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Cernuschi T, Malvolti S, Hall S, Debruyne L, Bak Pedersen H, Rees H, Cooke E. The quest for more effective vaccine markets - Opportunities, challenges, and what has changed with the SARS-CoV-2 pandemic. Vaccine 2024; 42 Suppl 1:S64-S72. [PMID: 38103962 PMCID: PMC9585501 DOI: 10.1016/j.vaccine.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 03/28/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022]
Abstract
The past two decades have seen important progress in access to timely, reliable, affordable, and quality-assured supplies of vaccines of global public health importance. The new vaccines developed are powerful tools to fight killers such as pneumonia, diarrhea, and cervical cancer. Global and regional financing and pooled procurement haveshortened the lag between access in high- andlower-income countries. The COVID-19 pandemic has shown that by addressing shortcomings and seizing opportunities, we can do even more. In response to COVID-19, vaccine development and access shifted from a sequential, risk-averse paradigm to a rapid approach with maximum compression of time to market while ensuring quality. Vast public investments and innovative technologies were key facilitators. The pandemic has shown that governments play a crucial role in investing in new vaccines and manufacturing capacity and sharing risks with industry. Despite impressive progress, equity in access remains elusive with important moral, economic, and health-related consequences. Global leaders are working on a new International Treaty for Pandemic Prevention, Preparedness, and Response. To apply the lessons of COVID-19, that treaty should include a new paradigm for access to vaccines in which governments agree to:This would ensure that COVID-19 catalyzes a shift toward greater access for all under Immunization Agenda 2030.
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Affiliation(s)
- Tania Cernuschi
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
| | | | - Shanelle Hall
- The Yellow House, Seattle, WA, USA; The Yellow House, Copenhagen, Denmark
| | - Luc Debruyne
- Access-to-Medicines Research Center, KU Leuven, Leuven, Belgium
| | | | - Helen Rees
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa; Chairperson of the South African Health Products Regulatory Authority Board, South Africa
| | - Emer Cooke
- European Medicines Agency, Amsterdam, North Holland, Netherlands
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2
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Ewe K, Fathima P, Effler P, Giele C, Richmond P. Impact of Meningococcal ACWY Vaccination Program during 2017-18 Epidemic, Western Australia, Australia. Emerg Infect Dis 2024; 30:270-278. [PMID: 38270172 PMCID: PMC10826768 DOI: 10.3201/eid3002.230144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
The rising incidence of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup W in Western Australia, Australia, presents challenges for prevention. We assessed the effects of a quadrivalent meningococcal vaccination program using 2012-2020 IMD notification data. Notification rates peaked at 1.8/100,000 population in 2017; rates among Aboriginal and Torres Strait Islander populations were 7 times higher than for other populations. Serogroup W disease exhibited atypical manifestations and increased severity. Of 216 cases, 20 IMD-related deaths occurred; most (19/20) were in unvaccinated persons. After the 2017-2018 targeted vaccination program, notification rates decreased from 1.6/100,000 population in 2018 to 0.9/100,000 population in 2019 and continued to decline in 2020. Vaccine effectiveness (in the 1-4 years age group) using the screening method was 93.6% (95% CI 50.1%-99.2%) in 2018 and 92.5% (95% CI 28.2%-99.2%) in 2019. Strategic planning and prompt implementation of targeted vaccination programs effectively reduce IMD.
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Affiliation(s)
| | | | - Paul Effler
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
| | - Carolien Giele
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
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3
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Azure S, Abdul-Karim A, Abubakari BB, Eleeza JB, Agboyie DDA, Weyori EW, Choi JY. Trends in Neisseria meningitidis serogroups amongst patients with suspected cerebrospinal meningitis in the meningitis belt of Ghana: a 5-year retrospective study. BMC Infect Dis 2023; 23:202. [PMID: 37024833 PMCID: PMC10077696 DOI: 10.1186/s12879-023-08196-x] [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: 10/26/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Serogroup A Neisseria meningitidis was the major cause of meningococcal meningitis epidemics in the African meningitis belt before 2010 when the monovalent meningococcal A conjugate vaccine (MenAfriVac) was introduced in the region. Therefore, this study aimed to establish the trends in N. meningitidis serogroups from 2016 to 2020 in Ghana's meningitis belt. METHODS Polymerase chain reaction (PCR) confirmed laboratory results of suspected cases of cerebrospinal meningitis from January, 2016 to March, 2020 were obtained from the Tamale Public Health Laboratory. The data were subjected to trend analysis using Statistical Package for the Social Sciences version 25. Differences between discrete variables were analyzed using the Cochran-Armitage trend test. RESULTS Of the 2,426 suspected cases, 395 (16.3%) were confirmed positive for N. meningitidis using PCR. Serogroup X showed a significant upward trend (P < 0.01), and serogroup W showed a downward trend (P < 0.01). However, no significant trend was observed for any other serogroup. CONCLUSION This study showed the emergence of serogroup X, a non-vaccine type, as the predominant N. meningitidis serogroup in the wake of a declining serogroup W in Ghana's meningitis belt.
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Affiliation(s)
- Stebleson Azure
- Yonsei University Graduate School of Public Health, Seoul, Korea
- Tamale Public Health Laboratory, Tamale, Ghana
| | | | | | | | | | | | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
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Rancher C, Moreland AD, Smith DW, Cornelison V, Schmidt MG, Boyle J, Dayton J, Kilpatrick DG. Using the 5C model to understand COVID-19 vaccine hesitancy across a National and South Carolina sample. J Psychiatr Res 2023; 160:180-186. [PMID: 36809746 PMCID: PMC9933856 DOI: 10.1016/j.jpsychires.2023.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/30/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Vaccine hesitancy is a serious threat to global health; however, significant COVID-19 vaccine hesitancy exists throughout the United States. The 5C model, which postulates five person-level determinants for vaccine hesitancy - confidence, complacency, constraints, risk calculation, and collective responsibility - provides one theoretical way of understanding COVID-19 vaccine hesitancy. The present study examined the effects of these 5C drivers of vaccine behavior on early vaccine adoption and vaccine intentions above and beyond theoretically salient demographic characteristics and compared these associations across a National sample (n = 1634) and a statewide sample from South Carolina (n = 784) - a state with documented low levels of COVID-19 vaccination uptake. This study used quantitative and qualitative data collected in October 2020 to January 2021 from the MFour-Mobile Research Panel, a large, representative non-probability sample of adult smartphone users. Overall, the South Carolina sample reported lower COVID-19 vaccine intentions and higher levels of 5C barriers to vaccine uptake compared to the National sample. Findings further indicated that both demographic characteristics (race) and certain drivers of vaccine behavior (confidence and collective responsibility) are associated with vaccine trust and intentions across samples above and beyond other variables. Qualitative data indicated that COVID-19 vaccine hesitancy was driven by fears about the quick vaccine development, limited research, and potential side effects. Although there are some limitations to the cross-sectional survey data, the present study offers valuable insight into factors associated with early COVID-19 vaccine hesitancy across the United States.
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Affiliation(s)
- Caitlin Rancher
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Angela D Moreland
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel W Smith
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Vickey Cornelison
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Michael G Schmidt
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - John Boyle
- ICF International, Rockville, MD, 20850, USA
| | | | - Dean G Kilpatrick
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
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Khurana R, Gupta L, Kumar N. Development and standardization of a COVID-19 Vaccination Anxiety scale for Adult Urban Indian Population (CVAS-A). Hum Vaccin Immunother 2022; 18:2059307. [PMID: 35442144 PMCID: PMC9897640 DOI: 10.1080/21645515.2022.2059307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Given the ongoing COVID-19 vaccination drive across the globe, a significant amount of confusion, mistrust, misunderstanding, and hesitancy had surfaced regarding the vaccine. A standardized tool to understand the possible reasons of COVID-19 vaccination anxiety and hesitancy would be valuable in this context. The current study aimed at developing a standardized tool to measure COVID-19 Vaccination Anxiety among Urban Indian adults. A 19-item scale was administered to an Urban adult Indian population (N = 760) between the period of February 2021- May 2021 to obtain factors associated with COVID-19 Vaccination Anxiety and establish reliability estimates of the scale. Infection-related anxiety, information-related anxiety and vaccine side-effect-related anxiety were the three factors determined through Factor Analysis. The scale was validated with Convergent and Discriminant Validity by finding correlation between the three factors of the scale and five factors of the Brief version of the Big-Five personality Inventory (extraversion, agreeableness, openness to experience, conscientiousness, and neuroticism). It is expected that a tool such as CVAS-A would help in understanding and managing COVID-19-related vaccination hesitancy.
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Affiliation(s)
- Rati Khurana
- Independent Practitioner,CONTACT Rati Khurana Independent Practitioner
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Whisnant J, Martin-Kerry J, Flett L, Knapp P. Predictors of meningococcal vaccine uptake in university and college students: a systematic review and meta-analysis. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1738-1753. [PMID: 33048644 DOI: 10.1080/07448481.2020.1819292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/19/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: To identify predictors of meningococcal vaccine uptake among university and college students, the most common carriers of meningococcal disease. Participants: University or college students aged 18 to 25 years. Methods: Multiple databases, citations, and gray literature were systematically searched in April 2017 and January 2019, for articles reporting rates and predictors of vaccine uptake. Included studies underwent quality appraisal, and, where suitable, meta-analyses were performed. Results: Twenty-one articles, covering 18 studies from six countries, were included. They were mostly cross-sectional surveys of routine vaccination. Meta-analyses were conducted on six predictors. Higher vaccination uptake was associated with being a first year student, an undergraduate student, not being an international student, perceiving meningococcal disease as a risk, and being female. Conclusion: Identified key predictors correspond with previous studies and other vaccines. The findings should inform the delivery and communication of meningococcal vaccination to university and college students.
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Affiliation(s)
| | | | - Lydia Flett
- Department of Health Sciences, University of York, York, UK
| | - Peter Knapp
- Department of Health Sciences, University of York & the Hull York Medical School, York, UK
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Taha MK, Martinon-Torres F, Köllges R, Bonanni P, Safadi MAP, Booy R, Smith V, Garcia S, Bekkat-Berkani R, Abitbol V. Equity in vaccination policies to overcome social deprivation as a risk factor for invasive meningococcal disease. Expert Rev Vaccines 2022; 21:659-674. [PMID: 35271781 DOI: 10.1080/14760584.2022.2052048] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Social deprivation is associated with poorer healthcare access. Vaccination is among the most effective public health interventions and achieving equity in vaccination access is vitally important. However, vaccines are often reimbursed by public funds only when recommended in national immunization programs (NIPs), which can increase inequity between high and low socioeconomic groups. Invasive meningococcal disease (IMD) is a serious vaccination-preventable disease. This review focuses on vaccination strategies against IMD designed to reduce inequity. AREAS COVERED We reviewed meningococcal epidemiology and current vaccination recommendations worldwide. We also reviewed studies demonstrating an association between social deprivation and risk of meningococcal disease, as well as studies demonstrating an impact of social deprivation on uptake of meningococcal vaccines. We discuss factors influencing inclusion of meningococcal vaccines in NIPs. EXPERT OPINION Incorporating meningococcal vaccines in NIPs is necessary to reduce inequity, but insufficient alone. Inclusion provides clear guidance to healthcare professionals and helps to ensure that vaccines are offered universally to all target groups. Beyond NIPs, cost of vaccination should be reimbursed especially for disadvantaged individuals. These approaches should help to achieve optimal protection against IMD, by increasing access and immunization rates, eventually reducing social inequities, and helping to protect those at greatest risk.
