The Meningitis Vaccine Project: Frequently Asked Questions
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African Meningitis Belt
WHO/EMC/BAC/98.3 Control of epidemic meningococcal disease. WHO practical guidelines. 2nd edition World Health Organization Emerging and other Communicable Diseases, Surveillance and Control This document has been downloaded from the WHO/EMC Web site. The original cover pages and lists of participants are not included. See http://www.who.int/emc for more information. © World Health Organization This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. The mention of specific companies or specific manufacturers' products does no imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. CONTENTS CONTENTS ................................................................................... i PREFACE ..................................................................................... vii INTRODUCTION ......................................................................... 1 1. MAGNITUDE OF THE PROBLEM ........................................................3 1.1 REVIEW OF EPIDEMICS SINCE THE 1970S .......................................................................................... 3 Geographical distribution -
Meningococcal a Conjugate Vaccine Into the Routine Immunization Programme
GUIDE TO INTRODUCING MENINGOCOCCAL A CONJUGATE VACCINE INTO THE ROUTINE IMMUNIZATION PROGRAMME GUIDE TO INTRODUCING MENINGOCOCCAL A CONJUGATE VACCINE INTO THE ROUTINE IMMUNIZATION PROGRAMME This publication was jointly developed by the WHO Regional Office for Africa and WHO headquarters. Guide to introducing meningococcal A conjugate vaccine into the routine immunization programme ISBN 978-92-4-151686-0 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc- sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Guide to introducing meningococcal A conjugate vaccine into the routine immunization programme. -
Meningococcal a Conjugate Vaccine Roll-Out in the African Meningitis Belt
Meningococcal A conjugate vaccine roll-out in the African meningitis belt Summary update prepared by the Meningitis Vaccine Project & partners SAGE, October 2014 Background Over the last century sub-Saharan Africa has been plagued by repeated epidemics of meningococcal meningitis. Almost all of the major outbreaks have been caused by group A Neisseria meningitidis . Reactive immunizations with polysaccharide vaccines have been used for the last 30 years but have not succeeded in controlling the problem. After the disastrous 1996–1997 epidemic with more than 250,000 cases and 25,000 deaths, there arose renewed interest in developing a preventive strategy based on new meningococcal conjugate vaccines. In June 2001, the Bill & Melinda Gates Foundation provided core funding for the establishment of the Meningitis Vaccine Project (MVP), a partnership between PATH and the World Health Organization (WHO), with the goal of eliminating epidemic meningitis as a public health problem in sub-Saharan Africa through the development, testing, licensure, and widespread introduction of meningococcal conjugate vaccines. A monovalent group A meningococcal (MenA) conjugate vaccine, MenAfriVac, a registered trademark of the Serum Institute of India, was developed through the MVP. The vaccine was licensed, for use in individuals aged 1 to 29 years, in 2009 and prequalified by WHO in 2010. Comprehensive mass immunization campaigns of 1- to 29-year olds with a single dose of MenAfriVac have been a cornerstone of the MenA conjugate vaccine introduction plan. This strategy aims to strongly and immediately protect individuals directly and reduce bacterial carriage and transmission, and thereby rapidly reduce overall disease-related morbidity and mortality rates within the community. -
Seasonal Meningococcal Meningitis Outbreaks in Nigeria: a Need for An
Available online at www.ijmrhs.com al R edic ese M a of rc l h a & n r H u e o a J l l t h International Journal of Medical Research & a n S ISSN No: 2319-5886 o c i t i Health Sciences, 2020, 9(6): 31-37 e a n n c r e e t s n I • • I J M R H S Seasonal Meningococcal Meningitis Outbreaks in Nigeria: A Need for an Accelerated Introduction of a Conjugated Meningococcal Vaccine into the National Routine Immunization Schedule Semeeh Akinwale Omoleke1 and Kehinde Kazeem Kanmodi2,3* 1 World Health Organization, Kebbi State Field Office, Birnin Kebbi, Nigeria 2 Cephas Health Research Initiative Inc, Ibadan, Nigeria 3 Mental and Oral Health Development Organization Inc, Birnin Kebbi, Nigeria *Corresponding e-mail: [email protected] ABSTRACT Epidemic meningococcal meningitis affects huge populations annually in sub-Saharan Africa with differentially higher death rates among children. Nigeria is one of the twenty-six countries that lie in ‘African meningitis belt’. This paper briefly describes the epidemiology of seasonal recurrent meningococcal meningitis, current efforts to address the epidemics, and then argues for an accelerated introduction of conjugated meningococcal vaccine into routine immunization in Nigeria. This paper also highlights the nature of the epidemics with its attendant impacts on the population; the weaknesses of the current strategies; the emergence of mixed pathogens; the challenges and potential opportunities associated with an introduction of routine vaccination against meningococcal meningitis. The quick introduction of the conjugated meningococcal vaccine into expanded program on immunization (EPI) schedule will mitigate the risk of future massive outbreaks and its attendant morbidity, mortality and larger societal cost. -
