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. 2012 Oct;12(10):757-64.
doi: 10.1016/S1473-3099(12)70168-8. Epub 2012 Jul 18.

Serogroup A meningococcal conjugate vaccination in Burkina Faso: analysis of national surveillance data

Ryan T Novak  1 , Jean Ludovic Kambou, Fabien Vk Diomandé, Tiga F Tarbangdo, Rasmata Ouédraogo-Traoré, Lassana Sangaré, Clement Lingani, Stacey W Martin, Cynthia Hatcher, Leonard W Mayer, F Marc Laforce, Fenella Avokey, Mamoudou H Djingarey, Nancy E Messonnier, Sylvestre R Tiendrébéogo, Thomas A Clark
Affiliations

Serogroup A meningococcal conjugate vaccination in Burkina Faso: analysis of national surveillance data

Ryan T Novak et al. Lancet Infect Dis. 2012 Oct.

Abstract

Background: An affordable, highly immunogenic Neisseria meningitidis serogroup A meningococcal conjugate vaccine (PsA-TT) was licensed for use in sub-Saharan Africa in 2009. In 2010, Burkina Faso became the first country to implement a national prevention campaign, vaccinating 11·4 million people aged 1-29 years. We analysed national surveillance data around PsA-TT introduction to investigate the early effect of the vaccine on meningitis incidence and epidemics.

Methods: We examined national population-based meningitis surveillance data from Burkina Faso using two sources, one with cases and deaths aggregated at the district level from 1997 to 2011, and the other enhanced with results of cerebrospinal fluid examination and laboratory testing from 2007 to 2011. We compared mortality rates and incidence of suspected meningitis, probable meningococcal meningitis by age, and serogroup-specific meningococcal disease before and during the first year after PsA-TT implementation. We assessed the risk of meningitis disease and death between years.

Findings: During the 14 year period before PsA-TT introduction, Burkina Faso had 148 603 cases of suspected meningitis with 17 965 deaths, and 174 district-level epidemics. After vaccine introduction, there was a 71% decline in risk of meningitis (hazard ratio 0·29, 95% CI 0·28-0·30, p<0·0001) and a 64% decline in risk of fatal meningitis (0·36, 0·33-0·40, p<0·0001). We identified a statistically significant decline in risk of probable meningococcal meningitis across the age group targeted for vaccination (62%, cumulative incidence ratio [CIR] 0·38, 95% CI 0·31-0·45, p<0·0001), and among children aged less than 1 year (54%, 0·46, 0·24-0·86, p=0·02) and people aged 30 years and older (55%, 0·45, 0·22-0·91, p=0·003) who were ineligible for vaccination. No cases of serogroup A meningococcal meningitis occurred among vaccinated individuals, and epidemics were eliminated. The incidence of laboratory-confirmed serogroup A N meningitidis dropped significantly to 0·01 per 100 000 individuals per year, representing a 99·8% reduction in the risk of meningococcal A meningitis (CIR 0·002, 95% CI 0·0004-0·02, p<0·0001).

Interpretation: Early evidence suggests the conjugate vaccine has substantially reduced the rate of meningitis in people in the target age group, and in the general population because of high coverage and herd immunity. These data suggest that fully implementing the PsA-TT vaccine could end epidemic meningitis of serogroup A in sub-Saharan Africa.

Funding: None.

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Figures

Figure 1
Figure 1
The meningitis belt of Africa and meningococcal serogroup A conjugate vaccine (PsA–TT) rollout plan 2010–16
Figure 2
Figure 2
Suspected cases of meningitis and deaths reported by the Télégramme Lettre Official Hebdomadaire surveillance system, by week, and number of health districts experiencing epidemics by year in Burkina Faso, 1997–2011
Figure 3
Figure 3
Cumulative curves of rates per 100 000 population of suspect meningitis cases (A) and deaths (B) reported through Télégramme Lettre Official Hebdomadaire by week during the meningitis season in Burkina Faso, 1997–2011
Figure 4
Figure 4
Proportions of confirmed meningitis cases by year attributable to Neisseria meningitidis, Haemophilus influenzae type b, and Streptococcus pneumoniae from Maladies Potentiel Épidémie surveillance compared with suspected cases reported by TLOH in Burkina Faso, 2007–11 TLOH=Télégramme Lettre Official Hebdomadaire.
Figure 5
Figure 5
Estimated annual incidence of confirmed meningitis by pathogen and year from Maladies Potentiel Épidémie surveillance in Burkina Faso, 2007–11
See this image and copyright information in PMC

Comment in

References

    1. Lapeyssonnie L. La méningite cérébrospinale en Afrique. Bull World Health Organ. 1963;28(suppl):1–114. - PMC - PubMed
    1. Greenwood B. Manson lecture. Meningococcal meningitis in Africa. Trans R Soc Trop Med Hyg. 1999;93:341–53. - PubMed
    1. Djingarey M, Noazin S, Préziosi MP. A 20-year retrospective analysis of epidemic meningitis surveillance data in Burkina Faso, Mali, and Niger. 16th International Pathogenic Neisseria Conference; Rotterdam, Netherlands. Sept 7–12, 2008.p. P166.
    1. Molesworth AM, Cuevas LE, Connor SJ, Morse AP, Thomson MC. Environmental risk and meningitis epidemics in Africa. Emerg Infect Dis. 2003;9:1287–93. - PMC - PubMed
    1. Colombini A, Badolo O, Gessner BD, Jaillard P, Seini E, Da Silva A. Costs and impact of meningitis epidemics for the public health system in Burkina Faso. Vaccine. 2011;29:5474–80. - PubMed

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