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Affiliation(s)
- Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus Influenza, Paris, France
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infectious Diseases, Pediatrics Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela, Galicia, Spain.,Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.,Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Ralph Köllges
- Praxis für Kinder und Jugendliche, Ralph Köllges und Partner, Mönchengladbach, Germany
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Robert Booy
- Department of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, NSW, Australia
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Franklin K, Kwambana-Adams B, Lessa FC, Soeters HM, Cooper L, Coldiron ME, Mwenda J, Antonio M, Nakamura T, Novak R, Cohen AL. Pneumococcal Meningitis Outbreaks in Africa, 2000-2018: Systematic Literature Review and Meningitis Surveillance Database Analyses. J Infect Dis 2021; 224:S174-S183. [PMID: 34469561 DOI: 10.1093/infdis/jiab105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The meningitis belt of sub-Saharan Africa has traditionally experienced large outbreaks of meningitis mainly caused by Neisseria meningitidis. More recently, Streptococcus pneumoniae has been recognized as a cause of meningitis outbreaks in the region. Little is known about the natural history and epidemiology of these outbreaks, and, in contrast to meningococcal meningitis, there is no agreed definition for a pneumococcal meningitis epidemic. The aim of this analysis was to systematically review and understand pneumococcal meningitis outbreaks in Africa between 2000 and 2018. METHODS Meningitis outbreaks were identified using a systematic literature review and analyses of meningitis surveillance databases. Potential outbreaks were included in the final analysis if they reported at least 10 laboratory-confirmed meningitis cases above baseline per week with ≥50% of cases confirmed as pneumococcus. RESULTS A total of 10 potential pneumococcal meningitis outbreaks were identified in Africa between 2000 and 2018. Of these, 2 were classified as confirmed, 7 were classified as possible, and 1 was classified as unlikely. Three outbreaks spanned more than 1 year. In general, the outbreaks demonstrated lower peak attack rates than meningococcal meningitis outbreaks and had a predominance of serotype 1. Patients with pneumococcal meningitis tended to be older and had higher case fatality rates than meningococcal meningitis cases. An outbreak definition, which includes a weekly district-level incidence of at least 10 suspected cases per 100 000 population per week, with >10 cumulative confirmed cases of pneumococcus per year, would have identified all 10 potential outbreaks. CONCLUSIONS Given the frequency of and high case fatality from pneumococcal meningitis outbreaks, public health recommendations on vaccination strategies and the management of outbreaks are needed. Improved laboratory testing for S. pneumoniae is critical for early outbreak identification.
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Affiliation(s)
| | | | - Fernanda C Lessa
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heidi M Soeters
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Cooper
- University of Cambridge, Cambridge, United Kingdom
| | | | | | - Martin Antonio
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | | | - Ryan Novak
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Wiysonge CS, Ndwandwe D, Ryan J, Jaca A, Batouré O, Anya BPM, Cooper S. Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future? Hum Vaccin Immunother 2021; 18:1-3. [PMID: 33684019 PMCID: PMC8920215 DOI: 10.1080/21645515.2021.1893062] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Vaccine hesitancy, which embodies the unwillingness to receive vaccines when vaccination services are available and accessible, is one of the greatest threats to global health. Although vaccine hesitancy has existed among a small percentage of people for centuries, its harmful effects are likely to be more pronounced during the COVID-19 pandemic than ever before. COVID-19 vaccine hesitancy will pose substantial risks for both people who delay or refuse to be vaccinated and the wider community. It will make communities unable to reach thresholds of coverage necessary for herd immunity against COVID-19, thus unnecessarily perpetuating the pandemic and resulting in untold suffering and deaths. Vaccine hesitancy is pervasive, misinformed, contagious, and is not limited to COVID-19 vaccination. Our work shows that vaccine hesitancy is a complex and dynamic social process that reflects multiple webs of influence, meaning, and logic. People’s vaccination views and practices usually comprise an ongoing engagement that is contingent on unfolding personal and social circumstances, which can potentially change over time. Therefore, as COVID-19 vaccination rolls out globally, scientists and decision-makers need to investigate the scale and determinants of vaccine hesitancy in each setting; so that tailored and targeted strategies can be developed to address it.
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Affiliation(s)
- Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Jill Ryan
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | | | | | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
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Epidemiological Characteristics of Meningococcal Meningitis (2016 to 2018) Four Years after the Introduction of Serogroup A Meningococcal Conjugate Vaccine in Benin. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/1932940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives. This study aims to study the epidemiological and geographic characteristics of the meningococcal serogroups four years after the introduction of serogroup A meningococcal conjugate vaccine. Methods. This is a prospective, descriptive, analytical study, and it took place from 2016 to 2018. Cerebrospinal fluid (CSF) samples were taken after the identification of meningitis cases. The samples, thus, taken were sent to the laboratory for culture and identification of Neisseria meningitidis in accordance with WHO standards. Results. Eight hundred and ninety-nine bacterial strains were identified, of which 219 were strains of Neisseria meningitidis. The majority of N. meningitidis-positive samples were from male patients (59.8%) with a median age of 4 (IQR: 1–13). Four of N. meningitidis serogroups were identified, namely, serogroups C (6.8%), W (19.6%), X (1.8%), and A (0.5%). Geographically, 92.7% of the identified N. meningitidis serogroups came from patients who lived in the northern region of the country. The departments most concerned were Alibori (N. meningitidis C (66.7%) and N. meningitidis W (20.9%)); Atacora (N. meningitidis W (41.9%), N. meningitidis X (75.0%), and N. meningitidis C (13.3%)); and Borgou (N. meningitidis W (23.3%)). Conclusion. The results of this study showed that there is an emergence of cases of meningococcal of serogroup C four years after the introduction of MenAfricVac in Benin. These results demonstrated the effectiveness of case-by-case surveillance in detecting small changes in the distribution of serogroups that could have important implications for public health strategies in the coming seasons.
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Sherman AC, Stephens DS. Serogroup A meningococcal conjugate vaccines: building sustainable and equitable vaccine strategies. Expert Rev Vaccines 2020; 19:455-463. [PMID: 32321332 DOI: 10.1080/14760584.2020.1760097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION For well over 100 years, meningococcal disease due to serogroup A Neisseria meningitidis (MenA) has caused severe epidemics globally, especially in the meningitis belt of sub-Saharan Africa. AREAS COVERED The article reviews the background and identification of MenA, the global and molecular epidemiology of MenA, and the outbreaks of MenA in the African meningitis belt. The implementation (2010) of an equitable MenA polysaccharide-protein conjugate vaccine (PsA-TT, MenAfriVac) and the strategy to control MenA in sub-Saharan Africa is described. The development of a novel multi-serogroup meningococcal conjugate vaccine (NmCV-5) that includes serogroup A is highlighted. The PubMed database (1996-2019) was searched for studies relating to MenA outbreaks, vaccine, and immunization strategies; and the Neisseria PubMLST database of 1755 MenA isolates (1915-2019) was reviewed. EXPERT OPINION Using strategies from the successful MenAfriVac campaign, expanded collaborative partnerships were built to develop a novel, low-cost multivalent component meningococcal vaccine that includes MenA. This vaccine promises greater sustainability and is directed toward global control of meningococcal disease in the African meningitidis belt and beyond. The new WHO global roadmap addresses the continuing problem of bacterial meningitis, including meningococcal vaccine prevention, and provides a framework for further reducing the devastation of MenA.
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Affiliation(s)
- Amy C Sherman
- Department of Medicine, Emory University School of Medicine , Atlanta, Georgia, USA
| | - David S Stephens
- Division of Infectious Diseases, Department of Medicine Emory University School of Medicine , Atlanta, Georgia, USA
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Amidu N, Antuamwine BB, Addai-Mensah O, Abdul-Karim A, Stebleson A, Abubakari BB, Abenyeri J, Opoku AS, Nkukah JE, Najibullah AS. Diagnosis of bacterial meningitis in Ghana: Polymerase chain reaction versus latex agglutination methods. PLoS One 2019; 14:e0210812. [PMID: 30653582 PMCID: PMC6336253 DOI: 10.1371/journal.pone.0210812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/02/2019] [Indexed: 01/01/2023] Open
Abstract
Bacterial meningitis is a public health crisis in the northern part of Ghana, where it contributes to very high mortality and morbidity rates. Early detection of the causative organism will lead to better management and effective treatment. Our aim was to evaluate the diagnostic accuracy of Pastorex and Wellcogen latex agglutination tests for the detection of bacterial meningitis in a resource-limited setting. CSF samples from 330 suspected meningitis patients within the northern zone of Ghana were analysed for bacterial agents at the zonal Public Health Reference Laboratory in Tamale using polymerase chain reaction (PCR) and two latex agglutination test kits; Pastorex and Wellcogen. The overall positivity rate of samples tested for bacterial meningitis was 46.4%. Streptococcus pneumoniae was the most common cause of bacterial meningitis within the sub-region, with positivity rate of 25.2%, 28.2% and 28.8% when diagnosed using Wellcogen, Pastorex and PCR respectively. The Pastorex method was 97.4% sensitive while the Wellcogen technique was 87.6% sensitive. Both techniques however produced the same specificity of 99.4%. Our study revealed that the Pastorex method has a better diagnostic value for bacterial meningitis than the Wellcogen method and should be the method of choice in the absence of PCR.
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MESH Headings
- Adolescent
- Adult
- Bacterial Typing Techniques
- Child
- Child, Preschool
- Female
- Ghana
- Humans
- Latex Fixation Tests/methods
- Male
- Meningitis, Bacterial/cerebrospinal fluid
- Meningitis, Bacterial/diagnosis
- Meningitis, Bacterial/microbiology
- Meningitis, Haemophilus/cerebrospinal fluid
- Meningitis, Haemophilus/diagnosis
- Meningitis, Haemophilus/microbiology
- Meningitis, Meningococcal/cerebrospinal fluid
- Meningitis, Meningococcal/diagnosis
- Meningitis, Meningococcal/microbiology
- Meningitis, Pneumococcal/cerebrospinal fluid
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/microbiology
- Predictive Value of Tests
- ROC Curve
- Real-Time Polymerase Chain Reaction
- Reproducibility of Results
- Serotyping
- Streptococcal Infections/cerebrospinal fluid
- Streptococcal Infections/diagnosis
- Streptococcal Infections/microbiology
- Streptococcus agalactiae/genetics
- Streptococcus agalactiae/isolation & purification
- Young Adult
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Affiliation(s)
- Nafiu Amidu
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- * E-mail:
| | - Benedict Boateng Antuamwine
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Otchere Addai-Mensah
- Department of Medical Laboratory Technology, School of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Azure Stebleson
- Public Health Reference Laboratory, Northern Region, Tamale, Ghana
| | | | - John Abenyeri
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Afia Serwaa Opoku
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - John Eyulaku Nkukah
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Ali Sidi Najibullah
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Manzo LM, Ousmane S, Ibrahim DD, Zaneidou M, Testa J, Maïnassara HB. Bacterial meningitis in Niger: an analysis of national surveillance data, 2003-2015. Pan Afr Med J 2018; 30:235. [PMID: 30574254 PMCID: PMC6295294 DOI: 10.11604/pamj.2018.30.235.15937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/12/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Bacterial meningitis (BM) is one of the most severe infectious disease in Niger republic. To best describe the trends of BM disease, meningitis surveillance data from the Centre de Recherche Medicale et Sanitaire (CERMES) and the Direction of Surveillance and Response to Epidemics (DSRE) were reviewed and analyzed. Methods Data on number of notified cases of BM and on pathogens were analyzed during 2003-2015. Excel 2013 was used for trend analysis on the etiology of BM prevalence and incidence. Results A total of 10051 cerebrospinal fluid (CSF) samples collected were confirmed by laboratory methods. The main etiologies of meningitis detected were N. meningitidis (82.1%), S. pneumonia (12.1%) and H. influenza (3.4%). N. meningitidis mostly affected children in the age groups of 5-9 years (32.9%) and 10-14 years (24.9%) with respective mean incidence of 14.9 and 11.3. The percentage estimate of N. meningitidis serogroup A (NmA) meningitis fell to 0% in 2015 while during the same year that of N. meningitidis serogroup C (NmC) and N. meningitidis serogroup W (NmW) reached 82.9% and 17% respectively. Conclusion Overall, the epidemiological trends of the BM in Niger were dynamic. The emergence of NmC strains suggests that there may be an urgent need for serogroup C containing vaccines in Niger in the coming years.
