Working to Eliminate Epidemic Meningitis in Sub-Saharan Africa

July 24, 2012: Content on this page kept for historical reasons.

Division of Bacterial Diseases (DBD) News Bulletin

Summer 2012

The "Meningitis Belt" in Africa includes 26 of the world’s poorest countries. Frequent outbreaks and sporadic explosive epidemics result in tens of thousands of meningitis cases. Elimination of this disease could reduce morbidity and mortality, disabilities, and countries’ health expenditures.

CDC’s work in meningitis prevention spans several decades and was important in establishing the burden of disease that contributed to the investment case for development of and the mass campaigns that first introduced MenAfriVac™ in Burkina Faso in 2010. This meningococcal A conjugate vaccine was developed specifically to combat epidemic meningitis in sub-Saharan Africa by a consortium of partners including CDC, PATH, WHO, FDA, the Health Protection Agency and the National Institute for Biological Standards and Control, with funding from the Bill & Melinda Gates Foundation.

Eliminating epidemic meningitis as a public health concern in the sub-Saharan African "Meningitis Belt" is a major initiative for the Meningitis and Vaccine Preventable Diseases Branch (MVPDB) and the agency. MVPDB supported the first mass vaccination campaigns in Burkina Faso in 2010 and in Mali and Niger in 2010-2011. In December 2011, Nigeria, Chad and Cameroon introduced the vaccine. As of May 2012, nearly 55 million people had been vaccinated. Surveillance in Burkina Faso during the spring 2011 meningitis season showed the lowest annual incidence of meningitis compared to any year. And there has not been a case of Men A meningitis in a vaccinated person.

Staff from the branch routinely travel to sub-Saharan Africa and have helped to strengthen surveillance for bacterial meningitis. Working alongside seconded epidemiologist Fabien Diomande (WHO Intercountry Support Team West Africa), MVPDB staff work with WHO and local health authorities to strengthen epidemiologic and laboratory capacity to provide high quality surveillance data to evaluate the immediate impact of the MenAfriVac™ vaccine on epidemics and disease. Additionally, staff have supported expanded safety studies in Burkina Faso, Mali and Niger following campaign rollouts in which data did not show any association of MenAfriVac™ with serious adverse events.

To support building the in-country capacity so essential to eliminating epidemic meningitis, MVPDB secures training opportunities for their African colleagues. Pictured on the right are NCIRD Director Anne Schuchat and MVPDB’s Ryan Novak with Tiga Felix Tarbangdo, a surveillance epidemiologist with the Burkina Faso Ministry of Health whose visit to the US was funded by an ICIED Leaders program as part of the group’s 8th International meeting in Atlanta in April. Mr. Tarbangdo also visited CDC to meet with MVPDB staff working on meningitis and attended an Intermediate Epi Info training program along with MVPDB’s Amanda Faulkner, Sema Mandal and Jessica MacNeil.

Staff are now ramping up to support campaigns in Ghana, where a mass campaign is planned for early October targeting more than 4 million people in the northern regions of the country, and in Nigeria which is now in its second phase of vaccine campaigns. MVPDB’s Ryan Novak says, "Nigeria’s population is massive and it will be a challenge for the country to reach vaccine coverage above 80%. Nigeria is the first MenAfriVac™ implementing country where CDC has had a country office. The institutional knowledge and technical assistance that CDC Nigeria provides is invaluable to success of our work there." Ryan Novak, Sema Mandal and Xin Wang are gearing up for travel to Nigeria within the next few months to work with country partners and the WHO country office to conduct real-time PCR training and implementation. Ryan Novak and others continue to help strengthen surveillance activities using funds from USAID.

MVDPB’s work in eliminating epidemic meningitis in sub-Saharan Africa is often cited by the CDC Director as an outstanding example of a public-private partnership that is having a substantial impact on improving health across the African continent. By year’s end, branch staff will have represented the agency in collaborations with WHO and Ministers of Health on evaluations in at least 2 additional hyper-endemic countries; established a pilot methodology for immunological assessment of vaccine failures; used modeling to evaluate strategies for the maintenance phase of vaccination campaigns (e.g., childhood vaccination); and conducted health systems research on key surveillance components to monitor vaccination programs.

MenAfriVac™ costs less than 50 US cents per dose and is expected to save as many as 150,000 lives between 2010 and 2015. By 2016, all 26 countries in the African Meningitis Belt are expected to have plans to complete the mass vaccination campaigns. In countries with some of the weakest supporting infrastructure, the logistical challenges of staging mass vaccination campaigns are immense but CDC is committed to collaborating with partners world-wide to eliminate epidemic meningitis.