Via MSF.org: Niger: Vaccine shortages causing delay in the fight against meningitis. Excerpt:
More than 6,000 suspected cases and 443 deaths from meningitis have been recorded in Niger in the past three months. But a shortage of vaccines has hindered timely implementation of a vaccination campaign.
Dr. Pauline Lechevalier, a Médecins Sans Frontières (MSF) vaccination specialist, discusses recent advances in responding to meningitis epidemics, and reflects on the improvements that are still needed.
Three months after the beginning of the meningitis epidemic in Niger, there are still difficulties with implementing a vaccination campaign. Why?
The World Health Organization (WHO) recommends that vaccination campaigns be implemented in response to epidemics. The threshold for declaration of an epidemic is when there are ten cases per 100,000 population recorded in one week. The first districts in Niger affected by the epidemic crossed this threshold in mid-February.
Since then, the vaccination response was limited to Niamey and two districts of the Dosso region, involving a total of about 500,000 doses of vaccine. By May 15, 11 other health districts had reached the epidemic threshold, but the vaccination campaign didn't reach them.
There are several reasons for the delay in the response to vaccinate. Firstly, the magnitude of the epidemic took everyone by surprise because since introduction of the meningococcal A vaccine in 2010, Niger had been free of epidemics of similar scale. Thus the international provisioning mechanism for vaccines was not prepared to respond to such an epidemic, which explains some of the initial delay.
Meanwhile the global emergency stockpile of vaccines had been exhausted in late April, largely the result of another epidemic in Nigeria and the cancelled delivery by one of the vaccine producers. It therefore became urgent to find alternative sources for hundreds of thousands of additional doses of the vaccine. These are now expected to be available in the coming days.
It was thought that the problem of meningitis had been resolved with the development of a new vaccine. Can you tell us about this vaccine?
The MenAfriVac vaccine, which has been introduced progressively across Sub-Saharan Africa since 2010, has so far been administered to over 200 million people in the 'meningitis belt', which runs from Senegal to Ethiopia. It is very effective against meningitis due to the meningococcal A strain, or serogroup.
A study in Chad in 2012, for example, showed a decrease of 94 per cent in meningitis A cases in three regions where the vaccine was introduced. In addition, this conjugate vaccine reduced nasopharyngeal carriage, in other words the person-to-person transmission of the disease, by 98 per cent.
MenAfriVac’s introduction has helped to stop the cycle of deadly meningococcal A epidemics in the region, but smaller-scale outbreaks caused by other strains—particularly the W135 and C strains—continue to be recorded. The current epidemic in Niger, which is an extension of the epidemic in neighbouring Nigeria, is the first large meningococcal C epidemic ever recorded in the country.