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Affiliation(s)
- Lawaly Maman Manzo
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
| | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
| | - Dan Dano Ibrahim
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
| | - Maman Zaneidou
- Direction de la Surveillance et Riposte aux Epidémies (DSRE), Ministère de la Santé Publique, Niamey, Niger
| | - Jean Testa
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
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14
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Kwambana-Adams BA, Amaza RC, Okoi C, Rabiu M, Worwui A, Foster-Nyarko E, Ebruke B, Sesay AK, Senghore M, Umar AS, Usman R, Atiku A, Abdullahi G, Buhari Y, Sani R, Bako HU, Abdullahi B, Yarima AI, Sikiru B, Moses AO, Popoola MO, Ekeng E, Olayinka A, Mba N, Kankia A, Mamadu IN, Okudo I, Stephen M, Ronveaux O, Busuttil J, Mwenda JM, Abdulaziz M, Gummi SA, Adedeji A, Bita A, Omar L, Djingarey MH, Alemu W, D'Alessandro U, Ihekweazu C, Antonio M. Meningococcus serogroup C clonal complex ST-10217 outbreak in Zamfara State, Northern Nigeria. Sci Rep 2018; 8:14194. [PMID: 30242204 PMCID: PMC6155016 DOI: 10.1038/s41598-018-32475-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/10/2018] [Indexed: 12/03/2022] Open
Abstract
After the successful roll out of MenAfriVac, Nigeria has experienced sequential meningitis outbreaks attributed to meningococcus serogroup C (NmC). Zamfara State in North-western Nigeria recently was at the epicentre of the largest NmC outbreak in the 21st Century with 7,140 suspected meningitis cases and 553 deaths reported between December 2016 and May 2017. The overall attack rate was 155 per 100,000 population and children 5–14 years accounted for 47% (3,369/7,140) of suspected cases. The case fatality rate (CFR) among children 5–9 years was 10%, double that reported among adults ≥ 30 years (5%). NmC and pneumococcus accounted for 94% (172/184) and 5% (9/184) of the laboratory-confirmed cases, respectively. The sequenced NmC belonged to the ST-10217 clonal complex (CC). All serotyped pneumococci were PCV10 serotypes. The emergence of NmC ST-10217 CC outbreaks threatens the public health gains made by MenAfriVac, which calls for an urgent strategic action against meningitis outbreaks.
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Affiliation(s)
- Brenda A Kwambana-Adams
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | | | - Catherine Okoi
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Murtala Rabiu
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | - Archibald Worwui
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Ebenezer Foster-Nyarko
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Bernard Ebruke
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Abdul K Sesay
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Madikay Senghore
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | | | - Rabi Usman
- Zamfara State Ministry of Health, Gusau, Nigeria
| | - Adamu Atiku
- Zamfara State Ministry of Health, Gusau, Nigeria
| | | | - Yahaya Buhari
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | - Rabiu Sani
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | - Husaini U Bako
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | - Bashir Abdullahi
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | - Alliyu I Yarima
- Ahmad Sani Yariman Bakura Specialist Hospital Gusau, Zamfara State, Gusau, Nigeria
| | | | | | | | - Eme Ekeng
- Nigeria Center for Disease Control, Abuja, Nigeria
| | | | - Nwando Mba
- Nigeria Center for Disease Control, Abuja, Nigeria
| | - Adamu Kankia
- World Health Organization, Country Office Nigeria, Abuja, Nigeria
| | - Ibrahim N Mamadu
- World Health Organization, Country Office Nigeria, Abuja, Nigeria
| | - Ifeanyi Okudo
- World Health Organization, Country Office Nigeria, Abuja, Nigeria
| | - Mary Stephen
- World Health Organization, Country Office Nigeria, Abuja, Nigeria
| | | | - Jason Busuttil
- UK-Public Health Rapid Support Team, Public Health England, Salisbury, UK
| | - Jason M Mwenda
- World Health Organization, Regional office for Africa, Brazzaville, Congo
| | - Mohammed Abdulaziz
- Africa Centres for Diseases Control and Prevention, Addis Ababa, Ethiopia
| | | | | | - Andre Bita
- World Health Organization Inter-Country Support Teams for West Africa, Ouagadougou, Burkina Faso
| | - Linda Omar
- World Health Organization, Regional office for Africa, Brazzaville, Congo
| | | | | | - Umberto D'Alessandro
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | | | - Martin Antonio
- World Health Organization, Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia. .,Division of Microbiology & Immunity, Warwick Medical School, University of Warwick, Coventry, UK.
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15
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Serra LC, York LJ, Gamil A, Balmer P, Webber C. A Review of Meningococcal Disease and Vaccination Recommendations for Travelers. Infect Dis Ther 2018; 7:219-234. [PMID: 29550909 PMCID: PMC5986680 DOI: 10.1007/s40121-018-0196-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 11/14/2022] Open
Abstract
International travel has been steadily increasing since the middle of the twentieth century, including travel to regions with high levels of endemic meningococcal disease and areas with sporadic or sustained meningococcal outbreaks. Although invasive meningococcal disease (IMD) is relatively rare in travelers since the advent of quadrivalent meningococcal vaccines, it remains a serious concern because of its rapid progression, poor prognosis and outcomes, associated treatment delays, and the potential to precipitate outbreaks. Moreover, fatality occurs in up to 22% of those infected. This review will focus on IMD in travelers, with an emphasis on IMD epidemiology and the geographic regions of potential concern for international travelers. As vaccination is the best approach for preventing IMD among travelers, currently available meningococcal vaccines and corresponding country-specific national meningococcal vaccination recommendations, where available, will be summarized by age and type of vaccine recommended. The use of the quadrivalent meningococcal vaccines, specifically the tetanus toxoid conjugate vaccine (including MenACWY-TT; Nimenrix®), as a protective measure against IMD in travelers will be emphasized. FUNDING Pfizer Inc.
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Affiliation(s)
- Lidia C Serra
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA.
| | - Laura J York
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Amgad Gamil
- Pfizer Vaccines, Global Medical Development, Scientific and Clinical Affairs, Dubai, United Arab Emirates
| | - Paul Balmer
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Chris Webber
- Pfizer Vaccines, Clinical Research and Development, Pearl River, NY, USA
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16
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Kulkarni PS, Jadhav SS, LaForce FM. Developmental strategy for a new Group A meningococcal conjugate vaccine (MenAfriVac R). Hum Vaccin Immunother 2018; 14:1103-1106. [PMID: 29048988 DOI: 10.1080/21645515.2017.1391434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Until recently, periodic Group A meningococcal meningitis outbreaks were a major public health problem in the sub-Saharan Africa. In 2001, the Meningitis Vaccine Project (MVP), a partnership between the World Health Organization (WHO) and PATH, a Seattle-based NGO, and the Serum Institute of India Pvt Ltd (SIIPL) initiated discussions aimed at establishing a collaboration to develop a Group A meningococcal conjugate vaccine for this unmet medical need. Over the next 8 years the partnership made countless strategic decisions about product characteristics, raw materials, potential target populations, geographic prioritization and affordability of the vaccine to name a few. These decisions evolved into detailed plans for preclinical development, extensive field trials in Africa and India and a focused regulatory strategy specific for the Men A conjugate vaccine. Important characteristics of the process included, flexibility, transparency andeffective partnerships that included public agencies as well as private companies in Africa, Europe, the United States and India.
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17
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LaForce FM, Djingarey M, Viviani S, Preziosi MP. Successful African introduction of a new Group A meningococcal conjugate vaccine: Future challenges and next steps. Hum Vaccin Immunother 2018; 14:1098-1102. [PMID: 28968148 PMCID: PMC5989906 DOI: 10.1080/21645515.2017.1378841] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022] Open
Abstract
The introduction of a new Group A meningococcal conjugate vaccine, MenAfriVacR, has been a important public health success. Group A meningococcal meningitis has disappeared in all countries where the new Men A conjugate vaccine has been used at public health scale. However, continued control of Group A disease in sub-Saharan Africa will require that community immunity against Group A meningococci be maintained. Modeling studies have shown that unless herd immunity is maintained Group A meningococcal disease will return. To ensure that African populations remain protected birth cohorts must be protected with an EPI formulation of MenAfriVacR (5 mcg) given at 9 months with Measles 1. In addition, populations born after the initial 1-29 year old campaigns and consequently not yet immunized with the new Men A conjugate vaccine, will have to be immunized in country-specific catch-up campaigns. Countries with poor EPI coverage (Measles 1 coverage < 60%) will likely need quinquennial vaccination campaigns aimed at covering 1-4 year olds. Implementing these strategies is the only sure way of ensuring that Group A meningococcal meningitis epidemics will not recur. A second problem that requires urgent attention is the challenge of dealing with Non-A meningococcal meningitis epidemics in sub-Saharan Africa. Groups C, W and X meningococci are well-established circulating strains in sub-Saharan Africa and are responsible for yearly focal meningitis epidemics that vary in severity and remain unpredictable as to size and geographic distribution. For this reason, polyvalent meningococcal conjugate vaccines that are affordable and appropriate for the African context must be developed and introduced. These new meningococcal vaccines when combined with more affordable pneumococcal conjugate vaccines offer the promise of a meningitis-free Sub-Saharan Africa.
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18
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Vuocolo S, Balmer P, Gruber WC, Jansen KU, Anderson AS, Perez JL, York LJ. Vaccination strategies for the prevention of meningococcal disease. Hum Vaccin Immunother 2018; 14:1203-1215. [PMID: 29543535 PMCID: PMC5989901 DOI: 10.1080/21645515.2018.1451287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/08/2018] [Indexed: 01/05/2023] Open
Abstract
Routine prophylactic vaccination and mass vaccination strategies have been used to control both endemic and epidemic disease caused by Neisseria meningitidis globally. This review discusses real-world examples of these vaccination strategies, their implementation, and outcomes of these efforts, with the overall goal of providing insights on how to achieve optimal control of meningococcal disease through vaccination in varied settings. Tailoring immunization programs to fit the needs of the target population has the potential to optimally reduce disease incidence.
