Epidemiological changes in meningococcal meningitis in Niger from 2008 to 2011 and the impact of vaccination

BMC Infectious Diseases

Jean-François Jusot²  Brian Greenwood¹  Muhamed-Kheir Taha³  Pierre Nicolas⁴  Stéphane Hugonnet⁶  Maman Zaneidou⁷  Bassira Issaka²  Jean-Marc Collard⁵ 

[1] Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;Centre de Recherche Médicale et Sanitaire, Niamey, Niger;Institut Pasteur, WHO Collaborating Centre for Reference and Research on Meningococci, Paris, France;WHO Collaborative Center for the meningococcus in IMTSSA (Institut de Médecine Tropicale du Service de Santé des Armées), Marseille, France;Current address: Scientific Institute of Public Health, Brussels, Belgium;World Health Organization, Geneva, Switzerland;Direction de la Surveillance et de la Riposte aux Epidémies, Ministère de la Santé Publique, Niamey, Niger

关键词: Immunization;    Sequence-type lineage evolution;    MenAfriVac®;    Vaccination;    Niger;    Meningitis;    Neisseria meningitidis serogroup A and W;   

Others  :  1145321
DOI  :  10.1186/1471-2334-13-576

 received in 2013-01-22, accepted in 2013-12-04,  发布年份 2013

【 摘 要 】

Background

The epidemiology of bacterial meningitis in the African ‘meningitis belt’ changes periodically. In order to design an effective vaccination strategy, we have examined the epidemiological and microbiological patterns of bacterial meningitis, and especially that of meningococcal meningitis, in Niger during the period 2008–2011. During this period a mass vaccination campaign with the newly developed meningococcal A conjugate vaccine (MenAfriVac®) was undertaken.

Method

Cerebrospinal fluid samples were collected from health facilities throughout Niger and analysed by culture, seroagglutination and/or speciation polymerase chain reaction, followed by genogrouping PCR for Neisseria meningitidis infections. A sample of strains were analysed by multi-locus sequence typing.

Results

N. meningitidis serogroup A cases were prevalent in 2008 and 2009 [98.6% and 97.5% of all N. meningitidis cases respectively]. The prevalence of serogroup A declined in 2010 [26.4%], with the emergence of serogroup W Sequence Type (ST) 11 [72.2% of cases], and the serogroup A meningococcus finally disappeared in 2011. The geographical distribution of cases N. meningitidis serogroups A and W within Niger is described.

Conclusion

The substantial decline of serogroup A cases that has been observed from 2010 onwards in Niger seems to be due to several factors including a major polysaccharide A/C vaccination campaign in 2009, the introduction of MenAfriVac® in 10 districts at risk in December 2010, the natural dynamics of meningococcal infection and the persistence of serogroup A sequence-type 7 for about 10 years. The emergence of serogroup W strains suggests that there may be a need for serogroup W containing vaccines in Niger in the coming years.

