(C) Our World in Data This story was originally published by Our World in Data and is unaltered. . . . . . . . . . . Meningococcal disease in the Middle East and Africa: Findings and updates from the Global Meningococcal Initiative [1] ['Ray Borrow', 'Ray.Borrow Phe.Gov.Uk', 'Vaccine Evaluation Unit', 'Public Health England', 'Manchester Royal Infirmary', 'Manchester', 'Dominique A. Caugant', 'Dominique.Caugant Fhi.No', 'Norwegian Institute Of Public Health', 'Po Box'] Date: 2022-11 Where do we go from here? ® was the outcome of a Meningitis Vaccine Project (MVP; lead by WHO-PATH), involving international cooperation and technology transfers. It was licensed by the Indian National Regulatory Authority in December 2009 and pre-qualified by the WHO in June 2010. 17 World Health Organization. Immunization standards – MenAfriVac: Meningococcal A conjugate 10 dose presentation. WHO web site. Available at: http://www.who.int/immunization_standards/vaccine_quality/PQ_197_MenAconjugate_10dose_SII/en/. [Accessed 22 December 2016]. 34 Kristiansen P.A. Diomande F. Ba A.K. Sanou I. Ouedraogo A.S. Ouedraogo R. et al. Impact of the serogroup A meningococcal conjugate vaccine, MenAfriVac, on carriage and herd immunity. ® MenA conjugate vaccine was introduced into the routine immunization schedule (for infants aged 9–18 months), thus protecting birth cohorts. As well as this, surveillance and epidemic response were strengthened. 52 World Health Organization. WHO position paper on meningococcal A conjugate vaccine. WHO web site. Available at: http://www.who.int/immunization/policy/position_papers/pp_menA_2015_presentation.pdf?ua=1. [Accessed 22 December 2016]. MenAfriVacwas the outcome of a Meningitis Vaccine Project (MVP; lead by WHO-PATH), involving international cooperation and technology transfers. It was licensed by the Indian National Regulatory Authority in December 2009 and pre-qualified by the WHO in June 2010.It was first introduced in Burkina Faso, Mali, and Niger in Q4 2010 as a 10-dose vial. New dosage presentations were developed for use in the routine infant schedule from 2015, and it remains an affordable vaccine for developing countries. The vaccine gives direct protection and reduces carriage.The WHO MenA strategy induced herd protection through mass vaccination campaigns, targeting 1–29 year olds. More recently, MenAfriVacMenA conjugate vaccine was introduced into the routine immunization schedule (for infants aged 9–18 months), thus protecting birth cohorts. As well as this, surveillance and epidemic response were strengthened.By August 2016, 265 million people had been vaccinated in 19 countries (Benin, Burkina Faso, Cameroon, Chad, Democratic Republic of Congo, Ethiopia, Gambia, Ghana, Guinea, Guinea Bissau, Ivory Coast, Mali, Mauritania, Niger, Nigeria, Senegal, South Sudan, Sudan, and Togo); around 30 million are still to be vaccinated in the remaining seven countries (Burundi, Central African Republic, Eritrea, Kenya, Rwanda, South Sudan [second phase], and Tanzania). In 12 countries, vaccination programs were prioritized and introduced following risk assessment using a standard tool based on risk indicators, mapping information, and local expert opinion. 53 Zipursky S. Djingarey M.H. Lodjo J.C. Olodo L. Tiendrebeogo S. Ronveaux O. Benefits of using vaccines out of the cold chain: delivering meningitis A vaccine in a controlled temperature chain during the mass immunization campaign in Benin. 35 Daugla D.M. Gami J.P. Gamougam K. Naibei N. Mbainadji L. Narbe M. et al. Effect of a serogroup A meningococcal conjugate vaccine (PsA-TT) on serogroup A meningococcal meningitis and carriage in Chad: a community study [corrected]. ® uses tetanus toxin as a carrier, and some serologic data have suggested protection against tetanus. 