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Affiliation(s)
- Scott Vuocolo
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Paul Balmer
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | | | | | - John L. Perez
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Laura J. York
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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19
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Affiliation(s)
- Hans Fredlund
- Department of laboratory Medicine, Clinical Microbiology, School of Medical Sciences, Örebro University, Örebro, Sweden
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20
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Cost-effectiveness of expanding childhood routine immunization against Neisseria meningitidis serogroups C, W and Y with a quadrivalent conjugate vaccine in the African meningitis belt. PLoS One 2017; 12:e0188595. [PMID: 29190699 PMCID: PMC5708681 DOI: 10.1371/journal.pone.0188595] [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: 07/23/2017] [Accepted: 11/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neisseria meningitidis constitutes a major public health problem among countries in the African meningitis belt. Following regional vaccination campaigns for serogroup A and subsequent increases in protection against this serogroup, non-A serogroups such as C and W now pose significant epidemic threats, particularly in young children. OBJECTIVE To evaluate the cost-effectiveness of broadening coverage from conjugate serogroup A to quadrivalent ACWY vaccination. METHODS We developed a 40-year Markov state transition model with annual cycles to simulate costs and clinical outcomes in children aged 1 to 10 in the 26 countries of the African meningitis belt. The incidence of CWY meningitis cases among an unvaccinated population was held constant at inter-epidemic rates of 50 per 100,000/year and 150 per 100,000/year. The country-specific cost and probability of access to meningitis care, vaccine efficacy, the mortality risk among treated and untreated meningitis cases, the risk of clinical sequelae and their respective disability weights were based on published sources. Vaccination cost was based on international prices lists, presented in 2014 US$. RESULTS At an incidence rate of 50 per 100,000/year, routine conjugate vaccination is highly cost-effective in 14 out of 26 countries with a cost/DALY averted ranging from US$555-US$787. At the higher incidence rate of 150 per 100,000/year, quadrivalent vaccination is cost-effective in all 26 countries with a cost/DALY averted ranging from US$105-US$250. The annual incidence rate at which routine conjugate quadrivalent vaccination is expected to be economically justifiable ranges from 13 per 100,000/year in Nigeria to 142 per 100,000/year in Burundi. CONCLUSION Routine quadrivalent conjugate vaccination against Neisseria meningitidis is cost-effective at incidence rates well below the epidemic threshold among children living in the African meningitis belt.
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21
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Kwambana-Adams BA, Asiedu-Bekoe F, Sarkodie B, Afreh OK, Kuma GK, Owusu-Okyere G, Foster-Nyarko E, Ohene SA, Okot C, Worwui AK, Okoi C, Senghore M, Otu JK, Ebruke C, Bannerman R, Amponsa-Achiano K, Opare D, Kay G, Letsa T, Kaluwa O, Appiah-Denkyira E, Bampoe V, Zaman SMA, Pallen MJ, D'Alessandro U, Mwenda JM, Antonio M. An outbreak of pneumococcal meningitis among older children (≥5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana. BMC Infect Dis 2016; 16:575. [PMID: 27756235 PMCID: PMC5070171 DOI: 10.1186/s12879-016-1914-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/11/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND An outbreak of pneumococcal meningitis among non-infant children and adults occurred in the Brong-Ahafo region of Ghana between December 2015 and April 2016 despite the recent nationwide implementation of a vaccination programme for infants with the 13-valent pneumococcal conjugate vaccine (PCV13). METHODS Cerebrospinal fluid (CSF) specimens were collected from patients with suspected meningitis in the Brong-Ahafo region. CSF specimens were subjected to Gram staining, culture and rapid antigen testing. Quantitative PCR was performed to identify pneumococcus, meningococcus and Haemophilus influenzae. Latex agglutination and molecular serotyping were performed on samples. Antibiogram and whole genome sequencing were performed on pneumococcal isolates. RESULTS Eight hundred eighty six patients were reported with suspected meningitis in the Brong-Ahafo region during the period of the outbreak. In the epicenter district, the prevalence was as high as 363 suspected cases per 100,000 people. Over 95 % of suspected cases occurred in non-infant children and adults, with a median age of 20 years. Bacterial meningitis was confirmed in just under a quarter of CSF specimens tested. Pneumococcus, meningococcus and Group B Streptococcus accounted for 77 %, 22 % and 1 % of confirmed cases respectively. The vast majority of serotyped pneumococci (80 %) belonged to serotype 1. Most of the pneumococcal isolates tested were susceptible to a broad range of antibiotics, with the exception of two pneumococcal serotype 1 strains that were resistant to both penicillin and trimethoprim-sulfamethoxazole. All sequenced pneumococcal serotype 1 strains belong to Sequence Type (ST) 303 in the hypervirulent ST217 clonal complex. CONCLUSION The occurrence of a pneumococcal serotype 1 meningitis outbreak three years after the introduction of PCV13 is alarming and calls for strengthening of meningitis surveillance and a re-evaluation of the current vaccination programme in high risk countries.
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Affiliation(s)
- Brenda Anna Kwambana-Adams
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | | | | | | | | | | | - Ebenezer Foster-Nyarko
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | | | | | - Archibald Kwame Worwui
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Catherine Okoi
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Madikay Senghore
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Jacob Kweku Otu
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Chinelo Ebruke
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Richard Bannerman
- Brong Ahafo Regional Health Directorate, Sunyani, Brong Ahafo, Ghana
| | | | - David Opare
- National Public Health Reference Laboratory, Ghana Health Service, Accra, Ghana
| | - Gemma Kay
- Microbiology and Infection Unit, Warwick Medical School, Warwick, UK
| | - Timothy Letsa
- Brong Ahafo Regional Health Directorate, Sunyani, Brong Ahafo, Ghana
| | | | | | | | - Syed M A Zaman
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Mark J Pallen
- Microbiology and Infection Unit, Warwick Medical School, Warwick, UK
| | - Umberto D'Alessandro
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia.,London School of Hygiene and Tropical Medicine, London, UK.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Martin Antonio
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia. .,Microbiology and Infection Unit, Warwick Medical School, Warwick, UK. .,London School of Hygiene and Tropical Medicine, London, UK.
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22
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Klepac P, Megiddo I, Grenfell BT, Laxminarayan R. Self-enforcing regional vaccination agreements. J R Soc Interface 2016; 13:20150907. [PMID: 26790996 PMCID: PMC4759795 DOI: 10.1098/rsif.2015.0907] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In a highly interconnected world, immunizing infections are a transboundary problem, and their control and elimination require international cooperation and coordination. In the absence of a global or regional body that can impose a universal vaccination strategy, each individual country sets its own strategy. Mobility of populations across borders can promote free-riding, because a country can benefit from the vaccination efforts of its neighbours, which can result in vaccination coverage lower than the global optimum. Here we explore whether voluntary coalitions that reward countries that join by cooperatively increasing vaccination coverage can solve this problem. We use dynamic epidemiological models embedded in a game-theoretic framework in order to identify conditions in which coalitions are self-enforcing and therefore stable, and thus successful at promoting a cooperative vaccination strategy. We find that countries can achieve significantly greater vaccination coverage at a lower cost by forming coalitions than when acting independently, provided a coalition has the tools to deter free-riding. Furthermore, when economically or epidemiologically asymmetric countries form coalitions, realized coverage is regionally more consistent than in the absence of coalitions.
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Affiliation(s)
- Petra Klepac
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - Itamar Megiddo
- Center for Disease Dynamics, Economics and Policy, Washington, DC 20036, USA
| | - Bryan T Grenfell
- Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544, USA Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ 08544, USA Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics and Policy, Washington, DC 20036, USA Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544, USA Public Health Foundation of India, New Delhi 110070, India
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23
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Abstract
The incidence of meningococcal disease is at an historic low in the United States, but prevention remains a priority because of the devastating outcomes and risk for outbreaks. Available vaccines are recommended routinely for persons at increased risk for disease to protect against all major serogroups of Neisseria meningitidis circulating in the United States. Although vaccination has virtually eliminated serogroup A meningococcal outbreaks from the Meningitis Belt of Africa and reduced the incidence of serogroup C disease worldwide, eradication of N meningitidis will unlikely be achieved by currently available vaccines because of the continued carriage and transmission of nonencapsulated organisms.
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Affiliation(s)
- Amanda Cohn
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jessica MacNeil
- Bacterial Diseases Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
The primary health care approach advanced at Alma Ata to address social determinants of health was replaced by selective health care a year later at Bellagio. Subsequently, immunization was endorsed as a cost-effective technical intervention to combat targeted infectious diseases. Multilateral efforts to collaborate on immunization as a universal public health good ambiguously capture the interests of the world's governments as well as private, public, and not-for-profit institutions. Global assemblages of scientists, governments, industry and nongovernmental organizations now work in public-private partnerships to develop and make essential vaccines accessible, with vaccines marketed as single fix solutions for global health. Drawing from ethnographic fieldwork in France and Burkina Faso that followed the development, regulation, and implementation of the group A meningococcal conjugate vaccine for sub-Saharan Africa, in this article I describe events during and after the development of MenAfriVac. A technological success narrative steeped in collaborative capitalist rhetoric disguises neglected health care systems.
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Affiliation(s)
- Janice Graham
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
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25
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Holme D, Findlow H, Sow SO, Idoko OT, Preziosi MP, Carlone G, Plikaytis BD, Borrow R. Neisseria meningitidis Group A IgG1 and IgG2 Subclass Immune Response in African Children Aged 12-23 Months Following Meningococcal Vaccination. Clin Infect Dis 2016; 61 Suppl 5:S563-9. [PMID: 26553689 PMCID: PMC4639486 DOI: 10.1093/cid/civ505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background. A group A meningococcal conjugate vaccine, PsA-TT, was licensed in 2010 and was previously studied in a phase 2 clinical trial to evaluate its safety and immunogenicity in African children 12–23 months of age. Methods. Subjects received either PsA-TT; meningococcal group A, C, W, Y polysaccharide vaccine (PsACWY); or Haemophilus influenzae type b conjugate vaccine (Hib-TT). Forty weeks following primary vaccination, the 3 groups were further randomized to receive either PsA-TT, one-fifth dose of PsACWY, or Hib-TT. Group A–specific immunoglobulin G (IgG) subclass response was characterized using an enzyme-linked immunosorbent assay. Results. The predominant IgG subclass response, regardless of vaccine, was IgG1. One month following primary vaccination, the geometric mean concentrations (GMCs) of IgG1 and IgG2 in the PsA-TT group were 21.73 µg/mL and 6.27 µg/mL, whereas in the PsACWY group the mean GMCs were 2.01 µg/mL and 0.97 µg/mL, respectively (P < .0001). Group A–specific IgG1 and IgG2 GMCs remained greater in the PsA-TT group than in the PsACWY group 40 weeks following primary vaccination (P < .0001). One week following revaccination, those given 2 doses of PsA-TT had the greatest IgG1 and IgG2 GMCs of 125.23 µg/mL and 36.12 µg/mL, respectively (P = .0008), and demonstrated a significant increase in IgG1:IgG2 mean ratio, indicative of the T-cell–dependent response associated with conjugate vaccines. Conclusions. Vaccination of African children aged 12–24 months with either PsA-TT or PsACWY elicited a predominantly IgG1 response. The IgG1:IgG2 mean ratio decreased following successive vaccination with PsACWY, indicating a shift toward IgG2, suggestive of the T-cell–independent immune response commonly associated with polysaccharide antigens. Clinical Trials Registration. SRCTN78147026.
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Affiliation(s)
- Daniel Holme
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | | | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - George Carlone
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
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Diomandé FVK, Yaméogo TM, Vannice KS, Preziosi MP, Viviani S, Ouandaogo CR, Keita M, Djingarey MH, Mbakuliyemo N, Akanmori BD, Sow SO, Zuber PLF. Lessons Learned From Enhancing Vaccine Pharmacovigilance Activities During PsA-TT Introduction in African Countries, 2010-2013. Clin Infect Dis 2016; 61 Suppl 5:S459-66. [PMID: 26553675 PMCID: PMC4639501 DOI: 10.1093/cid/civ599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background. The rollout of the group A meningococcal vaccine, PsA-TT, in Africa's meningitis belt countries represented the first introduction of a vaccine specifically designed for this part of the world. During the first year alone, the number of people who received the vaccine through mass vaccination campaigns was several hundredfold higher than that of subjects who participated in the closely monitored clinical trials. Implementation of a system to identify rare but potentially serious vaccine reactions was therefore a high priority in the design and implementation of those campaigns. Methods. National authorities and their technical partners set up effective vaccine pharmacovigilance systems, including conducting active surveillance projects. Results. Implementation of national expert advisory groups to review serious adverse events following immunization in all countries and active monitoring of conditions of interest in 3 early-adopter countries did not identify particular concerns with the safety profile of PsA-TT, which had already provided tremendous public health benefits. Conclusions. Lessons learned from this experience will help to improve preparations for future vaccine introductions in resource-poor settings and capitalize on such efforts to advance vaccine safety systems in the future.
