A conference assessing progress in tackling meningitis in Africa has been told that the type A version of the causative bacterium has been almost entirely eliminated in the space of five years. Thousands of lives have been saved and a model created for other diseases.
In 1996 more than a quarter of a million, mostly young, Africans were infected with meningitis A, also known as serogroup A meningococcal disease. Approximately 25,000 died. Even in better years, tens of thousands suffered from the bacterial infection of the lining around the brain and spinal cord associated with the disease – the meninges. In response, a vaccine called MenAfriVac® was designed and developed in Africa specifically to confront the scourge.
Like all forms of meningitis, serogroup A meningococcal disease causes inflammation of the lining around the brain and spinal cord. ellepigrafica/Shutterstock
The Meningitis Vaccine Project Closure conference in Addis Ababa heard that in 2015, just 80 cases of meningitis A were recorded, all in countries without vaccination campaigns. The vaccine was released in 2010 with funding from GAVI, the Global Alliance for Vaccines and Immunization, and 235 million people under the age of 29 have been vaccinated since.
The “closure” in the conference name refers to the fact that GAVI, having spent $367 million on distributing the vaccine, is now diverting funding in order to prioritize other diseases. However, speakers at the conference stressed that, even with infections this low, the fight against meningitis A can't be relaxed yet.
"Our great success against meningitis A is by no means permanent," said the World Health Organization's Dr. Matshidiso Moeti in a statement. "To sustain the protection that has been afforded to date against meningitis A, all at-risk countries must finish conducting vaccination campaigns and begin incorporating the vaccine into routine childhood immunization programs."
Modeling indicates that if vaccination were to stop now, the disease would slowly recover with widespread outbreaks expected within 15 years. GAVI will continue to offer financial support to include the meningitis A vaccine as part of regular immunization programs. It costs just US$0.50 per dose to add MenAfriVac® to broader vaccine schedules.
MenAfriVac® represents a milestone; an African-developed response to an endemic disease. Moreover, it overcomes one of the major obstacles to health programs in poorer parts of the world.
Previous vaccines against meningococcal A, like many medicines, required refrigeration, particularly in tropical climates. This represented an enormous challenge wherever reliable electricity was not available. MenAfriVac®, however, can survive for four days at up to 40°C (104°F). It is also more suitable for younger children than the older vaccines, and provides an accompanying protection against tetanus, although it is not a complete substitute for the tetanus vaccine.
Meningococcal C, W and X subtypes continue to plague Africa, although not to the extent that serogroup A once did, and the conference discussed programs to eradicate these. Vaccines exist against the first two, but continue to suffer from the need for refrigeration and provide protection for only three years. Meningococcal serogroup X remains a threat in northern and western Africa, with no current vaccine.