The World Health Organization has expressed alarm over the rapidly growing outbreak of meningococcal meningitis in Niger.
Background information
Niger falls in Africa’s ‘Meningitis belt’- extending from Senegal to Ethiopia, and including 26 countries, this region has the highest rates of meningococcal disease in the world.
Meningococcal meningitis is caused by the bacterium Neisseria meningitides (Nm). The disease involves a serious infection of the meninges- membranes covering the brain.
Untreated, it may cause death in 50% of the cases, and can cause severe brain damage.
There are 12 serotypes of Nm, of which 6 (A, B, C, W, X and Y) can cause epidemics.
Vaccines to protect against meningococcal disease are available.
Polysaccharide vaccines are inexpensive, and have been available for more than 30 years. These vaccines are either bivalent (groups A and C), trivalent (groups A, C and W) or tetravalent (A, C, Y and W).
Conjugate vaccines are typically more expensive, and available since 1999. Since 2010, MenAfriVac a relatively inexpensive conjugate vaccine against serogroup A has been gradually introduced in some countries of the meningitis belt. While this has reduced the occurrence of meningococcal disease due to serogroup A, there has been a resurgence of other groups.
Why the WHO is concerned about this outbreak
This is the first large-scale outbreak of serogroup C in any country within the meningitis belt.
Over the last 40 years, serogroup C has only caused sporadic and localized outbreaks, twice in Nigeria and once in Niger (1991).
There is an acute shortage of vaccines:
Since the licensing of conjugate vaccines in Europe and North America, the production of polysaccharide vaccines has reduced considerably.
The International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG) maintains a stockpile of polysaccharide vaccines for emergency situations. Existing polysaccharide vaccines have been exhausted, and no polysaccharide vaccines are available outside the ICG stockpile.
The global response to the outbreak
The ICG has approved 4 vaccine requests till date.
The WHO (on behalf of the ICG) has negotiated with vaccine manufacturers and pharmaceutical companies to urgently produce of 640,000 doses of polysaccharide vaccines. These will be shipped to Niger in the coming weeks.
Thanks to intervention by the ICG and financial support from the GAVI alliance, conjugate vaccines have been made available to Niger.
The government of Niger has also obtained 200,000 doses of polysaccharide ACWY vaccine from the government of Mali.
MSF (doctors without borders) is working with the Ministry of Public Health.
Through the joint efforts of various agencies, the case fatality rate has dropped from 11% to 7% over the past few weeks.
Useful links:
Link to the latest WHO situation assessment report:
http://www.who.int/mediacentre/news/situation-assessments/meningitis-niger/en/
Link to the WHO fact sheet on meningococcal disease:
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