【 授权许可】

   
2013 Collard et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Sultan B, Labadi K, Guégan JF, Janicot S: Climates drives the meningitis epidemics onset in West Africa. PLoS Med 2005, 2(1):43-49.
• [2]Whittle HC, Greenwood BM: Meningococcal meningitis in northern savanna of Africa. Trop Doct 1976, 6:99-104.
• [3]Broome CV, Rugh MA, Yada AA, Giat L, Giat H, Zeltner JM, Sanborn WR, Fraser DW: Epidemic group C meningococcal meningitis in Upper Volta, 1979. Bull World Health Organ 1983, 61(2):325-330.
• [4]Decosas J, Koama JB: Chronicle of an outbreak foretold: meningococcal meningitis W135 in Burkina Faso. Lancet Infect Dis 2002, 2(12):763-765.
• [5]Zombre S, Hacen MM, Ouango G, Sanou S, Adamou Y, Koumaré B, Kondé MK: The outbreak of meningitis due to Neisseria meningitidis W135 in 2003 in Burkina Faso and the national response: main lessons learnt. Vaccine 2007, 25(Suppl 1):A69-A71.
• [6]Boisier P, Nicolas P, Djibo S, Taha MK, Jeanne I, Maïnassara HB, Tenebray B, Kairo KK, Giorgini D, Chanteau S: Meningococcal meningitis: unprecedented incidence of serogroup X-related cases in 2006 in Niger. Clin Infect Dis 2007, 44(5):657-663.
• [7]World Health Organization: Detecting meningococcal meningitis epidemics in highly-endemic African countries. Wkly Epidemiol Rec 2000, 75(38):305-312.
• [8]LaForce MF, Ravenscroft N, Djingarey M, Viviani S: Epidemic meningitis due to Group A Neisseria meningitidis in the African meningitis belt: A persistent problem with an imminent solution. Vaccine 2009, 27(Suppl 2):B13-B19.
• [9]Kristiansen PA, Diomandé F, Ba AK, Sanou I, Ouédraogo AS, Ouédraogo R, Sangaré L, Kandolo D, Aké F, Saga IM, Clark TA, Misegades L, Martin SW, Thomas JD, Tiendrebeogo SR, Hassan-King M, Djingarey MH, Messonnier NE, Préziosi MP, Laforce FM, Caugant DA: Impact of the serogroup A meningococcal conjugate vaccine, MenAfriVac, on carriage and herd immunity. Clin Infect Dis 2013, 56(3):354-363.
• [10]Daugla D, Gami J, Gamougam K, Naibei N, Mbainadji L, Narbé M, Toralta J, Kodbesse B, Ngadoua C, Coldiron M, Fermon F, Page AL, Djingarey M, Hugonnet S, Harrison O, Rebbetts L, Tekletsion Y, Watkins E, Hill D, Caugant D, Chandramohan D, Hassan-King M, Manigart O, Nascimento M, Woukeu A, Trotter C, Stuart J, Maiden M, Greenwood B: Effect of a serogroup A meningococcal conjugate vaccine (PsA-TT) on serogroup A meningococcal meningitis and carriage in Chad: a community trial. Lancet 2013, 6736(13):61612-61618.
• [11]Campbell H, Borrow R, Salisbury D, Miller E: Meningococcal C conjugate vaccine: the experience in England and Wales. Vaccine 2009, 27(Suppl 2):B20-B29.
• [12]Chanteau S, Sidikou F, Djibo S, Moussa A, Mindadou H, Boisier P: Scaling up of PCR-based surveillance of bacterial meningitis in the African meningitis belt: indisputable benefits of multiplex PCR assay in Niger. Trans R Soc Trop Med Hyg 2006, 100(7):677-680.
• [13]Maiden MC, Bygraves JA, Feil E, Morelli G, Russell JE, Urwin R, Zhang Q, Zhou J, Zurth K, Caugant DA, Feavers IM, Achtman M, Spratt BG: Multilocus sequence typing: a portable approach to the identification of clones within populations of pathogenic microorganisms. Proc Natl Acad Sci U S A 1998, 95(6):3140-3145.
• [14]Djibo S, Nicolas P, Alonso JM, Djibo A, Couret D, Riou JY, Chippaux JP: Outbreaks of serogroup X meningococcal meningitis in Niger 1995-2000. Trop Med Int Health 2003, 8(12):1118-1123.