54 Borrow R. Tang Y. Yakubu A. Kulkarni P.S. Laforce F.M. MenAfriVac as an antitetanus vaccine. This was the first vaccine to be deployed locally using a controlled temperature chain (CTC) rather than needing a cold chainand, in 2016, >2.5 million people were vaccinated using the CTC method. Wastage was low, high coverage was achieved, there were no serious adverse events after vaccination, and the CTC protocol was well understood and accepted. Carriage of MenA was substantially reduced in areas where vaccination had been introduced (by 98% in Chad).In addition, MenAfriVacuses tetanus toxin as a carrier, and some serologic data have suggested protection against tetanus. 55 MacNeil J.R. Medah I. Koussoube D. Novak R.T. Cohn A.C. Diomande F.V. et al. Neisseria meningitidis serogroup W, Burkina Faso, 2012. ® outbreak and the largest MenC outbreak on record, and it has now spread into neighboring countries. The outbreak was large, rapid, and attack rates were high; it was found to be caused by a previously unrecorded MenC clone. It appeared to have emerged in Nigeria before the MenAfriVac® campaign and was not likely to be associated with the elimination of MenA epidemics following the vaccine's introduction. 56 Chow J. Uadiale K. Bestman A. Kamau C. Caugant D.A. Shehu A. et al. Invasive meningococcal meningitis serogroup C outbreak in northwest Nigeria, 2015-third consecutive outbreak of a new strain. 56 Chow J. Uadiale K. Bestman A. Kamau C. Caugant D.A. Shehu A. et al. Invasive meningococcal meningitis serogroup C outbreak in northwest Nigeria, 2015-third consecutive outbreak of a new strain. , 57 Kretz C.B. Retchless A.C. Sidikou F. Issaka B. Ousmane S. Schwartz S. et al. Whole-genome characterization of epidemic Neisseria meningitidis serogroup C and resurgence of serogroup W, Niger, 2015. 58 Funk A. Uadiale K. Kamau C. Caugant D.A. Ango U. Greig J. Sequential outbreaks due to a new strain of Neisseria meningitidis serogroup C in northern Nigeria, 2013-14. In 2010–2012, MenW disease reemerged in Burkina Faso.MenC emerged in northern Nigeria in 2013 and western Niger in 2015, resulting in the largest post-MenAfriVacoutbreak and the largest MenC outbreak on record, and it has now spread into neighboring countries. The outbreak was large, rapid, and attack rates were high; it was found to be caused by a previously unrecorded MenC clone. It appeared to have emerged in Nigeria before the MenAfriVaccampaign and was not likely to be associated with the elimination of MenA epidemics following the vaccine's introduction.All the MenC strains isolated were ST10217, they belong to an unassigned clonal complex, and all have the same molecular profile.They are genetically unrelated to the epidemic clones causing disease in Africa in the past decades, or to the rare MenC isolates that have circulated since the 1980s. A further outbreak of MenW occurred in Togo in 2016 and also in northern Ghana. In the past 16 years, there have been a number of non-MenA outbreaks in the region and MenA is still circulating at a low level, although the vaccine failure rate is very low. The success of MenAfriVac® to date needs to be sustained, with rollout into other countries, continuing introduction into routine programs, and ongoing surveillance to monitor long-term impact, effectiveness, failure, and non-MenA serogroups. There are a number of challenges to overcome for MenAfriVac®, such as bridging the gap between campaign and routine vaccinations, with a need for further catch-up vaccinations. Finally, there needs to be clear communication about the new dose sizes available, and vaccine supply must be maintained and programs financially enabled. [END] --- [1] Url: http://www.journalofinfection.com/article/S0163-4453(17)30114-7/abstract Published and (C) by Our World in Data Content appears here under this condition or license: Creative Commons BY. via Magical.Fish Gopher News Feeds: gopher://magical.fish/1/feeds/news/ourworldindata/