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Pneumococcal vaccine implementation in the African meningitis belt countries: the emerging need for alternative
Lassané Kaboré1, Annick Galetto-Lacour2, Annick R Sidibé3
1Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Abstract:
Introduction: Besides meningococcal disease, the African meningitis belt (AMB) region is also affected by pneumococcal disease. Most AMB countries have introduced pneumococcal conjugate vaccines (PCV) following a schedule of three primary doses without a booster or a catch-up campaign. PCV is expected to help control pneumococcal disease through both direct and indirect effects. Whether and how fast this will be achieved greatly depends on implementation strategies. Pre-PCV data from the AMB indicate high carriage rates of the pneumococcus, not only in infants but also in older children, and a risk of disease and death that spans lifetime. Post-PCV data highlight the protection of vaccinated children, but pneumococcal transmission remains important, resulting in a lack of indirect protection for unvaccinated persons.Areas covered: A non-systematic literature review focused on AMB countries. Relevant search terms were used in PubMed, and selected studies before and after PCV introduction were summarized narratively to appraise the suitability of current PCV programmatic strategies.Expert opinion: The current implementation strategy of PCV in the AMB appears suboptimal regarding the generation of indirect protection. We propose and discuss alternative programmatic strategies, including the implementation of broader age group mass campaigns, to accelerate disease control in this high transmission setting.
Insights
Pneumococcal conjugate vaccines (PCV) in the African meningitis belt show limited indirect protection. Alternative strategies like mass campaigns are needed to accelerate disease control.
Area of Science:
- * Public Health
- * Vaccinology
- * Infectious Disease Epidemiology
Background:
- * The African meningitis belt (AMB) faces significant burdens from both meningococcal and pneumococcal diseases.
- * Most AMB countries have adopted a three-dose primary schedule for pneumococcal conjugate vaccines (PCV) without boosters or catch-up campaigns.
- * High pneumococcal carriage rates in infants and older children, along with lifelong disease risk, characterize the AMB pre-PCV landscape.
Purpose of the Study:
- * To evaluate the effectiveness of current pneumococcal conjugate vaccine (PCV) implementation strategies in the African meningitis belt (AMB).
- * To assess the extent of direct and indirect protection afforded by PCV in high pneumococcal transmission settings.
- * To propose alternative PCV strategies for accelerated pneumococcal disease control in the AMB.
Main Methods:
- * A non-systematic literature review was conducted, focusing on studies from AMB countries.
- * PubMed was searched using relevant terms to identify studies predating and post-dating PCV introduction.
- * Data were narratively synthesized to analyze the suitability of current PCV programmatic strategies.
Main Results:
- * Post-PCV data indicate protection in vaccinated children but insufficient indirect protection for unvaccinated individuals due to ongoing pneumococcal transmission.
- * Current PCV implementation strategies in the AMB appear suboptimal in generating herd immunity.
- * High pneumococcal carriage persists, impacting the overall effectiveness of the vaccination program.
Conclusions:
- * The current PCV strategy in the AMB is insufficient for generating robust indirect protection.
- * Alternative programmatic strategies, such as mass vaccination campaigns targeting broader age groups, are recommended.
- * Implementing enhanced strategies is crucial to accelerate pneumococcal disease control in this high-risk region.
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