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Affiliation(s)
| | - Téné M Yaméogo
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, Burkina Faso
| | - Kirsten S Vannice
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Claude-Roger Ouandaogo
- Direction Générale de la Pharmacie du Médicament et des Laboratoire, Ministère de la santé, Ouagadougou, Burkina Faso
| | - Modibo Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Mamoudou H Djingarey
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Nehemie Mbakuliyemo
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Bartholomew Dicky Akanmori
- Department of Immunization Vaccines and Emergency, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
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Kulkarni PS, Socquet M, Jadhav SS, Kapre SV, LaForce FM, Poonawalla CS. Challenges and Opportunities While Developing a Group A Meningococcal Conjugate Vaccine Within a Product Development Partnership: A Manufacturer's Perspective From the Serum Institute of India. Clin Infect Dis 2016; 61 Suppl 5:S483-8. [PMID: 26553678 PMCID: PMC4639485 DOI: 10.1093/cid/civ500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background. In 2002, the Meningitis Vaccine Project (MVP) chose the Serum Institute of India, Ltd (SIIL), as its manufacturing partner to establish a product development partnership (PDP) with the Meningitis Vaccine Project (MVP). MVP was a collaboration between PATH and the World Health Organization (WHO) to develop meningococcal conjugate vaccines for sub-Saharan Africa. Method. From the outset, SIIL recognized that a partnership with MVP carried some risk but also offered important opportunities for accessing new conjugate vaccine technology and know-how. Over 3 years, SIIL successfully accepted technology transfer for the group A meningococcal polysaccharide from SynCo Bio Partners and a conjugation method from the US Food and Drug Administration. Results. SIIL successfully scaled up production of a group A meningococcal conjugate vaccine that used SIIL tetanus toxoid as the carrier protein. Phase 1 studies began in India in 2005, followed by phase 2/3 studies in Africa and India. A regulatory dossier was submitted to the Indian authorities in April 2009 and WHO in September 2009. Export license was granted in December 2009, and WHO prequalification was obtained in June 2010. Vaccine was introduced at public scale in Burkina Faso that December. The group A meningococcal conjugate vaccine was named MenAfriVac, and is the first internationally qualified vaccine developed outside of big pharma. Conclusions. The project proved to be a sound investment for SIIL and is a concrete example of the potential for PDPs to provide needed products for resource-poor countries.
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Sambo L, Chan M, Davis S, Lake A, Berkley S, Poonawalla C, Elias CJ. A Vaccine Meets Its Promise: Success in Controlling Epidemic Meningitis in Sub-Saharan Africa. Clin Infect Dis 2016; 61 Suppl 5:S387-8. [PMID: 26553663 PMCID: PMC4639480 DOI: 10.1093/cid/civ490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Luis Sambo
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | | | | - Anthony Lake
- United Nations Children's Fund, New York, New York
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Vannice KS, Keita M, Sow SO, Durbin AP, Omer SB, Moulton LH, Yaméogo TM, Zuber PLF, Onwuchekwa U, Sacko M, Diomandé FVK, Halsey NA. Active Surveillance for Adverse Events After a Mass Vaccination Campaign With a Group A Meningococcal Conjugate Vaccine (PsA-TT) in Mali. Clin Infect Dis 2016; 61 Suppl 5:S493-500. [PMID: 26553680 PMCID: PMC4639483 DOI: 10.1093/cid/civ497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The monovalent meningococcal A conjugate vaccine (PsA-TT, MenAfriVac) was developed for use in the "meningitis belt" of sub-Saharan Africa. Mali was 1 of 3 countries selected for early introduction. As this is a new vaccine, postlicensure surveillance is particularly important to identify and characterize possible safety issues. METHODS The national vaccination campaign was phased from September 2010 to November 2011. We conducted postlicensure safety surveillance for PsA-TT in 40 government clinics from southern Mali serving approximately 400 000 people 1-29 years of age. We conducted analyses with individual-level data and population-level data, and we calculated rates of adverse events using the conditional exact test, a modified vaccine cohort risk interval method, and a modified self-controlled case series method for each outcome of interest, including 18 prespecified adverse events and 18 syndromic categories. RESULTS An increased rate of clinic visits for fever within 3 days after vaccination was found using multiple methods for all age groups. Although other signals were found with some methods, complete assessment of all other prespecified outcomes and syndromic categories did not reveal that PsA-TT was consistently associated with any other health problem. CONCLUSIONS No new safety concerns were identified in this study. These results are consistent with prelicensure data and other studies indicating that PsA-TT is safe. The approach presented could serve as a model for future active postlicensure vaccine safety monitoring associated with large-scale immunization campaigns in low-income countries.
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Affiliation(s)
- Kirsten S Vannice
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Modibo Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Anna P Durbin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Saad B Omer
- Emory Vaccine Center and Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Téné M Yaméogo
- Institut supérieur des sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, Burkina Faso
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Massambou Sacko
- World Health Organization, Mali Country Office, Bamako, Mali
| | | | - Neal A Halsey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Basta NE, Borrow R, Berthe A, Dembélé ATE, Onwuchekwa U, Townsend K, Boukary RM, Mabey L, Findlow H, Bai X, Sow SO. Population-Level Persistence of Immunity 2 Years After the PsA-TT Mass-Vaccination Campaign in Mali. Clin Infect Dis 2016; 61 Suppl 5:S547-53. [PMID: 26553687 PMCID: PMC4639504 DOI: 10.1093/cid/civ602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background. In 2010, Africa's first preventive meningococcal mass vaccination campaign was launched using a newly developed Neisseria meningitidis group A (NmA) polysaccharide–tetanus toxoid conjugate vaccine, PsA-TT (MenAfriVac), designed specifically for the meningitis belt. Given PsA-TT's recent introduction, the duration of protection against meningococcal group A is unknown. Methods. We conducted a household-based, age-stratified seroprevalence survey in Bamako, Mali, in 2012, 2 years after the vaccination campaign targeted all 1- to 29-year-olds. Randomly selected participants who had been eligible for PsA-TT provided a blood sample and responded to a questionnaire. Sera were analyzed to assess NmA-specific serum bactericidal antibody titers using rabbit complement (rSBA) and NmA-specific immunoglobulin G (IgG) by enzyme-linked immunosorbent assay. The proportion of participants putatively protected and the age group- and sex-specific rSBA geometric mean titers (GMTs) and IgG geometric mean concentrations (GMCs) were determined. Results. Two years postvaccination, nearly all of the 800 participants (99.0%; 95% confidence interval [CI], 98.3%–99.7%) maintained NmA-specific rSBA titers ≥8, the accepted threshold for protection; 98.6% (95% CI, 97.8%–99.4%) had titers ≥128, and 89.5% (95% CI, 87.4%–91.6%) had titers ≥1024. The rSBA GMTs were significantly higher in females than in males aged <18 years at vaccination (P < .0001). NmA-specific IgG levels ≥2 µg/mL were found in 88.5% (95% CI, 86.3%–90.7%) of participants. Conclusions. Two years after PsA-TT introduction, a very high proportion of the population targeted for vaccination maintains high antibody titers against NmA. Assessing the duration of protection provided by PsA-TT is a priority for implementing evidence-based vaccination strategies. Representative, population-based seroprevalence studies complement clinical trials and provide this key evidence.
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Affiliation(s)
- Nicole E Basta
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - Abdoulaye Berthe
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | | | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Kelly Townsend
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - Rahamatou M Boukary
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - Lesley Mabey
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - 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
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
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31
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Frasch CE, Kapre SV, Lee CH, Préaud JM. Technical Development of a New Meningococcal Conjugate Vaccine. Clin Infect Dis 2016; 61 Suppl 5:S404-9. [PMID: 26553667 PMCID: PMC4639497 DOI: 10.1093/cid/civ595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background. Group A Neisseria meningitidis has been a major cause of bacterial meningitis in the sub-Saharan region of Africa in the meningitis belt. Neisseria meningitidis is an encapsulated pathogen, and antibodies against the capsular polysaccharide are protective. Polysaccharide–protein conjugate vaccines have proven to be highly effective against several different encapsulated bacterial pathogens. Purified polysaccharide vaccines have been used to control group A meningococcal (MenA) epidemics with minimal success. Methods. A monovalent MenA polysaccharide–tetanus toxoid conjugate was therefore developed. This vaccine was developed by scientists working with the Meningitis Vaccine Project, a partnership between PATH and the World Health Organization. Results. A high-efficiency conjugation method was developed in the Laboratory of Bacterial Polysaccharides in the Center for Biologics Evaluation and Research and transferred to the Serum Institute of India, Ltd, which then developed methods for purification of the group A polysaccharide and used its tetanus toxoid as the carrier protein to produce the now-licensed, highly effective MenAfriVac conjugate vaccine. Conclusions. Although many years of application of meningococcal polysaccharide vaccines have had minimal success in preventing meningococcal epidemics in the meningitis belt of Africa, our collaborative efforts to develop a MenA conjugate vaccine yielded a safe and highly effective vaccine.
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Affiliation(s)
- Carl E Frasch
- Frasch Biologics Consulting, Martinsburg, West Virginia
| | | | - Che-Hung Lee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland
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Diokhane AM, Jenkins GS, Manga N, Drame MS, Mbodji B. Linkages between observed, modeled Saharan dust loading and meningitis in Senegal during 2012 and 2013. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2016; 60:557-75. [PMID: 26296434 DOI: 10.1007/s00484-015-1051-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 08/08/2015] [Accepted: 08/09/2015] [Indexed: 05/24/2023]
Abstract
The Sahara desert transports large quantities of dust over the Sahelian region during the Northern Hemisphere winter and spring seasons (December-April). In episodic events, high dust concentrations are found at the surface, negatively impacting respiratory health. Bacterial meningitis in particular is known to affect populations that live in the Sahelian zones, which is otherwise known as the meningitis belt. During the winter and spring of 2012, suspected meningitis cases (SMCs) were with three times higher than in 2013. We show higher surface particular matter concentrations at Dakar, Senegal and elevated atmospheric dust loading in Senegal for the period of 1 January-31 May during 2012 relative to 2013. We analyze simulated particulate matter over Senegal from the Weather Research and Forecasting (WRF) model during 2012 and 2013. The results show higher simulated dust concentrations during the winter season of 2012 for Senegal. The WRF model correctly captures the large dust events from 1 January-31 March but has shown less skill during April and May for simulated dust concentrations. The results also show that the boundary conditions are the key feature for correctly simulating large dust events and initial conditions are less important.