Immunization Strategies: Eradicating Meningitis in Sub-Saharan Africa
CIGI JUNIOR FELLOWS POLICY BRIEF NO. 1 AUGUST 2012 IMMUNIZATION KEY POINTS STRATEGIES: • Meningitis epidemics are highly concentrated in a 25-country area ERADICATING of Sub-Saharan Africa known as the “meningitis belt” and result in MENINGITIS IN SUB- an average of approximately 5,000 confirmed deaths in the region each SAHARAN AFRICA year. SARAH CRUICKSHANK AND SAMANTHA GRILLS • A new, low-cost vaccine called MenAfriVac™, developed by an innovative international health alliance INTRODUCTION to specifically target the source of these epidemics, has been shown to Meningitis epidemics are a major concern in the 25-country area from be highly effective, with no new cases of meningitis reported in those who Senegal to Ethiopia known as the “meningitis belt.” A communicable have received one dose of the vaccine. disease, meningitis affects large portions of the population, causes high • As the MenAfriVac™ vaccination rates of death and disability, and worsens the plight of families and campaign expands, three strategies are recommended that will bring the communities in a region marked by extreme poverty. MenAfriVac™ vaccine to hard-to-reach populations is the least expensive and longest lasting meningitis vaccine created and ensure that its full potential to date, and is the best medicinal tool currently available to the global is achieved. By employing these strategies and adapting them to health community to combat this serious disease. Developed through local conditions, the MenAfriVac™ a partnership between the Programme for Appropriate Technology in campaign will have the greatest chance of eliminating meningitis epidemics in Health (PATH), an international non-governmental organization, and Sub-Saharan Africa. -
GRADE Table 01. Efficacy of a Single-Dose Mena Conjugate Vaccination in Immunocompetent Children (9 to 24 Months of Age) Against Serogroup a Meningococcal Disease
GRADE Table 01. Efficacy of a single-dose MenA conjugate vaccination in immunocompetent children (9 to 24 months of age) against serogroup A meningococcal disease Population : Immunocompetent children aged 9–24 months Intervention: Single-dose MenA conjugate vaccine (5 µg dosage) Comparison: No MenA vaccination Outcome : Serogroup A meningococcal disease What is the scientific evidence concerning the efficacy of a single dose of MenA conjugate vaccine (versus no Men A vaccination) against serogroup A meningococcal disease in immunocompetent children aged 9–24 months? Rating Adjustment to rating 21/ RCT No. of studies/starting rating 4 Limitation in None serious 0 study design Factors Inconsistency None serious 0 decreasing 2 Indirectness None serious 0 confidence Imprecision None serious 0 Publication bias None serious 0 Large effect Not applicable 0 Quality Assessment Quality Factors Dose-response Not applicable 0 increasing Antagonistic confidence bias and Not applicable 0 confounding Final numerical rating of quality of 4 evidence We are very confident that the true effect lies close to the Statement on quality of evidence estimated effect on health outcome. We are very confident that the administration of a single dose of MenA conjugate vaccine in children Conclusion aged 9–24 months prevents serogroup A Findings Summary of of Summary meningococcal disease. 1 Two double blind, randomized, controlled clinical studies were conducted – a phase II dose ranging study (PsA-TT-004) in 1200 healthy infants and toddlers in Ghana and a phase III study (PsA-TT-007) in 1500 healthy infants and young children in Mali. Both studies examined various dosages and schedules of MenA conjugate vaccine co-administered with other vaccines routinely administered in this age range. -
(Meningitis a Vaccine) in a Controlled Temperature Chain (CTC) During Campaigns