• [15]World Health Organization: Inter country Support Team – West Africa Weekly feedback bulletin on cerebrospinal meningitis. Epidemiological situation of week 35 -39; From 29 August to 1st October 2011. [http://www.who.int/csr/disease/meningococcal/BulletinMeningite2011_S35_39.pdf webcite]
• [16]Lapeyssonnie L: La méningite cérébro-spinale en Afrique. Bull World Health Organ 1963, 28(Suppl):1-114.
• [17]Nicolas P, Décousset L, Riglet V, Castelli P, Stor R, Blanchet G: Multilocus sequence typing of serogroup A meningococci isolated in Africa between 1988 and 1999 shows the clonal expansion of ST-5 and emergence of ST-7. Emerg Infect Dis 2001, 7(5):849-854.
• [18]Nicolas P, Djibo S, Moussa A, Tenebray B, Boisier P, Chanteau S: Molecular epidemiology of meningococci isolated in Niger in 2003 shows serogroup A sequence type (ST)-7 and serogroup W135 ST-11 and T-2881 strains. J Clin Microbiol 2005, 43(3):1437-1438.
• [19]Collard JM, Maman Z, Abani A, Mainasara HB, Djibo S, Yacouba H, Maitournam R, Sidikou F, Nicolas P, Rocourt J, Jusot JF: Microbiological and epidemiological investigation of the Neisseria meningitidis serogroup A epidemic in Niger in 2009: last wave before the introduction of the serogroup A meningococcal conjugate vaccine? Epidemiol Infect 2011, 139(11):1656-1660.
• [20]Caugant DA, Kristiansen PA, Wang X, Mayer LW, Taha MK, Ouédraogo R, Kandolo D, Bougoudogo F, Sow S, Bonte L: Molecular characterization of invasive meningococcal isolates from countries in the African meningitis belt before introduction of a serogroup A conjugate vaccine. PLoS One 2012, 7(9):e46019.
• [21]Huber CA, Pflüger V, Hamid AW, Forgor AA, Hodgson A, Sié A, Junghanss T, Pluschke G: Lack of antigenic diversification of major outer membrane proteins during clonal waves of Neisseria meningitidis serogroup A colonization and disease. FEMS Immunol Med Microbiol 2012. doi:10.1111/1574-695X.12000
• [22]Bart A, Barnabé C, Achtman M, Dankert J, van der Ende A, Tibayrenc M: The population structure of Neisseria meningitidis serogroup A fits the predictions for clonality. Infect Genet Evol 2001, 1(2):117-122.
• [23]Nicolas P, Norheim G, Garnotel E, Djibo S, Caugant DA: Molecular epidemiology of Neisseria meningitidis isolated in the African meningitis belt between 1988 and 2003 shows dominance of sequence type 5 (ST-5) and ST-11 complexes. J Clin Microbiol 2005, 43(10):5129-5135.
• [24]Dellicour S, Greenwood B: Impact of meningococcal vaccination on pharyngeal carriage of meningococci. Trop Med Int Health 2007, 12(12):1409-1421.
• [25]Hassan-King MKA, Wall RA, Greenwood BM: Meningococcal carriage, meningococcal disease and vaccination. J Infect 1988, 16(1):55-59.
• [26]Kwara A, Adegbola RA, Corrah PT, Weber M, Achtman M, Morelli G, Caugant DA, Greewood BM: Meningitis caused by a serogroup W135 clone of the ET-37 complex of Neisseria meningitidis in west Africa. Trop Med Int Health 1998, 3:742-746.
• [27]Nathan N, Rose AM, Legros D, Tiendrebeogo SR, Bachy C, Bjørløw E, Firmenich P, Guerin PJ, Caugant DA: Meningitis serogroup W135 outbreak, Burkina Faso, 2002. Emerg Infect Dis 2007, 13(6):920-923.
• [28]Collard JM, Maman Z, Yacouba H, Djibo S, Nicolas P, Jusot JF, Rocourt J, Maitournam R: Increase in Neisseria meningitidis serogroup W135, Niger, 2010. Emerg Infect Dis 2010, 16(9):1496-1498.
• [29]Paireau J, Girond F, Collard JM, Maïnassara HB, Jusot JF: Analysing spatio-temporal clustering of meningococcal meningitis outbreaks in Niger reveals opportunities for improved disease control. PLoS Negl Trop Dis 2012, 6(3):e1577.