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | | | - Judith E. Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
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17
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Abstract
The exclusive reservoir of the genus Neisseria is the human. Of the broad range of species that comprise the Neisseria, only two are frequently pathogenic, and only one of those is a resident of the nasopharynx. Although Neisseria meningitidis can cause severe disease if it invades the bloodstream, the vast majority of interactions between humans and Neisseria are benign, with the bacteria inhabiting its mucosal niche as a non-invasive commensal. Understandably, with the exception of Neisseria gonorrhoeae, which preferentially colonises the urogenital tract, the neisseriae are extremely well adapted to survival in the human nasopharynx, their sole biological niche. The purpose of this review is to provide an overview of the molecular mechanisms evolved by Neisseria to facilitate colonisation and survival within the nasopharynx, focussing on N. meningitidis. The organism has adapted to survive in aerosolised transmission and to attach to mucosal surfaces. It then has to replicate in a nutrition-poor environment and resist immune and competitive pressure within a polymicrobial complex. Temperature and relative gas concentrations (nitric oxide and oxygen) are likely to be potent initial signals of arrival within the nasopharyngeal environment, and this review will focus on how N. meningitidis responds to these to increase the likelihood of its survival.
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Sáfadi MA, Bettinger JA, Maturana GM, Enwere G, Borrow R. Evolving meningococcal immunization strategies. Expert Rev Vaccines 2014; 14:505-17. [DOI: 10.1586/14760584.2015.979799] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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19
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Banke-Thomas AO, Kouraogo SF, Siribie A, Taddese HB, Mueller JE. Knowledge of obstetric fistula prevention amongst young women in urban and rural Burkina Faso: a cross-sectional study. PLoS One 2013; 8:e85921. [PMID: 24392032 PMCID: PMC3877393 DOI: 10.1371/journal.pone.0085921] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 12/06/2013] [Indexed: 11/18/2022] Open
Abstract
Obstetric fistula is a sequela of complicated labour, which, if untreated, leaves women handicapped and socially excluded. In Burkina Faso, incidence of obstetric fistula is 6/10,000 cases amongst gynaecological patients, with more patients affected in rural areas. This study aims to evaluate knowledge on obstetric fistula among young women in a health district of Burkina Faso, comparing rural and urban communities. This cross-sectional study employed multi-stage sampling to include 121 women aged 18-20 years residing in urban and rural communities of Boromo health district. Descriptive statistics and multiple logistic regression analysis were used to compare differences between the groups and to identify predictors of observed knowledge levels. Rural women were more likely to be married (p<0.000) and had higher propensity to teenage pregnancy (p=0.006). The survey showed overall poor obstetric fistula awareness (36%). Rural residents were less likely to have adequate preventive knowledge than urban residents [OR=0.35 (95%-CI, 0.16–0.79)]. This effect was only slightly explained by lack of education [OR=0.41 (95%-CI, 0.18–0.93)] and only slightly underestimated due to previous pregnancy [OR=0.27 (95%-CI, 0.09–0.79)]. Media were the most popular source of awareness amongst urban young women in contrast to their rural counterparts (68% vs. 23%). Most rural young women became ‘aware’ through word-of-mouth (68% vs. 14%). All participants agreed that the hospital was safer for emergency obstetric care, but only 11.0% believed they could face pregnancy complications that would require emergency treatment. There is urgent need to increase emphasis on neglected health messages such as the risks of obstetric fistula. In this respect, obstetric fistula prevention programs need to be adapted to local contexts, whether urban or rural, and multi-sectoral efforts need to be exerted to maximise use of other sectoral resources and platforms, including existing routine health services and schools, to ensure sustainability of health literacy efforts.
