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ATH The MenAfriVac will be rolled out to 12.5 million people in countries. “When the epidemic arrives, the : P : e THE BELT , 4 million people in and 4 million people in . entire community shuts down,” says LaForce. RC The disease — which infects the meninges, the sOu MAURITANIA membranes surrounding the brain and spinal 3.4 million MALI cord — begins with mild symptoms of stiff neck, SENEGAL 15.2 million NIGER high fever, confusion and headache, but can kill 12.8 million ERITREA 15.9 million 10.8 million 5 million within 48 hours. Of those infected with menin- BURKINA FASO SUDAN gococcal meningitis A, 5–10% die and 10–20% 14.9 million 39.4 million GUINEA NORTHERN of survivors are left with severe disabilities. 10.2 million 60 million IVORY Until now, the only weapon against meningi- SOUTHERN NIGERIA COAST CENTRAL AFRICAN tis A in Africa was a polysaccharide vaccine that 19.4 million 83 million REPUBLIC 85 million 4.3 million offered protection for a very short time. Using it GUINEA-BISSAU 17.4 million as a preventative vaccine would have required 1.8 million UGANDA 33.3 million repeated vaccination of the population — a GAMBIA 9.5 million DEMOCRATIC KENYA 1.7 million 23.9 million REPUBLIC 38 million logistically and financially impossible approach. OF CONGO So it was used only to vaccinate people after an 65 million 6.8 million epidemic was under way, often too late to have Total population for 2009 is shown. an impact. By contrast, MenAfriVac is a longer- Hyperendemic countries Other meningitis-belt countries lasting , in which an antigen is coupled to a protein to provoke a stronger immune response. LaForce says that clinical- public health trial subjects who received the vaccine more than three years ago are still protected. The previous polysaccharide vaccine also did not work well in children, whereas MenAfriVac Vaccine offers is approved for children aged one year and over, and trials are under way for children as young as one month, with results expected next year. meningitis hope MenAfriVac has the added advantage of stop- ping people from becoming carriers that spread the disease, protecting unvaccinated people First affordable and effective weapon against killer through ‘’. meningococcal meningitis A rolled out in Africa. In June, the WHO decided that the vaccine met international standards of safety and effi- cacy, and results from phase III trials have been by declan butler itself, and contracted the Serum Institute of submitted for journal publication. The roll out India in Pune to make the vaccine. The entire will be accompanied by a ‘pharmacovigilance’ rom Senegal to Ethiopia, December her- research and development cost of the project system for reporting adverse events. alds the arrival of intense epidemics across was just $70 million — five to ten times less Several international groups, including the Africa’s ‘meningitis belt’ (see map). Kill- than typical . LaForce hopes that the US Centers for Disease Control and Prevention Fing thousands, and leaving many more with a MenAfriVac model can be applied successfully in Atlanta, Georgia, and the Norwegian Institute host of after-effects such as brain damage and to other vaccines. of Public Health in Oslo, will run surveillance deafness, the scourge of meningitis A terrifies During next month’s campaign, backed by the programmes to prove the vaccine’s effectiveness communities. WHO and the United Nations Children’s Fund to donors and governments. This year will be different. Millions will (UNICEF), the government of Burkina Faso Yet millions may miss out. Some $475 mil- receive a new vaccine, MenAfriVac, that prom- will vaccinate everyone aged 1–29 — the group lion is needed to expand coverage to other ises protection against the meningococcal hit hardest by the disease, numbering 12.5 mil- countries in the meningitis belt, says Marie- bacterium . It is the cul- lion people. Mali and Niger will each vaccinate Pierre Preziosi, an official at the WHO’s mination of ten years’ work by an international 4 million people in the same age bracket. Department of Immunization, Vaccines and consortium to develop a vaccine at a price low Meningitis A epidemics cause fewer cases and Biologicals in Geneva. Raising the money will enough for massive use in Africa: just US$0.40 deaths in Africa than AIDS or malaria, but this be challenging, she says, particularly because a dose. “MenAfriVac is a fantastic initiative,” masks its huge social and economic toll in those the GAVI Alliance, the main sponsor of vac- says Andrew Riordan, a meningitis expert at cination in low-income countries, is facing a Alder Hey Children’s NHS Foundation Trust, financial crunch (see Nature 464, 338; 2010)

e: MVP e: in Liverpool, UK. “For the first time, we may be EPIDEMIC CYCLE Ultimately, public-health officials would like RC able to prevent these huge epidemics.” Africa’s meningitis epidemics usually take place in to deploy several conjugate vaccines that pro- irregular cycles every 5–12 years. sOu The Meningitis Vaccine Project (MVP), led tect against not just meningococcal type A but by the World Health Organization (WHO) 200 250,000+ also the other subgroups in the region that can and PATH, a non-profit body based in Seattle, cause smaller meningitis epidemics. 140 92,347 88,199 Washington, was born in 2001 after a particu- For now, researchers are satisfied that an larly bad epidemic in 1996–97 caused 250,000 80 affordable meningitis vaccine will at last be cases and 25,000 deaths (see ‘Epidemic cycle’). available in Africa. As Andrew Pollard, a men- Commercial manufacturers in developed coun- 40 ingitis researcher at the Jenner Institute at the tries could not produce the vaccine at such a low University of Oxford, UK, says: “The roll out of No. of cases (thousands) cases of No. 0 target price, according to Marc LaForce, director 1950 1970 1990 2010 MenAfriVac in Burkina Faso is a triumph for of the MVP. So the consortium did the research this unique partnership.” ■

11 NOvembeR 2010 | vOL 468 | NATURe | 143 © 2010 Macmillan Publishers Limited. All rights reserved