NEWS - April 2003
Triple attack on African meningitis outbreak
FOR the second year running, Burkina Faso is struggling with an outbreak of meningitis exacerbated by a virulent strain of meningococcus called W135. But as the epidemic season peaks this month, officials are hopeful that a three-pronged strategy combining mass campaigns with a newly licensed vaccine, better case management, and more efficient surveillance are already beginning to reduce the impact of the disease.
a recovering child in Burkina Faso
So far this year in Burkina, there have been almost 6000 cases of meningitis and more than 800 deaths. A number of survivors have also suffered permanent disabilities, such as hearing impairments.
The African "meningitis belt" is accustomed to outbreaks caused by the more familiar meningococcal strains, or serogroups, known as A and C. But last year the W135 serogroup, which had until then appeared only sporadically in Africa, emerged to kill more than 1700 in Burkina Faso. The vaccine that was available at the time protected only against the A and C serogroups. A vaccine against W135 already existed, but its high price had put it beyond the reach of most African governments. Last September, African governments issued an urgent call for an affordable vaccine that would also protect against W135.
WHO contacted several vaccine manufacturers and a trivalent "ACW" vaccine was developed by GlaxoSmithKline (see Immunization Focus, November 2002). In December 2002, the Belgian authorities granted the ACW vaccine a licence. In February, after surveillance reports indicated that meningococcal disease was increasing and that W135 was present in several districts, the vaccine was released at the request of the Burkina government by the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control. WHO and the health ministry are now assessing the vaccine's impact. The results will be available to help plan for the 2004 epidemic season.
Dr Chris Nelson of WHO's department of Vaccines and Biologicals said that the tight timetable could not have been met without the leadership of key individuals and collaboration between WHO, GSK and the Bill & Melinda Gates Foundation.
But vaccination is only part of the strategy for controlling the disease, said Nelson. Equally important is prompt treatment with an affordable antibiotic, oily chloramphenicol. The proportion of sick individuals who are dying from the disease (the case-fatality ratio) has fallen from as high as 15% to 10% in most districts as the epidemic has progressed, indicating improved case management, he said. He has also observed a marked improvement in the quality of surveillance data this year, due to improved training and collaboration between WHO and the ministry of health, which has received extra resources for the work.
Immunization Focus April 2003 - Contents