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Affiliation(s)
- Aduragbemi O. Banke-Thomas
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, United Kingdom
- Epidemiology and Bio-statistics Department, École des Hautes Études en Santé Publique, Rennes, Bretagne, France
- School of Health and Related Research, the University of Sheffield, Sheffield, South Yorkshire, United Kingdom
- *
| | - Salam F. Kouraogo
- Surgery department, District Hospital (Centre Médical avec Antenne chirurgicale), Boromo, Boucle du Mouhoun, Burkina Faso
| | - Aboubacar Siribie
- Surgery department, District Hospital (Centre Médical avec Antenne chirurgicale), Boromo, Boucle du Mouhoun, Burkina Faso
| | - Henock B. Taddese
- School of Health and Related Research, the University of Sheffield, Sheffield, South Yorkshire, United Kingdom
| | - Judith E. Mueller
- Epidemiology and Bio-statistics Department, École des Hautes Études en Santé Publique, Rennes, Bretagne, France
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Yaro S, Njanpop-Lafourcade BM, Drabo A, Idohou RS, Kroman SS, Sanou O, Traoré Y, Sangaré L, Diagbouga SP, Koeck JL, Borrow R, Gessner BD, Mueller JE. Antipneumococcal seroprevalence and pneumococcal carriage during a meningococcal epidemic in Burkina Faso, 2006. J Infect Dis 2013; 209:1241-50. [PMID: 24277740 DOI: 10.1093/infdis/jit641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To better understand the high incidence of pneumococcal meningitis in the African meningitis belt, we conducted a pneumococcal seroprevalence study during a meningococcal meningitis epidemic in Western Burkina Faso, March 2006. METHODS In 3 villages experiencing epidemics, we included 624 healthy persons (1-39 years) by cluster sampling. We determined pneumococcal serum immunoglobulin G (IgG) antibody concentrations against 12 serotypes contained in 13-valent pneumococcal conjugate vaccine, and evaluated determinants for IgG ≥ 0.35 μg/mL by multivariate logistic regression. RESULTS The percentage of subjects with serotype-specific IgG concentrations ≥0.35 μg/mL increased with age and was similar for the different serotypes: it was 20%-43% among 1-4-year-olds and 56%-90% among 20-39-year-olds. Prevalence of IgG ≥ 0.35 μg/mL against serotype 1 was up to 71% after age 10 years. During multivariate analyses, determinants of IgG concentrations ≥0.35 μg/mL varied by serotype; for 5 and 6 serotypes, respectively, female sex (around 2-fold increased odds) and cigarette smoking (about 5-fold reduced odds) predicted elevated titers. CONCLUSIONS Despite a substantially higher historical pneumococcal meningitis incidence in Burkina Faso, the general population has an antibody seroprevalence against 12 pneumococcal serotypes similar to that reported from the United Kingdom. The role of putatively protective antibody seroprevalence in preventing pneumococcal meningitis in the meningitis belt requires more thorough evaluation.
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Affiliation(s)
- Seydou Yaro
- Centre Muraz, Ministry of Health, Bobo-Dioulasso, Burkina Faso
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Xie O, Pollard AJ, Mueller JE, Norheim G. Emergence of serogroup X meningococcal disease in Africa: Need for a vaccine. Vaccine 2013; 31:2852-61. [DOI: 10.1016/j.vaccine.2013.04.036] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/02/2013] [Accepted: 04/11/2013] [Indexed: 12/27/2022]
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Trotter CL, Yaro S, Njanpop-Lafourcade BM, Drabo A, Kroman SS, Idohou RS, Sanou O, Bowen L, Findlow H, Diagbouga S, Gessner BD, Borrow R, Mueller JE. Seroprevalence of bactericidal, specific IgG antibodies and incidence of meningitis due to group A Neisseria meningitidis by age in Burkina Faso 2008. PLoS One 2013; 8:e55486. [PMID: 23457471 PMCID: PMC3573051 DOI: 10.1371/journal.pone.0055486] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/27/2012] [Indexed: 01/17/2023] Open
Abstract
Background We investigated serological correlates of protection against Neisseria meningitidis serogroup A (NmA) in Burkina Faso before the introduction of NmA conjugate vaccine. Methodology/Principal Findings We collected blood from a representative sample (N = 1022) of Bobo-Dioulasso residents. Sera were evaluated for serum bactericidal antibody (SBA) activity against NmA strains of immunotype L11 (F8238) and L10 (3125) and NmA-specific IgG. Seroprevalence was compared to the age-specific NmA meningitis incidence in Bobo-Dioulasso during March 2007–February 2008. Meningococcal carriage was evaluated in a subset (N = 538). Geometric mean titres (GMT)/concentrations (GMC) of SBA and NmA-specific IgG increased with age, peaking around age 20 years. Overall, 70% of our sample had NmA-specific IgG ≥2 ug/mL. Meningitis incidence was highest in those aged <6 months and 5–19 years. No NmA carriers were found. Compared to the reference strain SBA, GMTs were higher against a locally isolated strain and around 40-fold lower against Dutch strain 3125. Conclusions/Significance This study provides estimates of natural immunity to NmA, according to a variety of antibody measures, which will be helpful in ascertaining antibody persistence after MenAfriVac™ introduction. Age-specific seroprevalence of reference strain SBA titres most likely reflects exposure to meningococci and consecutive reactive immunity. We could not define any serological correlate of protection.