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Affiliation(s)
- Aminata Mbow Diokhane
- Centre de Gestion de la Qualité de l'Air (CGQA), from the Direction de l'Environnement et des Etablissements Classés (DEEC), Dakar, Senegal
| | - Gregory S Jenkins
- Department of Physics and Astronomy, Howard University, Washington, DC, USA.
| | - Noel Manga
- Unité de formation et de recherche en Sciences de la santé (UFR-2S), Université Assane Seck Ziguinchor (UASZ), Ziguinchor, Senegal
| | - Mamadou S Drame
- Laboratory for Atmospheric-Oceanic Physics-Simeon Fongang (LPAO-SF), Cheikh Anta Diop University, Dakar, Senegal
| | - Boubacar Mbodji
- Centre de Gestion de la Qualité de l'Air (CGQA), from the Direction de l'Environnement et des Etablissements Classés (DEEC), Dakar, Senegal
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Portnoy A, Jit M, Lauer J, Blommaert A, Ozawa S, Stack M, Murray J, Hutubessy R. Estimating costs of care for meningitis infections in low- and middle-income countries. Vaccine 2016; 33 Suppl 1:A240-7. [PMID: 25919168 DOI: 10.1016/j.vaccine.2014.11.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/22/2014] [Accepted: 11/18/2014] [Indexed: 11/24/2022]
Abstract
Meningitis infections are often associated with high mortality and risk of sequelae. The costs of treatment and care for meningitis are a great burden on health care systems, particularly in resource-limited settings. The objective of this study is to review data on the costs of care for meningitis in low- and middle-income countries, as well as to show how results could be extrapolated to countries without sound data. We conducted a systematic review of the literature from six databases to identify studies examining the cost of care in low- and middle-income countries for all age groups with suspected, probable, or confirmed meningitis. We extracted data on treatment costs and sequelae by infectious agent and/or pathogen, where possible. Using multiple regression analysis, a relationship between hospital costs and associated determinants was investigated in order to predict costs in countries with missing data. This relationship was used to predict treatment costs for all 144 low- and middle-income countries. The methodology of conducting a systematic review, extrapolating, and setting up a standard database can be used as a tool to inform cost-effectiveness analyses in situations where cost of care data are poor. Both acute and long-term costs of meningitis could be extrapolated to countries without reliable data. Although only bacterial causes of meningitis can be vaccine-preventable, a better understanding of the treatment costs for meningitis is crucial for low- and middle-income countries to assess the cost-effectiveness of proposed interventions in their country. This cost information will be important as inputs in future cost-effectiveness studies, particularly for vaccines.
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Affiliation(s)
- Allison Portnoy
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Modelling and Economics Unit, Public Health England, London NW9 5EQ, United Kingdom.
| | - Jeremy Lauer
- World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
| | - Adriaan Blommaert
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, Campus Drie Eiken Lokaal D.R.212, 2610 Wilrijk, Antwerp, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Campus Diepenbeek Agoralaan Gebouw D; BE 3590, Diepenbeek, Belgium.
| | - Sachiko Ozawa
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Meghan Stack
- Independent Consultant, 2417 Panama Street, Philadelphia, PA 19103, USA.
| | - Jillian Murray
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Raymond Hutubessy
- World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
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Aguado MT, Jodar L, Granoff D, Rabinovich R, Ceccarini C, Perkin GW. From Epidemic Meningitis Vaccines for Africa to the Meningitis Vaccine Project. Clin Infect Dis 2015; 61 Suppl 5:S391-5. [PMID: 26553665 PMCID: PMC4639495 DOI: 10.1093/cid/civ593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Polysaccharide vaccines had been used to control African meningitis epidemics for >30 years but with little or modest success, largely because of logistical problems in the implementation of reactive vaccination campaigns that are begun after epidemics are under way. After the major group A meningococcal meningitis epidemics in 1996-1997 (250,000 cases and 25,000 deaths), African ministers of health declared the prevention of meningitis a high priority and asked the World Health Organization (WHO) for help in developing better immunization strategies to eliminate meningitis epidemics in Africa. METHODS WHO accepted the challenge and created a project called Epidemic Meningitis Vaccines for Africa (EVA) that served as an organizational framework for external consultants, PATH, the US Centers for Disease Control and Prevention (CDC), and the Bill & Melinda Gates Foundation (BMGF). Consultations were initiated with major vaccine manufacturers. EVA commissioned a costing study/business plan for the development of new group A or A/C conjugate vaccines and explored the feasibility of developing these products as a public-private partnership. Representatives from African countries were consulted. They confirmed that the development of conjugate vaccines was a priority and provided information on preferred product characteristics. In parallel, a strategy for successful introduction was also anticipated and discussed. RESULTS The expert consultations recommended that a group A meningococcal conjugate vaccine be developed and introduced into the African meningitis belt. The results of the costing study indicated that the "cost of goods" to develop a group A - containing conjugate vaccine in the United States would be in the range of US$0.35-$1.35 per dose, depending on composition (A vs A/C), number of doses/vials, and presentation. Following an invitation from BMGF, a proposal was submitted in the spring of 2001. CONCLUSIONS In June 2001, BMGF awarded a grant of US$70 million to create the Meningitis Vaccine Project (MVP) as a partnership between PATH and WHO, with the specific goal of developing an affordable MenA conjugate vaccine to eliminate MenA meningitis epidemics in Africa. EVA is an example of the use of WHO as an important convening instrument to facilitate new approaches to address major public health problems.
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Affiliation(s)
| | | | - Dan Granoff
- Children's Hospital Oakland Research Institute, California
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Ouatara S, Faye A, Leye MMM, Niang K, Tal-Dia A. [Study of the immunization coverage determinants of vaccination campaign against meningococcal A meningitis in Burkina Faso]. Rev Epidemiol Sante Publique 2015; 63:347-53. [PMID: 26547670 DOI: 10.1016/j.respe.2015.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 08/31/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa countries suffer from repeated and explosive epidemics of meningitis mainly due to Neisseria meningitidis A. In December 2010, Burkina Faso organized a vaccination campaign with MenAfriVac® for people aged 1-29 years old. The objective of this study was to analyze the determinants of immunization coverage. METHODS We used a cross-sectional survey by cluster sampling in two stages, descriptive and analytical, conducted in the region of "Boucle du Mouhoun". Data were collected during a home interview. The dependent variable was vaccination status and the independent variables included individual and household characteristics but also the means of communication used during the campaign. A logistic regression model was used to estimate the risk of being vaccinated using the 'Survey' Package (SVYGLM) of R. RESULTS Two thousand and twenty-five people were included with a 93.5 % estimated coverage. Factors associated with high vaccination coverage are rural areas (ORa=2.53 [1.53-4.17]) and smaller households (ORa=3.06 [1.36-6.91]). The risk of being vaccinated was lower for persons from salaried heads of household (ORa=0.14 [0.02-0.87]) versus farmers, persons informed by religious and traditional leaders (ORa=0.25 [0.11-0.57]) or family and friends (ORa=0.51 [0.29-0.9]) versus community mobilizers. CONCLUSION The coverage recorded is sufficient to provide community immunity. However, a part of the target population could not benefit from vaccination due to lack of information. Particular emphasis should be placed on large urban families using community mobilizers.
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Affiliation(s)
- S Ouatara
- Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Sénégal; Ministère de la Santé, Ouagadougou, Burkina Faso
| | - A Faye
- Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Sénégal; Université de Montréal, Montréal, QC, Canada.
| | - M M M Leye
- Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Sénégal
| | - K Niang
- Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Sénégal
| | - A Tal-Dia
- Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Sénégal
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Litschko C, Romano MR, Pinto V, Claus H, Vogel U, Berti F, Gerardy-Schahn R, Fiebig T. The capsule polymerase CslB of Neisseria meningitidis serogroup L catalyzes the synthesis of a complex trimeric repeating unit comprising glycosidic and phosphodiester linkages. J Biol Chem 2015; 290:24355-66. [PMID: 26286750 DOI: 10.1074/jbc.m115.678094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Indexed: 11/06/2022] Open
Abstract
Neisseria meningitidis is a human pathogen causing bacterial meningitis and sepsis. The capsular polysaccharide surrounding N. meningitidis is a major virulence factor. The capsular polysaccharide consists of polyhexosamine phosphates in N. meningitidis serogroups A and X. The capsule polymerases (CPs) of these serogroups are members of the Stealth protein family comprising d-hexose-1-phosphate transferases from bacterial and protozoan pathogens. CslA, one of two putative CPs of the pathophysiologically less relevant N. meningitidis serogroup L, is one of the smallest known Stealth proteins and caught our attention for structure-function analyses. Because the N. meningitidis serogroup L capsule polymer consists of a trimeric repeating unit ([→3)-β-d-GlcNAc-(1→3)-β-d-GlcNAc-(1→3)-α-d-GlcNAc-(1→OPO3→]n), we speculated that the two predicted CPs (CslA and CslB) work together in polymer production. Consequently, both enzymes were cloned, overexpressed, and purified as recombinant proteins. Contrary to our expectation, enzymatic testing identified CslB to be sufficient to catalyze the synthesis of the complex trimeric N. meningitidis serogroup L capsule polymer repeating unit. No polymerase activity was detected for CslA, although the enzyme facilitated the hydrolysis of UDP-GlcNAc. Bioinformatics analyses identified two glycosyltransferase (GT) domains in CslB. The N-terminal domain modeled with 100% confidence onto a number of GT-A folded proteins, whereas the C-terminal domain modeled with 100% confidence onto TagF, a GT-B folded teichoic acid polymerase from Staphylococcus epidermidis. Amino acid positions known to have critical catalytic functions in the template proteins were conserved in CslB, and their point mutation abolished enzyme activity. CslB represents an enzyme of so far unique complexity regarding both the catalyzed reaction and enzyme architecture.
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Affiliation(s)
- Christa Litschko
- From the Institute for Cellular Chemistry, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | | | - Vittoria Pinto
- Research, GSK Vaccines, Via Fiorentina 1, 53100 Siena, Italy, and
| | - Heike Claus
- the Institute for Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany
| | - Ulrich Vogel
- the Institute for Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany
| | - Francesco Berti
- Research, GSK Vaccines, Via Fiorentina 1, 53100 Siena, Italy, and
| | - Rita Gerardy-Schahn
- From the Institute for Cellular Chemistry, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - Timm Fiebig
- From the Institute for Cellular Chemistry, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany,
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Meyer SA, Kambou JL, Cohn A, Goodson JL, Flannery B, Medah I, Messonnier N, Novak R, Diomande F, Djingarey MH, Clark TA, Yameogo I, Fall A, Wannemuehler K. Serogroup A meningococcal conjugate (PsA-TT) vaccine coverage and measles vaccine coverage in Burkina Faso--implications for introduction of PsA-TT into the Expanded Programme on Immunization. Vaccine 2015; 33:1492-8. [PMID: 25636915 DOI: 10.1016/j.vaccine.2015.01.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/21/2014] [Accepted: 01/15/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND A new serogroup A meningococcal conjugate vaccine (PsA-TT, MenAfriVac™) has been developed to combat devastating serogroup A Neisseria meningitis (MenA) epidemics in Africa. A mass immunization campaign targeting 1-29 year olds was conducted in Burkina Faso in December 2010. Protection of subsequent infant cohorts will be necessary through either introduction of PsA-TT into the routine Expanded Programme on Immunization (EPI) or periodic repeat mass vaccination campaigns. OBJECTIVES To inform future immunization policy for PsA-TT vaccination of infants through a comparison of PsA-TT campaign vaccination coverage and routine measles-containing vaccine (MCV) coverage in Burkina Faso. METHODS A national survey was conducted in Burkina Faso during December 17-27, 2011 using stratified cluster sampling to assess PsA-TT vaccine coverage achieved by the 2010 nationwide immunization campaign among 2-30 year olds and routine MCV coverage among 12-23 month olds. Coverage estimates and 95% Confidence Intervals (CI) were calculated, reasons for non-vaccination and methods of campaign communication were described, and a multivariable analysis for factors associated with vaccination was conducted. RESULTS National overall PsA-TT campaign coverage was 95.9% (95% CI: 95.0-96.7) with coverage greater than 90% all 13 regions of Burkina Faso. National overall routine MCV coverage was 92.5% (95% CI: 90.5-94.1), but ranged from 75.3% to 95.3% by region. The primary predictor for PsA-TT vaccination among all age groups was a head of household informed of the campaign. PsA-TT vaccination was more likely in residents of rural settings, whereas MCV vaccination was more likely in residents of urban settings. CONCLUSION Overall national vaccination rates in Burkina Faso were similar for PsA-TT and MCV vaccine. The regions with MCV coverage below targets may be at risk for sub-optimal vaccination coverage if PsA-TT is introduced in EPI. These results highlight the need for assessments of routine vaccination coverage to guide PsA-TT immunization policy in meningitis belt countries.
