Emergency vaccination against epidemic meningitis in Ghana: implications for the control of meningococcal disease in West Africa

• Published in: The Lancet (British edition) Vol. 355; no. 9197; pp. 30 - 33
• Main Authors: Woods, Christoper W, Armstrong, Gregory, Sackey, Samuel O, Tetteh, Christopher, Bugri, Samuel, Perkins, Bradley A, Rosenstein, Nancy E
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 2000; Lancet; Elsevier Limited
• Subjects: Adult; Africa South of the Sahara; Bacterial Vaccines; Biological and medical sciences; Child; Disease Outbreaks - prevention & control; Epidemics; Epidemiology. Vaccinations; General aspects; Ghana - epidemiology; Humans; Immunization; Infectious diseases; Medical disorders; Medical research; Medical sciences; Meningitis, Meningococcal - epidemiology; Meningitis, Meningococcal - mortality; Meningitis, Meningococcal - prevention & control; Meningococcal Vaccines; Population; Tropical medicine; Vaccines; West Africa; Ghana; Africa; Africa South of the Sahara; Infection; Epidemic; Human; Prevention; Nervous system diseases; Treatment efficiency; Vaccination; Central nervous system disease; Bacteriosis; Meningitis; Emergency; Meningococcal disease; Epidemics; Health Services; Organization And Administration; Bacterial And Fungal Diseases > prevention and control; Evaluation Report; Biology; Infections; Delivery Of Health Care; Research Methodology; English Speaking Africa; Physiology; Programs; Evaluation; Immunization; Health; Population At Risk; Africa; Ghana; Diseases; Western Africa; Central Nervous System; Central Nervous System Effects > prevention and control; Developing Countries; Primary Health Care; Africa South Of The Sahara; Planning; Program Evaluation; Policy Development
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(99)03366-8

Recurrent epidemics of meningococcal disease have been reported throughout the African meningitis belt since description of the disease in 1912. Meningooccal polysaccharide vaccines can effectively prevent disease but the optimum strategy for their use in this setting has been controversial. We used data from an outbreak of meningococcal disease in northern Ghana in 1997 to assess the potential effect of different vaccination strategies.
We identified all reported cases of meningococcal meningitis and estimated the number of cases and deaths that could have been prevented by vaccination through use of a simple mathematical model. We then assessed the potential effect of different vaccination strategies and the burden of these strategies on the public-health system.
In the three affected regions in northern Ghana there were 18 703 cases and 1356 deaths reported between November, 1996, and May, 1997. Vaccination began in the third week of February and continued to April, reaching 72% of the at-risk population and preventing an estimated 23% of cases and 18% of deaths. A strategy of routine childhood and adult immunisation would have prevented 61% of cases had this same rate of vaccine coverage been achieved and maintained before the epidemic. If vaccination had started after the onset of the epidemic in January, as currently advocated by WHO guidelines, a similar proportion (61%) of cases could have been prevented.
Prevention of epidemics of meningococal disease in west Africa will be difficult until long-lasting conjugate vaccines capable of interrupting transmission of
Neisseria meningitidis can be incorporated into routine infant-immunisation schedules. Until then, the strategy of surveillance and response advocated by WHO is as effective and more practical than a strategy of routine childhood and adult vaccination with currently available polysaccharide vaccines.