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Affiliation(s)
- Caroline L Trotter
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
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Agier L, Deroubaix A, Martiny N, Yaka P, Djibo A, Broutin H. Seasonality of meningitis in Africa and climate forcing: aerosols stand out. J R Soc Interface 2012; 10:20120814. [PMID: 23221989 DOI: 10.1098/rsif.2012.0814] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Bacterial meningitis is an ongoing threat for the population of the African Meningitis Belt, a region characterized by the highest incidence rates worldwide. The determinants of the disease dynamics are still poorly understood; nevertheless, it is often advocated that climate and mineral dust have a large impact. Over the last decade, several studies have investigated this relationship at a large scale. In this analysis, we scaled down to the district-level weekly scale (which is used for in-year response to emerging epidemics), and used wavelet and phase analysis methods to define and compare the time-varying periodicities of meningitis, climate and dust in Niger. We mostly focused on detecting time-lags between the signals that were consistent across districts. Results highlighted the special case of dust in comparison to wind, humidity or temperature: a strong similarity between districts is noticed in the evolution of the time-lags between the seasonal component of dust and meningitis. This result, together with the assumption of dust damaging the pharyngeal mucosa and easing bacterial invasion, reinforces our confidence in dust forcing on meningitis seasonality. Dust data should now be integrated in epidemiological and forecasting models to make them more realistic and usable in a public health perspective.
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Affiliation(s)
- L Agier
- Combining Health Information, Computation and Statistics, School of Health and Medicine, Lancaster University, Lancaster, UK.
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24
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Mueller JE. Conjugate vaccine introduction in the African meningitis belt: meeting surveillance objectives. Trop Med Int Health 2012; 18:58-64. [DOI: 10.1111/tmi.12009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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A multi-state spatio-temporal Markov model for categorized incidence of meningitis in sub-Saharan Africa. Epidemiol Infect 2012; 141:1764-71. [PMID: 22995184 DOI: 10.1017/s0950268812001926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Meningococcal meningitis is a major public health problem in the African Belt. Despite the obvious seasonality of epidemics, the factors driving them are still poorly understood. Here, we provide a first attempt to predict epidemics at the spatio-temporal scale required for in-year response, using a purely empirical approach. District-level weekly incidence rates for Niger (1986-2007) were discretized into latent, alert and epidemic states according to pre-specified epidemiological thresholds. We modelled the probabilities of transition between states, accounting for seasonality and spatio-temporal dependence. One-week-ahead predictions for entering the epidemic state were generated with specificity and negative predictive value >99%, sensitivity and positive predictive value >72%. On the annual scale, we predict the first entry of a district into the epidemic state with sensitivity 65∙0%, positive predictive value 49∙0%, and an average time gained of 4∙6 weeks. These results could inform decisions on preparatory actions.
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Tall H, Hugonnet S, Donnen P, Dramaix-Wilmet M, Kambou L, Drabo F, Mueller JE. Definition and characterization of localised meningitis epidemics in Burkina Faso: a longitudinal retrospective study. BMC Infect Dis 2012; 12:2. [PMID: 22221583 PMCID: PMC3280175 DOI: 10.1186/1471-2334-12-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 01/05/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The epidemiology of meningococcal meningitis in the African meningitis belt is characterised by seasonality, localised epidemics and epidemic waves. To facilitate research and surveillance, we aimed to develop a definition for localised epidemics to be used in real-time surveillance based on weekly case reports at the health centre level. METHODS We used national routine surveillance data on suspected meningitis from January 2004 to December 2008 in six health districts in western and central Burkina Faso. We evaluated eight thresholds composed of weekly incidence rates at health centre level for their performance in predicting annual incidences of 0.4%and 0.8% in health centre areas. The eventually chosen definition was used to describe the spatiotemporal epidemiology and size of localised meningitis epidemics during the included district years. RESULTS Among eight weekly thresholds evaluated, a weekly incidence rate of 75 cases per 100,000 inhabitants during at least two consecutive weeks with at least 5 cases per week had 100% sensitivity and 98% specificity for predicting an annual incidence of at least 0.8% in health centres. Using this definition, localised epidemics were identified in all but one years during 2004-2008, concerned less than 10% of the districts' population and often were geographically dispersed. Where sufficient laboratory data were available, localised epidemics were exclusively due to meningococci. CONCLUSIONS This definition of localised epidemics a the health centre level will be useful for risk factor and modelling studies to understand the meningitis belt phenomenon and help documenting vaccine impact against epidemic meningitis where no widespread laboratory surveillance exists for quantifying disease reduction after vaccination.
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Affiliation(s)
- Haoua Tall
- Agence de Médecine Préventive, 164 rue de Vaugirard, 75015 Paris, France
| | - Stéphane Hugonnet
- World Health Organization, Department of Epidemic and Pandemic Alert and Response (HSE/EPR), 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Philippe Donnen
- Université Libre de Bruxelles, Route de Lennik 808, Bruxelles 1070, Belgique
| | | | - Ludovic Kambou
- Ministry of Health, 03 BP 7035, Ouagadougou, Burkina Faso
| | - Frank Drabo
- Ministry of Health, 03 BP 7035, Ouagadougou, Burkina Faso
| | - Judith E Mueller
- Agence de Médecine Préventive, 164 rue de Vaugirard, 75015 Paris, France
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