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Neisseria meningitidis Serogroup W Meningitis Epidemic in Togo, 2016
Didier Mounkoro1, Christelle S Nikiema2, Issaka Maman3
1Agence de Médecine Préventive, Dapaong, Togo.
Background:
During 2014, 4 regions in Togo within the African meningitis belt implemented vaccination campaigns with meningococcal serogroup A conjugate vaccine (MACV). From January to July 2016, Togo experienced its first major Neisseria meningitidis serogroup W (NmW) outbreak. We describe the epidemiology, response, and management of the outbreak.
Methods:
Suspected, probable, and confirmed cases were identified using World Health Organization case definitions. Through case-based surveillance, epidemiologic and laboratory data were collected for each case. Cerebrospinal fluid specimens were analyzed by polymerase chain reaction, culture, or latex agglutination. Vaccination campaigns were conducted in affected districts.
Results:
From January 11 to July 5, 2016, 1995 suspected meningitis cases were reported, with 128 deaths. Among them, 479 (24.0%) were confirmed by laboratory testing, and 94 (4.7%) and 1422 (71.3%) remained as probable and suspected cases, respectively. Seven epidemic districts had cumulative attack rates greater than 100 per 100 000 population. Of the confirmed cases, 91.5% were NmW; 39 of 40 available NmW isolates were sequence type-11/clonal complex-11.
Conclusions:
This outbreak demonstrates that, although high coverage with MACV has reduced serogroup A outbreaks, large meningococcal meningitis outbreaks due to other serogroups may continue to occur; effective multivalent meningococcal conjugate vaccines could improve meningococcal disease prevention within meningitis belt populations.
Insights
Meningococcal serogroup A conjugate vaccine (MACV) reduced serogroup A meningitis, but a large Neisseria meningitidis serogroup W (NmW) outbreak occurred in Togo. Multivalent vaccines are needed for broader protection in the African meningitis belt.
Area of Science:
- Epidemiology
- Infectious Diseases
- Vaccinology
Background:
- Togo implemented meningococcal serogroup A conjugate vaccine (MACV) campaigns in 2014.
- In 2016, Togo experienced its first major Neisseria meningitidis serogroup W (NmW) outbreak.
Observation:
- 1995 suspected meningitis cases and 128 deaths were reported between January and July 2016.
- Laboratory confirmation identified 479 cases, with 91.5% caused by NmW (ST-11/CC-11).
- Seven districts reported attack rates exceeding 100 per 100,000 population.
Findings:
- The outbreak primarily involved Neisseria meningitidis serogroup W (NmW).
- The identified NmW isolates belonged to sequence type-11/clonal complex-11.
Implications:
- High MACV coverage can reduce serogroup A outbreaks but does not prevent outbreaks from other serogroups.
- Multivalent meningococcal conjugate vaccines are crucial for enhancing disease prevention in the African meningitis belt.
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