Meningococcal meningitis in sub-Saharan Africa: the case for mass and routine vaccination with available polysaccharide vaccines

• Published in: Bulletin of the World Health Organization Vol. 81; no. 10; pp. 745 - 50; discussion 751-5
• Main Authors: Robbins, John B, Schneerson, Rachel, Gotschlich, Emil C, Mohammed, Idris, Nasidi, Abdulsalami, Chippaux, Jean-Philippe, Bernardino, Luis, Maiga, Moussa A
• Format: Journal Article
• Language: English
• Published: Switzerland World Health Organization 01-10-2003; The World Health Organization
• Subjects: Africa South of the Sahara; Africa South of the Sahara - epidemiology; Age; Age groups; Antibodies; Child; Child, Preschool; Confidence intervals; Disease; Disease Outbreaks - prevention & control; Disease prevention; Endemic Diseases - prevention & control; Endemic diseases/prevention and control; Epidemics; Epidemiology; Fatalities; Health aspects; Health Policy & Services; Humans; Immunization programs; Infant; Mass immunization; Mass Vaccination - utilization; Meningitis; Meningitis, Cerebrospinal; Meningitis, Meningococcal - epidemiology; Meningitis, Meningococcal - prevention & control; Meningitis, Meningococcal/prevention and control; Meningococcal Vaccines - administration & dosage; Meningococcal Vaccines - immunology; Meningococcal vaccines/pharmacology; Mortality; Nervous system; Patient outcomes; Population; Prevention; Surveillance; Treatment Outcome; Vaccines; World Health Organization; Africa South of the Sahara; Sub-Saharan Africa; Programmes de vaccination; Enfermedades endémicas; Africa South of the Sahara; Endemic diseases; Mass immunization; Programas de inmunización; Maladie endémique; Immunization programs; Meningitis meningocócica; Vacunas meningocócicas; Meningitis, Meningococcal; Meningococcal vaccines; Afrique subsaharienne; Méningite méningococcique; Immunisation de masse; Vaccins antiméningococciques; Inmunización masiva; Africa del Sur del Sahara
• ISSN: 0042-9686; 1564-0604
• DOI: 10.1590/S0042-96862003001000010

Endemic and epidemic group A meningococcal meningitis remains a major cause of morbidity and mortality in sub-Saharan Africa, despite the availability of the safe and inexpensive group A meningococcal polysaccharide vaccine, which is protective at all ages when administered as directed. Despite optimal therapy, meningococcal meningitis has a 10% fatality rate and at least 15% central nervous system damage. WHO's policy of epidemic containment prevents, at best, about 50% of cases and ignores endemic meningitis, which is estimated at 50,000 cases per year. The effectiveness of group A, C, W135, and Y capsular polysaccharides is the basis for recommending universal vaccination with group A meningococcal polysaccharide twice in infancy, followed by the four-valent vaccine in children aged two and six years. This could eliminate epidemic and endemic disease, prepare for the use of conjugates when they become available, and probably could have prevented the recent epidemics of groups A and W135 meningitis in Burkina Faso.