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Invasive Meningococcal Disease in Africa's Meningitis Belt: More Than Just Meningitis?
Heather E Reese1,2, Olivier Ronveaux3, Jason M Mwenda4
1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, Atlanta, Georgia.
Abstract:
Since the progressive introduction of the meningococcal serogroup A conjugate vaccine within Africa's meningitis belt beginning in 2010, the burden of meningitis due to Neisseria meningitidis serogroup A (NmA) has substantially decreased. Non-A serogroups C/W/X are now the most prevalent. Surveillance within the belt has historically focused on the clinical syndrome of meningitis, the classic presentation for NmA, and may not adequately capture other presentations of invasive meningococcal disease (IMD). The clinical presentation of infection due to serogroups C/W/X includes nonmeningeal IMD, and there is a higher case-fatality ratio associated with these non-A serogroups; however, data on the nonmeningeal IMD burden within the belt are scarce. Expanding surveillance to capture all cases of IMD, in accordance with the World Health Organization's updated vaccine-preventable disease surveillance standards and in preparation for the anticipated introduction of a multivalent meningococcal conjugate vaccine within Africa's meningitis belt, will enhance meningococcal disease prevention across the belt.
Insights
Meningococcal serogroup A (NmA) cases have decreased due to vaccination. Surveillance must expand to include non-meningeal invasive meningococcal disease (IMD) from other serogroups to improve prevention.
Area of Science:
- Public Health
- Epidemiology
- Vaccinology
Background:
- Introduction of meningococcal serogroup A conjugate vaccine in Africa has reduced NmA burden.
- Non-A serogroups (C/W/X) are now the most prevalent cause of invasive meningococcal disease (IMD).
- Traditional surveillance focused on meningitis may miss non-meningeal IMD presentations.
Discussion:
- Non-A serogroups C/W/X are associated with higher case-fatality ratios.
- Data on non-meningeal IMD burden in Africa's meningitis belt are limited.
- Current surveillance may underestimate the full impact of IMD.
Key Insights:
- Vaccination success against NmA necessitates updated surveillance strategies.
- Non-meningeal IMD presentations are a significant concern for serogroups C/W/X.
- Expanded surveillance is crucial for accurate disease burden assessment.
Outlook:
- WHO standards guide enhanced IMD surveillance.
- Preparation for multivalent conjugate vaccines requires comprehensive data.
- Improved surveillance will strengthen meningococcal disease control across the meningitis belt.