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Affiliation(s)
- Sarah A Meyer
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C25, Atlanta, GA 30333, United States; Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E92, Atlanta, GA 30333, United States.
| | - Jean Ludovic Kambou
- Direction de la Prévention par les Vaccinations, Burkina Faso Ministry of Health, 03 BP 7009 Ouagadougou, Burkina Faso.
| | - Amanda Cohn
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C25, Atlanta, GA 30333, United States.
| | - James L Goodson
- Global Immunizations Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A04, Atlanta, GA 30333, United States.
| | - Brendan Flannery
- Global Immunizations Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A04, Atlanta, GA 30333, United States.
| | - Isaïe Medah
- Direction de la Lutte contre la Maladie, Burkina Faso Ministry of Health, 03 BP 7009 Ouagadougou, Burkina Faso.
| | - Nancy Messonnier
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C25, Atlanta, GA 30333, United States.
| | - Ryan Novak
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C25, Atlanta, GA 30333, United States.
| | - Fabien Diomande
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C25, Atlanta, GA 30333, United States.
| | - Mamoudou H Djingarey
- World Health Organization Intercountry Support Team for West Africa, 158 Avenue de l'Indépendance, 03 BP 7019 Ouagadougou, Burkina Faso.
| | - Thomas A Clark
- Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C25, Atlanta, GA 30333, United States.
| | - Issaka Yameogo
- Direction de la Lutte contre la Maladie, Burkina Faso Ministry of Health, 03 BP 7009 Ouagadougou, Burkina Faso.
| | - Amadou Fall
- World Health Organization Intercountry Support Team for West Africa, 158 Avenue de l'Indépendance, 03 BP 7019 Ouagadougou, Burkina Faso.
| | - Kathleen Wannemuehler
- Global Immunizations Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A04, Atlanta, GA 30333, United States.
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Kristiansen PA, Ba AK, Ouédraogo AS, Sanou I, Ouédraogo R, Sangaré L, Diomandé F, Kandolo D, Saga IM, Misegades L, Clark TA, Préziosi MP, Caugant DA. Persistent low carriage of serogroup A Neisseria meningitidis two years after mass vaccination with the meningococcal conjugate vaccine, MenAfriVac. BMC Infect Dis 2014; 14:663. [PMID: 25472422 PMCID: PMC4267149 DOI: 10.1186/s12879-014-0663-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/24/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The conjugate vaccine against serogroup A Neisseria meningitidis (NmA), MenAfriVac, is currently being introduced throughout the African meningitis belt. In repeated multicentre cross-sectional studies in Burkina Faso we demonstrated a significant effect of vaccination on NmA carriage for one year following mass vaccination in 2010. A new multicentre carriage study was performed in October-November 2012, two years after MenAfriVac mass vaccination. METHODS Oropharyngeal samples were collected and analysed for presence of N. meningitidis (Nm) from a representative selection of 1-29-year-olds in three districts in Burkina Faso using the same procedures as in previous years. Characterization of Nm isolates included serogrouping, multilocus sequence typing, and porA and fetA sequencing. A small sample of invasive isolates collected during the epidemic season of 2012 through the national surveillance system were also analysed. RESULTS From a total of 4964 oropharyngeal samples, overall meningococcal carriage prevalence was 7.86%. NmA prevalence was 0.02% (1 carrier), significantly lower (OR, 0.05, P = 0.005, 95% CI, 0.006-0.403) than pre-vaccination prevalence (0.39%). The single NmA isolate was sequence type (ST)-7, P1.20,9;F3-1, a clone last identified in Burkina Faso in 2003. Nm serogroup W (NmW) dominated with a carriage prevalence of 6.85%, representing 87.2% of the isolates. Of 161 NmW isolates characterized by molecular techniques, 94% belonged to the ST-11 clonal complex and 6% to the ST-175 complex. Nm serogroup X (NmX) was carried by 0.60% of the participants and ST-181 accounted for 97% of the NmX isolates. Carriage prevalence of serogroup Y and non-groupable Nm was 0.20% and 0.18%, respectively. Among the 20 isolates recovered from meningitis cases, NmW dominated (70%), followed by NmX (25%). ST-2859, the only ST with a serogroup A capsule found in Burkina Faso since 2004, was not found with another capsule, neither among carriage nor invasive isolates. CONCLUSIONS The significant reduction of NmA carriage still persisted two years following MenAfriVac vaccination, and no cases of NmA meningitis were recorded. High carriage prevalence of NmW ST-11 was consistent with the many cases of NmW meningitis in the epidemic season of 2012 and the high proportion of NmW ST-11 among the characterized invasive isolates.
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Affiliation(s)
- Paul A Kristiansen
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.
| | - Absatou Ky Ba
- Laboratoire National de Santé Public, Ouagadougou, Burkina Faso.
| | | | - Idrissa Sanou
- Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso.
- Centre Hospitalier Universitaire Yalgado, Ouagadougou, Burkina Faso.
| | - Rasmata Ouédraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.
| | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado, Ouagadougou, Burkina Faso.
| | - Fabien Diomandé
- WHO Inter Country Support Team, Ouagadougou, Burkina Faso.
- Centers for Disease Control and Prevention, Atlanta, USA.
| | - Denis Kandolo
- WHO Inter Country Support Team, Ouagadougou, Burkina Faso.
| | - Inger Marie Saga
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.
| | - Lara Misegades
- Centers for Disease Control and Prevention, Atlanta, USA.
| | - Thomas A Clark
- Centers for Disease Control and Prevention, Atlanta, USA.
| | - Marie-Pierre Préziosi
- Meningitis Vaccine Project, Ferney, France.
- WHO Initiative for Vaccine Research, Geneva, Switzerland.
| | - Dominique A Caugant
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
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Ferraro CF, Trotter CL, Nascimento MC, Jusot JF, Omotara BA, Hodgson A, Ali O, Alavo S, Sow S, Daugla DM, Stuart JM. Household crowding, social mixing patterns and respiratory symptoms in seven countries of the African meningitis belt. PLoS One 2014; 9:e101129. [PMID: 24988195 PMCID: PMC4079295 DOI: 10.1371/journal.pone.0101129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/03/2014] [Indexed: 12/24/2022] Open
Abstract
Objectives To describe the variation in household crowding and social mixing patterns in the African meningitis belt and to assess any association with self-reported recent respiratory symptoms. Methods In 2010, the African Meningococcal Carriage Consortium (MenAfriCar) conducted cross-sectional surveys in urban and rural areas of seven countries. The number of household members, rooms per household, attendance at social gatherings and meeting places were recorded. Associations with self-reported recent respiratory symptoms were analysed by univariate and multivariate regression models. Results The geometric mean people per room ranged from 1.9 to 2.8 between Ghana and Ethiopia respectively. Attendance at different types of social gatherings was variable by country, ranging from 0.5 to 1.5 per week. Those who attended 3 or more different types of social gatherings a week (frequent mixers) were more likely to be older, male (OR 1.27, p<0.001) and live in urban areas (OR 1.45, p<0.001). Frequent mixing and young age, but not increased household crowding, were associated with higher odds of self-reported respiratory symptoms (aOR 2.2, p<0.001 and OR 2.8, p<0.001 respectively). A limitation is that we did not measure school and workplace attendance. Conclusion There are substantial variations in household crowding and social mixing patterns across the African meningitis belt. This study finds a clear association between age, increased social mixing and respiratory symptoms. It lays the foundation for designing and implementing more detailed studies of social contact patterns in this region.
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Affiliation(s)
- Claire F. Ferraro
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline L. Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Maria C. Nascimento
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jean-François Jusot
- Unité d'Epidémiologie, Centre de Recherches Médicales et Sanitaires (CERMES), Niamey, Niger
| | | | - Abraham Hodgson
- Navrongo Health Research Centre, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Ghana
| | - Oumer Ali
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Serge Alavo
- L'institut de recherche pour le développement, Dakar, Senegal
| | - Samba Sow
- Center for Vaccine Development-Mali (CVD-MALI), Bamako, Mali
| | | | - James M. Stuart
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Fiebig T, Freiberger F, Pinto V, Romano MR, Black A, Litschko C, Bethe A, Yashunsky D, Adamo R, Nikolaev A, Berti F, Gerardy-Schahn R. Molecular cloning and functional characterization of components of the capsule biosynthesis complex of Neisseria meningitidis serogroup A: toward in vitro vaccine production. J Biol Chem 2014; 289:19395-407. [PMID: 24849599 DOI: 10.1074/jbc.m114.575142] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The human pathogen Neisseria meningitidis (Nm) is a leading cause of bacterial meningitis and sepsis globally. A major virulence factor of Nm is the capsular polysaccharide (CPS), which in Nm serogroup A consists of N-acetyl-mannosamine-1-phosphate units linked together by phosphodiester linkages [ → 6)-α-D-ManNAc-(1 → OPO3 (-)→]n. Acetylation in O-3 (to a minor extent in O-4) position results in immunologically active polymer. In the capsule gene cluster (cps) of Nm, region A contains the genetic information for CPSA biosynthesis. Thereby the open reading frames csaA, -B, and -C are thought to encode the UDP-N-acetyl-D-glucosamine-2-epimerase, poly-ManNAc-1-phosphate-transferase, and O-acetyltransferase, respectively. With the aim to use a minimal number of recombinant enzymes to produce immunologically active CPSA, we cloned the genes csaA, csaB, and csaC and functionally characterized the purified recombinant proteins. If recombinant CsaA and CsaB were combined in one reaction tube, priming CPSA-oligosaccharides were efficiently elongated with UDP-GlcNAc as the donor substrate, confirming that CsaA is the functional UDP-N-acetyl-D-glucosamine-2-epimerase and CsaB the functional poly-ManNAc-1-phosphate-transferase. Subsequently, CsaB was shown to transfer ManNAc-1P onto O-6 of the non-reducing end sugar of priming oligosaccharides, to prefer non-O-acetylated over O-acetylated primers, and to efficiently elongate the dimer of ManNAc-1-phosphate. The in vitro synthesized CPSA was purified, O-acetylated with recombinant CsaC, and proven to be identical to the natural CPSA by (1)H NMR, (31)P NMR, and immunoblotting. If all three enzymes and their substrates were combined in a one-pot reaction, nature identical CPSA was obtained. These data provide the basis for the development of novel vaccine production protocols.