WHO/IVB/13.04 Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns Guidance for immunization programme decision-makers and managers Immunization, Vaccines and Biologicals WHO/IVB/13.04 Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns Guidance for immunization programme decision-makers and managers Immunization, Vaccines and Biologicals The Department of Immunization, Vaccines and Biologicals thanks the donors whose unspecified financial support has made the production of this document possible. This document was produced by the Expanded Programme on Immunization (EPI) of the Department of Immunization, Vaccines and Biologicals This document forms part 1 of 3 parts of the training guide for the Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns Ordering code: WHO/IVB/13.04 Printed: July 2013 This publication is available on the Internet at: www.who.int/vaccines-documents/ Copies of this document as well as additional materials on immunization, vaccines and biologicals may be requested from: World Health Organization Department of Immunization, Vaccines and Biologicals CH-1211 Geneva 27, Switzerland • Fax: + 41 22 791 4227 • Email: [email protected] • © World Health Organization 2013 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: [email protected]). -
Yaoundé Declaration
YAOUNDE DECLARATION ON ELIMINATION OF MENINGOCOCCAL MENINGITIS TYPE A EPIDEMICS AS A PUBLIC HEALTH PROBLEM IN AFRICA _________________________________________________________________________ Sub-Saharan Africa is plagued by repeated meningitis epidemics concentrated in the “meningitis belt”, a vast region stretching from Senegal, on the west coast, to Somalia, on the east coast. The epidemics occur every year, with recurrent peaks every 8 to 12 years. The disease takes a heavy socioeconomic and human toll. More than a decade after a major meningitis epidemic in 1996 which resulted in more than 250 000 cases and 25 000 deaths, there is another threat to the countries of the African meningitis belt. An epidemiological survey of previous epidemics shows that Neisseria meningitis A is the main cause of meningococcal meningitis epidemics in Africa. About 500 million people living in countries of the meningitis belt are at risk of contracting meningococcus type A. Despite an appropriate management of cases, at least 10% of patients still die from the disease and nearly 20% recover with serious irreversible sequelae. For more than 20 years now, the control of meningitis epidemics is principally based on epidemiological surveillance and response mass immunization campaigns with meningococcal polysaccaharide vaccines which have shown their limits. The implementation of a new strategy to combat meningococcal meningitis epidemics in the African belt is necessary. It consists of organizing preventive mass campaigns and seeks to introduce a new meningococcal type A conjugate vaccine. It will help immunize, during the 2009 to 2015 period, about 250 million people aged 1 to 29 years, including 23 million children living in 25 African countries. -
Emergence of Neisseria Meningitidis Serogroup W, Central African Republic, 2015–2016
DISPATCHES Emergence of Neisseria meningitidis Serogroup W, Central African Republic, 2015–2016 Thierry Frank, Eva Hong, Jean-Robert Mbecko, after the 1996–1997 epidemic in Africa that killed nearly Jean-Pierre Lombart, Muhamed-Kheir Taha,1 250,000 persons, the introduction of the MenAfriVac vaccine Pierre-Alain Rubbo1 in 2010 contributed to dramatically reduced NmA cases in 26 countries of the meningitis belt by targeting roughly 65 mil- We analyzed data from the 2015 and 2016 meningitis epi- lion persons 1–29 years of age (WHO, http://www.who.int/ demic seasons in Central African Republic as part of the immunization/newsroom/menafrivac_20121114/en/). Conse- national disease surveillance. Of 80 tested specimens, 66 quently, serogroup replacement has been noted. For example, belonged to meningococcal serogroup W. Further analysis found that 97.7% of 44 isolates belonged to the hyperinva- in 2015, an epidemic with a novel strain of serogroup C was sive clonal complex sequence type 11. recorded in Niger and Nigeria for the first time since 1975 (WHO, http://www.who.int/wer/2015/wer9047.pdf?ua=1). Hyperinvasive N. meningitidis serogroup W (NmW) entral African Republic (CAR) is localized in the men- cases belonging to the clonal complex ST11 (NmW/cc11) Cingitis belt that spans from Senegal to Ethiopia in sub- have been reported worldwide since the Hajj 2000–linked Saharan Africa. The country experiences meningitis epi- outbreak (3–6). Moreover, NmW/cc11 cases have been re- demics every year. Eight health districts (Nana Mambéré, ported in the African meningitis belt at least since the late Ouham Pendé, Ouham, Nana Gribizi, Bamingui Bangoran, 1990s (7). -
The Meningitis Vaccine Project Closure Conference Addis Ababa
