Introduction and Rollout of a New Group A Meningococcal Conjugate Vaccine (PsA-TT) in African Meningitis Belt Countries, 2010–2014

Abstract

Background. A group A meningococcal conjugate vaccine (PsA-TT) was developed specifically for the African “meningitis belt” and was prequalified by the World Health Organization (WHO) in June 2010. The vaccine was first used widely in Burkina Faso, Mali, and Niger in December 2010 with great success. The remaining 23 meningitis belt countries wished to use this new vaccine.Methods. With the help of African countries, WHO developed a prioritization scheme and used or adapted existing immunization guidelines to mount PsA-TT vaccination campaigns. Vaccine requirements were harmonized with the Serum Institute of India, Ltd.Results. Burkina Faso was the first country to fully immunize its 1- to 29-year-old population in December 2010. Over the next 4 years, vaccine coverage was extended to 217 million Africans living in 15 meningitis belt countries.Conclusions. The new group A meningococcal conjugate vaccine was well received, with country coverage rates ranging from 85% to 95%. The rollout proceeded smoothly because countries at highest risk were immunized first while attention was paid to geographic contiguity to maximize herd protection. Community participation was exemplary.

Impact of MenAfriVac in nine countries of the African meningitis belt, 2010–15: an analysis of surveillance data

“…This information is often not confirmed at district level, and vaccine uptake was reported as exceptionally high. 11 We observed an increase over time in the IRR of confirmed cases due to other (non-A) meningococcal serogroups in vaccinated compared with previously unvaccinated populations. The emergence of a novel serogroup C strain causing epidemics in Niger 17 and Nigeria 2 is a key event, and indeed the IRR decreases if the data from the epidemic in Niger in 2015 are removed.…”

“…We considered the time of vaccination relative to the meningitis season (eg, Burkina Faso was considered unvaccinated in 2010 because the MenAfriVac campaigns were done in December 2010 and nearly all of the data for meningitis were collected between January and June). Given that measures of vaccine uptake were universally high, 11 and large indirect effects were expected, 12,13 we did not adjust further for country level vaccination uptake (coverage) in the campaigns.…”

Introducing new vaccines in low- and middle-income countries: challenges and approaches

“…While mass media played an important role, local events involved local personages (community volunteers, traditional and religious leaders). This translated into a highly effective campaign with 11.4 million individuals between the ages of 1 and 29 years (100% of target population being vaccinated) [65,83]. Subsequent mass campaign strategies followed alongside vaccine implementation by other countries in the region ('African Meningitis Belt') with vaccine coverage rates ranging from 85% to 95% [83].…”

Prevalence and epidemiology of meningococcal carriage in Southern Ethiopia prior to implementation of MenAfriVac, a conjugate vaccine

“…The vaccine, MenAfriVac, contains 10 μg serogroup A polysaccharide conjugated to tetanus toxoid, and has been introduced in mass vaccination campaigns of all 1–29 year olds in more than 15 countries. In Ethiopia, one of the countries with high epidemic risk and high disease burden, vaccination has been implemented in 3 phases from 2013 to 2015 [25]. Prior to and in relation to the implementation of the vaccine, several carriage studies have been conducted across the meningitis belt, showing the vaccine’s ability to prevent carriage, and giving useful information about which serogroups and clones that circulate [5, 26–28].…”