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Affiliation(s)
- Timm Fiebig
- From the Institute for Cellular Chemistry, Hannover Medical School, 30625 Hannover, Germany
| | - Friedrich Freiberger
- From the Institute for Cellular Chemistry, Hannover Medical School, 30625 Hannover, Germany
| | - Vittoria Pinto
- Novartis Vaccines, Research, Via Fiorentina 1, 53100 Siena, Italy
| | | | - Alan Black
- College of Life Sciences, University of Dundee, Dundee, DD1 5EH, Scotland, United Kingdom, and
| | - Christa Litschko
- From the Institute for Cellular Chemistry, Hannover Medical School, 30625 Hannover, Germany
| | - Andrea Bethe
- From the Institute for Cellular Chemistry, Hannover Medical School, 30625 Hannover, Germany
| | - Dmitry Yashunsky
- the Institute of Biomedical Chemistry, Russian Academy of Medical Sciences, Pogodinskaya Street 10, Moscow 119832, Russian Federation
| | - Roberto Adamo
- Novartis Vaccines, Research, Via Fiorentina 1, 53100 Siena, Italy
| | - Andrei Nikolaev
- College of Life Sciences, University of Dundee, Dundee, DD1 5EH, Scotland, United Kingdom, and
| | - Francesco Berti
- Novartis Vaccines, Research, Via Fiorentina 1, 53100 Siena, Italy,
| | - Rita Gerardy-Schahn
- From the Institute for Cellular Chemistry, Hannover Medical School, 30625 Hannover, Germany,
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Lee LA, Franzel L, Atwell J, Datta SD, Friberg IK, Goldie SJ, Reef SE, Schwalbe N, Simons E, Strebel PM, Sweet S, Suraratdecha C, Tam Y, Vynnycky E, Walker N, Walker DG, Hansen PM. The estimated mortality impact of vaccinations forecast to be administered during 2011-2020 in 73 countries supported by the GAVI Alliance. Vaccine 2014; 31 Suppl 2:B61-72. [PMID: 23598494 DOI: 10.1016/j.vaccine.2012.11.035] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 11/04/2012] [Accepted: 11/09/2012] [Indexed: 01/20/2023]
Abstract
INTRODUCTION From August to December 2011, a multidisciplinary group with expertise in mathematical modeling was constituted by the GAVI Alliance and the Bill & Melinda Gates Foundation to estimate the impact of vaccination in 73 countries supported by the GAVI Alliance. METHODS The number of deaths averted in persons projected to be vaccinated during 2011-2020 was estimated for ten antigens: hepatitis B, yellow fever, Haemophilus influenzae type B (Hib), Streptococcus pneumoniae, rotavirus, Neisseria meningitidis serogroup A, Japanese encephalitis, human papillomavirus, measles, and rubella. Impact was calculated as the difference in the number of deaths expected over the lifetime of vaccinated cohorts compared to the number of deaths expected in those cohorts with no vaccination. Numbers of persons vaccinated were based on 2011 GAVI Strategic Demand Forecasts with projected dates of vaccine introductions, vaccination coverage, and target population size in each country. RESULTS By 2020, nearly all GAVI-supported countries with endemic disease are projected to have introduced hepatitis B, Hib, pneumococcal, rotavirus, rubella, yellow fever, N. meningitidis serogroup A, and Japanese encephalitis-containing vaccines; 55 (75 percent) countries are projected to have introduced human papillomavirus vaccine. Projected use of these vaccines during 2011-2020 is expected to avert an estimated 9.9 million deaths. Routine and supplementary immunization activities with measles vaccine are expected to avert an additional 13.4 million deaths. Estimated numbers of deaths averted per 1000 persons vaccinated were highest for first-dose measles (16.5), human papillomavirus (15.1), and hepatitis B (8.3) vaccination. Approximately 52 percent of the expected deaths averted will be in Africa, 27 percent in Southeast Asia, and 13 percent in the Eastern Mediterranean. CONCLUSION Vaccination of persons during 2011-2020 in 73 GAVI-eligible countries is expected to have substantial public health impact, particularly in Africa and Southeast Asia, two regions with high mortality. The actual impact of vaccination in these countries may be higher than our estimates because several widely used antigens were not included in the analysis. The quality of our estimates is limited by lack of data on underlying disease burden and vaccine effectiveness against fatal disease outcomes in developing countries. We plan to update the estimates annually to reflect updated demand forecasts, to refine model assumptions based on results of new information, and to extend the analysis to include morbidity and economic benefits.
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Koeberling O, Ispasanie E, Hauser J, Rossi O, Pluschke G, Caugant DA, Saul A, MacLennan CA. A broadly-protective vaccine against meningococcal disease in sub-Saharan Africa based on Generalized Modules for Membrane Antigens (GMMA). Vaccine 2014; 32:2688-95. [DOI: 10.1016/j.vaccine.2014.03.068] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 12/01/2022]
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Fiebig T, Berti F, Freiberger F, Pinto V, Claus H, Romano MR, Proietti D, Brogioni B, Stummeyer K, Berger M, Vogel U, Costantino P, Gerardy-Schahn R. Functional expression of the capsule polymerase of Neisseria meningitidis serogroup X: a new perspective for vaccine development. Glycobiology 2013; 24:150-8. [PMID: 24259400 DOI: 10.1093/glycob/cwt102] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neisseria meningitidis (Nm) is a leading cause of bacterial meningitis and sepsis. A key feature in pathogenicity is the capsular polysaccharide (CPS) that prevents complement activation and thus supports bacterial survival in the host. Twelve serogroups characterized by immunologically and structurally different CPSs have been identified. Meningococcal CPSs elicit bactericidal antibodies and consequently are used for the development of vaccines. Vaccination against the epidemiologically most relevant serogroups was initially carried out with purified CPS and later followed by conjugate vaccines which consist of CPS covalently linked to a carrier protein. Of increasing importance in the African meningitis belt is NmX for which no vaccine is currently available. Here, we describe the molecular cloning, recombinant expression and purification of the capsule polymerase (CP) of NmX called CsxA. The protein expressed with N- and/or C-terminal epitope tags was soluble and could be purified to near homogeneity. With short oligosaccharide primers derived from the NmX capsular polysaccharide (CPSX), recombinant CsxA produced long polymer chains in vitro that in immunoblots were detected with NmX-specific antibodies. Moreover, the chemical identity of in vitro produced NmX polysaccharides was confirmed by NMR. Besides the demonstration that the previously identified gene csxA encodes the NmX CP CsxA, the data presented in this study pave the way for the use of the recombinant CP as a safe and economic way to generate the CPSX in vaccine developmental programs.
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Affiliation(s)
- Timm Fiebig
- Institute for Cellular Chemistry, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
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Kristiansen PA, Ba AK, Sanou I, Ouédraogo AS, Ouédraogo R, Sangaré L, Diomandé F, Kandolo D, Thomas JD, Clark TA, Laforce M, Caugant DA. Phenotypic and genotypic characterization of meningococcal carriage and disease isolates in Burkina Faso after mass vaccination with a serogroup a conjugate vaccine. BMC Infect Dis 2013; 13:363. [PMID: 23914778 PMCID: PMC3750508 DOI: 10.1186/1471-2334-13-363] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/12/2013] [Indexed: 01/09/2023] Open
Abstract
Background The conjugate vaccine against serogroup A Neisseria meningitidis (NmA), MenAfriVac, was first introduced in mass vaccination campaigns of the 1-29-year-olds in Burkina Faso in 2010. The aim of this study was to genetically characterize meningococcal isolates circulating in Burkina Faso before and up to 13 months after MenAfriVac mass vaccination. Methods A total of 1,659 meningococcal carriage isolates were collected in a repeated cross-sectional carriage study of the 1-29-year-olds in three districts of Burkina Faso in 2010 and 2011, before and up to 13 months after mass vaccination. Forty-two invasive isolates were collected through the national surveillance in Burkina Faso in the same period. All the invasive isolates and 817 carriage isolates were characterized by serogroup, multilocus sequence typing and porA-fetA sequencing. Results Seven serogroup A isolates were identified, six in 2010, before vaccination (4 from carriers and 2 from patients), and one in 2011 from an unvaccinated patient; all were assigned to sequence type (ST)-2859 of the ST-5 clonal complex. No NmA carriage isolate and no ST-2859 isolate with another capsule were identified after vaccination. Serogroup X carriage and disease prevalence increased before vaccine introduction, due to the expansion of ST-181, which comprised 48.5% of all the characterized carriage isolates. The hypervirulent serogroup W ST-11 clone that was responsible for most of meningococcal disease in 2011 and 2012 was not observed in 2010; it appeared during the epidemic season of 2011, when it represented 40.6% of the serogroup W carriage isolates. Conclusions Successive clonal waves of ST-181 and ST-11 may explain the changing epidemiology in Burkina Faso after the virtual disappearance of NmA disease and carriage. No ST-2859 strain of any serogroup was found after vaccination, suggesting that capsule switching of ST-2859 did not occur, at least not during the first 13 months after vaccination.
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John TJ, Gupta S, Chitkara A, Dutta AK, Borrow R. An overview of meningococcal disease in India: Knowledge gaps and potential solutions. Vaccine 2013; 31:2731-7. [DOI: 10.1016/j.vaccine.2013.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/13/2013] [Accepted: 04/01/2013] [Indexed: 01/02/2023]
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Holst J, Oster P, Arnold R, Tatley MV, Næss LM, Aaberge IS, Galloway Y, McNicholas A, O'Hallahan J, Rosenqvist E, Black S. Vaccines against meningococcal serogroup B disease containing outer membrane vesicles (OMV): lessons from past programs and implications for the future. Hum Vaccin Immunother 2013; 9:1241-53. [PMID: 23857274 PMCID: PMC3901813 DOI: 10.4161/hv.24129] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The utility of wild-type outer membrane vesicle (wtOMV) vaccines against serogroup B (MenB) meningococcal disease has been explored since the 1970s. Public health interventions in Cuba, Norway and New Zealand have demonstrated that these protein-based vaccines can prevent MenB disease. Data from large clinical studies and retrospective statistical analyses in New Zealand give effectiveness estimates of at least 70%. A consistent pattern of moderately reactogenic and safe vaccines has been seen with the use of approximately 60 million doses of three different wtOMV vaccine formulations. The key limitation of conventional wtOMV vaccines is their lack of broad protective activity against the large diversity of MenB strains circulating globally. The public health intervention in New Zealand (between 2004–2008) when MeNZB was used to control a clonal MenB epidemic, provided a number of new insights regarding international and public-private collaboration, vaccine safety surveillance, vaccine effectiveness estimates and communication to the public. The experience with wtOMV vaccines also provide important information for the next generation of MenB vaccines designed to give more comprehensive protection against multiple strains.
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Affiliation(s)
- Johan Holst
- Division of Infectious Disease Control; Norwegian Institute of Public Health; Oslo, Norway
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Caini S, Beck NS, Yacouba H, Maiga I, Chaibou I, Hinsa I, Adakal A, Issoufou A, Kim SH, Pezzoli L. From Agadez to Zinder: estimating coverage of the MenAfriVac™ conjugate vaccine against meningococcal serogroup A in Niger, September 2010 - January 2012. Vaccine 2013; 31:1597-603. [PMID: 23337027 DOI: 10.1016/j.vaccine.2013.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 12/29/2012] [Accepted: 01/07/2013] [Indexed: 01/11/2023]
Abstract
MenAfriVac™ is a conjugate vaccine against meningitis A specifically designed for Africa. In Niger, the MenAfriVac™ vaccination campaign was conducted in people aged 1-29 years in three phases. The third phase was conducted in November/December 2011 targeting more than 7 million people. We estimated vaccination coverage for the third phase; classified the 31 target districts according to vaccination coverage levels; analysed the factors associated with being vaccinated; described the reasons for non-vaccination; and estimated coverage of the MenAfriVac™ introduction in Niger by aggregating data from all three phases. We classified the districts by clustered lot quality assurance sampling according to a 75% lower threshold and a 90% upper threshold. We estimated coverage using a minimum cluster-sample of 30 x 10 in each region. Two criteria were used to document vaccination status: presentation of vaccination card only or by card and/or verbal history of vaccination (card+history). We surveyed 2390 persons. After the third phase, estimated coverage was 68.8% (95% CI 64.9-72.8) by card only and 90.9% (95% CI 88.6-93.2) by card+history. Five districts were accepted for coverage above 75% based on card only, whereas 25 were accepted based on card+history. Factors positively associated with being vaccinated were younger age (<15 years), female sex, residing in the same household for more than three months, and being informed about the vaccination campaign. The main reason for non-vaccination was not being at home during the campaign. Overall coverage for MenAfriVac™ introduction via 3 phases was 76.1% (95% CI: 72.5-79.6) by card only and 91.9% (95%CI: 89.7-94.1) by card+history.Although estimated coverage was high, pockets of non-vaccination probably still exist in the country; thus, the implementation of mop-up campaigns should be considered. Priorities for the future should include incorporating meningitis A vaccination into the existing immunization schedule and assessing its impact at a population level.
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Affiliation(s)
- Saverio Caini
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
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