Epidemic forecast and preparedness for explosive-cerebrospinal meningitis outbreak in Nigeria using the preventive vaccination strategy

Iseimokumo C Peletiri; Rosemary C Nwachukwu; Diweni C Peletiri; Esther Q Onoja; Charity T Tulagha; Ikaprite I Igbalibo; Grace M Ayanbimpe; Eugene I Ikeh

doi:10.4102/ajlm.v12i1.2086

Epidemic forecast and preparedness for explosive-cerebrospinal meningitis outbreak in Nigeria using the preventive vaccination strategy

Afr J Lab Med. 2023 Nov 17;12(1):2086. doi: 10.4102/ajlm.v12i1.2086. eCollection 2023.

Authors

Iseimokumo C Peletiri^{1

2}, Rosemary C Nwachukwu³, Diweni C Peletiri⁴, Esther Q Onoja⁵, Charity T Tulagha⁶, Ikaprite I Igbalibo², Grace M Ayanbimpe¹, Eugene I Ikeh¹

Affiliations

¹ Department of Medical Microbiology, Faculty of Clinical Sciences, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria.
² Medical Microbiology & Parasitology Laboratories, National Hospital, Abuja, Federal Capital Territory, Nigeria.
³ Medical Microbiology Laboratory, Department of Medical Laboratory Services, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
⁴ Medical Biotechnology Department, National Biotechnology Development Agency, Abuja, Federal Capital Territory, Nigeria.
⁵ Hematology and Blood Transfusion Laboratory Department, National Hospital, Abuja, Federal Capital Territory, Nigeria.
⁶ Nursing Services Department, Diete-Koki Memorial Hospital, Opolo, Yenagoa, Bayelsa State, Nigeria.

Abstract

Background: Within the African meningitis belt, yearly outbreaks of cerebrospinal meningitis (CSM), with incidence rates of 10-100 cases per 100 000 population, are typically punctuated by explosive epidemics occurring every 8-12 years, with incidence rates that can exceed 1000 cases per 100 000 population. From 1928 to 2018, Nigeria recorded the highest number (21%) of cases in the region. The reactive vaccination strategy, a protocol with major drawbacks, has been the vaccination method utilised in Nigeria.

Aim: This review highlights the need for governments within the African meningitis belt to start preparations against the next explosive CSM epidemic expected to occur between 2024 and 2028 using the preventive vaccination strategy.

Methods: We performed a literature search on the Google Scholar search engine using relevant search strings and included studies and reports between 1905 and 2022 that met set criteria.

Results: Neisseria meningitidis serogroups A, B, C, W135, X, and Y; Haemophilus influenzae serotypes a, b, c, e, and f; and Streptococcus pneumoniae serotypes 1, 4, 5, 6, 9, 19, 19F, and 20 were implicated as aetiologies. However, the reactive vaccination strategy was only used against N. meningitidis A or C, H. influenzae b, and pneumococcal conjugate vaccine. Between 2011 and 2017, a polysaccharide vaccine (ACW or ACYW) active against serogroups A, C, W and Y was used within the African meningitis belt for the first time. Varying genotypes of N. meningitidis, H. influenzae and S. pneumoniae were identified.

Conclusion: Our results revealed a very high success rate for the preventive vaccination strategy.

What this study adds: In order to ensure reductions in the morbidity and mortality associated with invasive CSM, the Federal Ministry of Health, Nigeria, should leverage existing knowledge of the circulating serogroups, serotypes, and genotypes of the primary bacterial aetiologies and commence the implementation of the preventive vaccination strategy.

Keywords: African meningitis belt; Nigeria; explosive-cerebrospinal meningitis outbreak; meningitis epidemic forecast; preventive vaccination strategy; reactive vaccination strategy.

Publication types

Review