Meningococcal disease in Africa

Area of Science:

• Microbiology
• Epidemiology
• Infectious Diseases

Background:

• Neisseria meningitidis (meningococcus) causes endemic and epidemic meningococcal disease globally.
• Sub-Saharan Africa's "meningitis belt" experiences devastating group-A meningococcal epidemics every 5-10 years.
• Group-B meningococci are associated with sporadic endemic disease, while group-A causes large-scale epidemics.

Purpose of the Study:

• To outline the epidemiology and clinical presentation of meningococcal disease in Africa.
• To discuss appropriate treatment strategies, considering antimicrobial resistance.
• To explore preventive measures, including vaccination.

Main Methods:

• Review of existing literature on meningococcal disease in Africa.
• Analysis of serogroup distribution and epidemic patterns.
• Evaluation of treatment options and preventive strategies.

Main Results:

• Group-A meningococci are the primary cause of major epidemics in the African meningitis belt, with high attack rates.
• Meningococcal septicaemia, though rare, has a high mortality rate (up to 75%) and requires prompt recognition.
• Penicillin-resistant meningococci have emerged in Africa, necessitating alternative treatments like chloramphenicol.

Conclusions:

• Chloramphenicol is the preferred treatment for meningococcal disease in Africa due to penicillin resistance.
• Dexamethasone's role in treating meningococcal meningitis in developing countries is uncertain and potentially harmful.
• Mass vaccination with group-A and -C polysaccharide conjugate vaccines could prevent epidemics but may be expensive.