1. Chief, Meningitis and Vaccine Preventable Diseases Branch
From Epidemic to Elimination: Serogroup A Conjugate Meningococcal Vaccine for the Meningitis Belt
Nancy Messonnier, M.D.
Chief, Meningitis and Vaccine Preventable Diseases Branch
Division of Bacterial Diseases
National Center for Immunization and Respiratory Diseases

3. The “Meningitis Belt” of sub-Saharan Africa*
430 million at risk
*“Meningitis belt” defined by Lapeyssonnie in 1963
Redefined by Greenwood in 1987

4. *Greenwood, Trans Roy Soc 1979

5. Meningococcal Disease Epidemics, Africa - 1970- 1996*
Country
Year
Cases
Incidence
(per 100,000)
Nigeria
1977
1,257
360
Rwanda
1978
248
729
Burkina Faso (NmC)
1979
539
517
Cote d’Ivoire
1983
414
107
Chad
1988
4,542
826
Sudan
32,016
133
Kenya
1989
3,800
250
Burundi
1992
1,615
608
Burkina Faso
1996
7,221
1,249
10,089
426
Ghana
1997
14,277
1,260
*Adapted from Control of Epidemic Meningococcal Disease, WHO Practical Guidelines, 2nd edition

6. Meningitis Cases, Selected Countries, 2003-5*
Country
2003
2004
2005
Benin
367
269
172
Burkina Faso
7869
5296
2929
Chad
614
863
1001
Cote d’Ivoire
N/A
280 39
Ethiopa
2768
564
Ghana
1454
859
525
Mali
868
906
326
Niger
8082
3483
1031
Nigeria
3508
247
*WER 2005, 80:

7. Predominence of Serogroup A in Epidemic Districts, Africa, 2003-2007*
World Health Organization
7 November 2019
Predominence of Serogroup A in Epidemic Districts, Africa, *
Serogroup
2003
(n=44)
2004
(n=22)
2005
(n=19)
2006
(n=74)
2007
(n=96)
Total A
70.5
95.5
89.5
85.1
95.8
87.8
W-135
29.5
4.5
10.5
9.5
3.1
10.2 X
4.1
1.0
1.6
*WHO, unpublished data 7

8. *Campagne et al. Bull World Health Organ 1999;77(6):499-508.
Incidence of Meningococcal Meningitis by Age Groups - Niger, *
*Campagne et al. Bull World Health Organ 1999;77(6):

9. Economic Impact of Epidemic Meningitis, Burkina Faso
Household cost: US $90 per case
34% per capita GDP
Up to an additional US $ 154 if sequelae occur
Urban cost >200% higher than rural
outbreak cost US $7.1M
2% of national health expenditure
85% vaccination, 10% case management
*Colombini, CID 2009

10. Conjugate vs Polysaccharide Vaccines
Immunogenicity
5 yr olds-adults
Young children
Response to booster
Quality of antibody in children
Avidity
Bactericidal activity
Induction of memory
Long term effect on colonization
High
Low No
Polysaccharide
vaccines
Conjugate
Yes

11. Meningococcal Conjugate Vaccines for Africa, View from cy2000
A/C conjugate vaccine field trials
Gambia ( )
Niger ( )
Studies on A containing conjugate in Europe/US
Progress and timelines slow
Availability of new funds

12. The Meningitis Vaccine Project: Novel Approach to Vaccine Development
Partnership between WHO and PATH, with a Grant from Bill and Melinda Gates foundation (2001)
Manufacturer consortium
SynCo BioPartners (Amsterdam) - NmA PS
Statens Serum Institute (Denmark) - TT
FDA-developed conjugation method
Serum Institute of India – vaccine
Price = $0.40 per dose

13. *herd immunity – 80% in unvaccinated
Potential Impact of Meningococcal Conjugate A Vaccine Strategies, 3 Regions, Burkina Faso, [80% vaccine coverage] * *
*herd immunity – 80% in unvaccinated

14. MenAfriVac – Recent Progress
Good safety profile
About 7000 adults and children vaccinated in India and Africa
Licenced Indian NRA
December 2009
WHO prequalified
June 2010

15. MenAfriVac hSBA Immunogenicity Compared to PS, in 2-29yo Africans*
*B. Mocca, IPNC, 2010

16. MenAfriVac rSBA Immunogenicity, Africa, 12-23mo (n=601)**
Vaccine
4-fold responders SeroA rSBA
[95%CI]
PsA-TT
(n=198)
96%*
[92-98]
PsACYW
(n=193)
64%*
[57-71]
Hib-TT
(n=195)
36%
[29-43]
*delta = p(PsACWY) – p(PsA-TT) = -32% [-40% - -25%]; “immunologically superior”
**IPNC, 2008

17. Introduction – Burkina Faso, Mali, Niger
Phase 1: September 2010:
Introduction in a limited population: doses in each country
Active Surveillance of AEFIs
Assess logistical constraints
Phase 2: December 2010:
Burkina: 11 millions persons
Mali: 4 millions persons
Niger: 4 millions persons
Phase 3: 4th quarter 2011:
Mali: 7 millions persons
Niger: 8 million persons

18. MenAfriVac Intro, Phase 2*
Country
No. of Districts Vaccinated
Target Population (2-29yo)
Vaccination Coverage
Burkina Faso 63
11,133,831
102.6%
Mali 23
4,879,059
101.2%
Niger 11
3,135,961
*WHO, SRWG meeting, 3/5/11

19. Adverse Events- MenAfriVac Intro, Phase 2*
Country
Mild Adverse Events
Severe Adverse Events
Burkina Faso
1857 33
Mali
277 17
Niger
256 31
*WHO, SRWG meeting, 3/5/11

20. “Early Returns”
MenAfriVac Impact
20/28

21. Burkina Faso Meningitis Surveillance 2011*
*courtesy Dr. M. Djingary, AFRO

22. Meningitis Attack Rates by District, 2006-2009, Burkina Faso
2007
2006
2008
2009
Districts that have not reached threshold
Districts that have reached alert threshold
Districts that have reached epidemic threshold 22

23. Burkina Faso Meningitis Surveillance – 2007
*MOH/WHO/Burkina Faso

24. Burkina Faso Meningitis Surveillance – Serogroup Week 9 (as of March 9, 2011)*
One confirmed case of serogroup A meningococcal disease in an unvaccinated adolescent!
*MOH/WHO/Burkina Faso

25. Niger Meningitis Surveillance –

26. Burkina Faso Meningitis Surveillance 2010 vs 2011*–
*Meningitis Weekly Bulletin, week 10, IST/AFR–

28. Post Licensure Impact Assessment
Impact on outbreaks
Field effectiveness
Vaccine safety
Correlates of protection
Indirect effects of vaccination
Duration of protection
Impact on molecular epidemiology
Impact of variations in programs

29. MenAfriVac Introduction Planning
2010/11
2012
> 2014
2013

30. *courtesy M. LaForce

31. Elimination of Epidemic Meningitis is Possible, with Good Partners!

32. Extra slides

33. MVP: Serogroup A-specific IgG GMCs
before and 4 weeks post-immunisation*
P<0.05
P<0.05
*Borrow et al, IPNC 2006

34. Epidemic Meningitis:
A, C
B, C

35. *MOH/Burkina Faso 35