On June 2, 2015, the World Health Organization (WHO) reported 8,234 cases of meningitis with 545 deaths in Niger. It is not the numbers that are alarming because it is the meningitis season in Africa, and Niger is in the meningitis belt.  But this season, the outbreak in Niger is unusually alarming for five major reasons.

Every year from December to June, the meningitis belt, which consists of 21 countries in sub-Saharan Africa that extend from Senegal in the west to Djibouti in the east, is hit by more meningitis cases than anywhere else in the world. This meningitis epidemic is due to Nesisseria meningococus serotype C. Until this meningitis season, serotype C was a type of meningitis common in the U.S., Canada and Europe. The other major serotypes associated with this deadly disease are A, B, C, Y, and W-135. It is type A that has been ravaging Africa for over 100 years.

According to WHO,  this is the largest outbreak of serotype C recorded in any country in Africa’s meningitis belt. It has affected 13 districts in Niger. Sixty-five percent of the cases are located in 4 out of 5 districts in the capital city, Niamey.

There are four conditions in the meningitis belt that make it ripe for recurrent meningitis epidemics in general: the drought and dust storms, impoverished living conditions/overcrowded housing, large population displacements and the immunological susceptibility of the population.

While the outbreak started slowly, it is now spreading quickly across the region. The number of cases has tripled during the first two weeks of May—near the end of the meningitis season. Doctors Without Borders reported that 350 meningitis patients a day were admitted to the hospital in Niamey during the first two weeks of May. Patients had to be discharged early and continue their treatment plan at home in order to make room for incoming cases. Doctors Without Borders also had to add an additional medical team.

Because serotype C meningitis has never been a major threat in Africa, efforts have been focused on eradicating epidemics of serotype A. From 2010 to January 2015, over 217 million people in 15 African countries had been vaccinated with MenAfriVac. MenAfriVac is a new vaccine developed by the Meningitis Vaccine Project coordinated by WHO and PATH to be affordable and effective in Africa. It has long lasting effects and has been so successful that serogroup A epidemics are expected to be eliminated from this region, according to WHO’s Weekly Epidemiological Record published on March 27, 2015.

Because this is the first large outbreak of serotype C in the meningitis belt, there has not been enough vaccine available to fight it. The vaccine is also not affordable for the people and the governments in Africa. The vaccine that prevents serotype C meningitis is often combined with vaccines that prevent the other types of meningitis producing a multivalent polysaccharide vaccine. It is available in the U.S., Canada and Europe, where type C has been most prevalent. Furthermore, due to the success of MedAfriVac, the need for the multivalent polysaccharide vaccine has diminished and has only been used in emergencies—not for prevention.

Although WHO and the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control requested 1.5 million doses of multivalent polysaccharide vaccine and 1.5 million doses of MenAfriVac to prepare for the 2015 meningitis season, one manufacturer had production problems and could not completely fill the request. Fortunately, GlaxoSmithKline in Britain, Instituto Finley in Cuba and BioManguinhos in Brazil provided most of the requested amount of the polysaccharide vaccine. WHO and ICG continue to stockpile the vaccine to combat future outbreaks in Africa’s meningitis belt.

This current meningitis epidemic in Niger peaked after the first few weeks in May, and by May 21 about 100 patients a day instead of 350 patients a day were being admitted to the hospital according to Doctors Without Borders. The Disaster Relief Emergency Fund has requested to extend its operation by six weeks to June 30 in order to reach 71,000 more beneficiaries in eight new districts.

– Janet Quinn

Sources: WHO—Africa, CDC, Doctors Without Borders, Relief Web, Reuters, WHO, WHO, WHO, Outbreak News Today
Photo: Doctors Without Borders