The Meningitis Vaccine Project Closure Conference Addis Ababa, Ethiopia: 22-25 February 2016 Meningitis surveillance in the African meningitis belt Dr André Bita, Clément Lingani, Olivier Ronveaux WHO ISTWA, HQ Outline 1. Background 2. Objectives of meningitis surveillance 3. Epidemiological situation of meningitis in Africa 4. Performance analysis of meningitis surveillance 5. Lessons learned 6. Summary 7. Way forward Annexes :Definition case; Operational thresholds; Performance indicators of surveillance 2 | Epidemic meningitis in Africa: Disease burden Reported cases 200,000 188,345 170,000 140,000 92,347 100,000 88,939 88,199 80,743 80,000 68,089 60,000 40,000 27,3011 20,000 0 Years 3 | Background -1 l Meningitis remains a major public health problem in Africa especially in the 26 countries of the meningitis belt. l The bacterial status changed since the introduction of MenAfriVac in Africa in 2010. Previously, NmA that was predominant. Thus, from 2010 to now, S.Pn, NmW, and NmC are predominant l The 3-pillar strategy to eliminate meningitis in Africa; Surveillance; case management; and vaccination l In order to improve the detection of meningitis case and assess the impact of introduction of MenAfriVac, Enhance surveillance (ES) and case based surveillance (CBS) have been introduced respectively in 2003 and 2010 4 | Background -2 l 2003 - 2015: introduction of ES in 19 countries of meningitis belt l 2010-2015: introduction of CBS; currently 13 countries are experiencing CBS l Initiated in 2010 in BFA, Mali, and Niger l 2014: Improvement of CBS in BFA, Mali, Niger, Togo, and (Ethiopia & Chad are in the process) through the MenAfriNet project conducted by CDC with the partnership of WHO, AMP & MoH countries concerned 5 | Background -3 Main differences between ES & CBS Elements ES CBS Lumbar puncture and CSF analysis for suspected meningitis cases >= 80% >= 90% Case investigation form filled for suspected meningitis cases >=80% 100% epidemiological data followed by lab data Routine reporting, management, and analysis of case-level data. -
Stockpile Needs for Epidemic Meningitis Response 2018-2022 Dr Caroline Trotter [email protected]
Stockpile needs for epidemic meningitis response 2018-2022 Dr Caroline Trotter [email protected] Report prepared by: Dr Caroline Trotter, University of Cambridge, UK [email protected] Date: 8th December 2017 With thanks to: Dr Olivier Ronveaux, Katya Fernandez, WHO Geneva and Clement Lingani, WHO-IST Ouagadougou for providing data and expert advice. Disclaimer The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable whatsoever for any damages incurred as a result of its use. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Links to the WHO web site Any external web site may provide a hyperlink to the WHO web site or to any of its pages without requesting permission. However this use must not infringe WHO's intellectual property rights, in particular relating to its name, emblem, copyright or authors' rights. The WHO emblem may not be used in providing a link. WHO's regulations, accepted by all WHO Member States, expressly prohibit the Organization from endorsing specific organisations, products or services. Therefore a link to the WHO web site must be used for information only, and not for the promotion of any organisation, product or service. A link to the WHO web site does not, and should not, imply any association between WHO and the owner of the linking site. Summary Despite much progress in the control of epidemic meningitis through the roll-out of a group A meningococcal conjugate vaccine (MenAfriVac), other meningococcal groups and the pneumococcus continue to cause epidemics in the African meningitis belt. -
Menafrivac As an Antitetanus Vaccine
SUPPLEMENT ARTICLE MenAfriVac as an Antitetanus Vaccine Ray Borrow,1 Yuxiao Tang,2 Ahmadu Yakubu,3 Prasad S. Kulkarni,4 and F. Marc LaForce4,a 1Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom; 2Meningitis Vaccine Project, PATH, Seattle, Washington; 3Immunization, Vaccines and Biologicals/Expanded Programme on Immunization, World Health Organization, Geneva, Switzerland; and 4Serum Institute of India Ltd, Pune Background. The group A meningococcal conjugate vaccine, PsA-TT, uses tetanus toxoid (TT) as a carrier pro- tein (PsA-TT). TT as a carrier protein in other conjugate vaccines is known to be immunogenic and generates a robust anti-TT response. Methods. Clinical studies in Africa assessed whether PsA-TT generated tetanus serologic responses when tested in African populations (toddlers to adults). Second, the high acceptance of PsA-TT mass immunization campaigns in the 1- to 29-year age group meant that a sizeable fraction of women of reproductive age received PsA-TT. Inci- dence data for neonatal tetanus were reviewed for countries with and without PsA-TT campaigns to check whether this had any impact on the incidence. Results. PsA-TT generated robust tetanus serologic responses in 1- to 29-year-olds, similar to those expected after a booster dose of TT. Neonatal cases of tetanus fell by 25% in countries that completed PsA-TT campaigns in 1- to 29-year-olds. Conclusions. Although these data are not yet definitive, they are consistent with the hypothesis that improved community immunity to tetanus as a result of the PsA-TT campaigns may be having an impact on the incidence of neonatal tetanus in sub-Saharan Africa.