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Group A and C meningococci: Neisseria (N.) meningitidis group A is the cause of major epidemics in sub-Saharan Africa, with thousands of cases per outbreak and a case fatality rate of about 10 %.

Between 1988 and 1997, 704,000 cases of meningitis and 100,000 deaths were reported in the so-called "African meningitis belt," which stretches from Ethiopia in East Africa to The Gambia in the west. The largest recorded epidemic, with more than 200,000 cases and 20,000 deaths reported, occurred in 1996. These reports typically substantially underestimate the actual burden of the disease. During epidemics, routine reporting systems break down, many patients die before reaching a health center, and the cause of death goes unrecorded.

Epidemic meningitis attacks a broad age range, with young people at particular risk. Infants less than a year old are most at risk. Infection is characterized by high fever, vomiting, and confusion, which can progress over several hours to death. Despite antibiotic therapy, at least one in 10 with the disease will die, and another 10 percent are left with neurologic disorders and the loss of the use of their limbs through paralysis. Untreated, up to 50 percent of cases result in death.

Currently used polysaccharide vaccines are not effective in inducing protection in infants and can only be used in expensive and disruptive emergency interventions in older children. Therefore, the overall goal is to develop a (conjugate) vaccine to be incorporated into routine immunization programs in areas at risk of epidemics.

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