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• W2016013835 abstract "We understand the frustration of John Robbins and colleagues1Robbins JB Towne DW Gotschlich EC Schneerson R “Love's labours lost”: failure to implement mass vaccination against group A meningococcal meningitis in sub-Saharan Africa.Lancet. 1997; 350: 880-882Summary Full Text Full Text PDF PubMed Scopus (58) Google Scholar about the prevention of meningococcal disease in sub-Saharan Africa. These epidemics strike otherwise healthy people from infants to young adulthood and the disease often results in death or disability. The current meningococcal polysaccharide vaccine is useful for control of epidemic meningococcal disease but it is a poor public-health tool for prevention of epidemics through routine childhood vaccination. A single dose of the serogroup A polysaccharide vaccine provides a limited duration of protection to children less than 4 years of age,2Makela PH Serum antibodies and bacterial meningitis.Trans R Soc Trop Med Hyg. 1991; 85: s32-s36Summary Full Text PDF PubMed Scopus (4) Google Scholar so multiple doses beyond 1 year of age will be needed, and that would require a new vaccine infrastructure because the Expanded Program for Immunization (EPI) only targets children aged 1 year or less. Many studies have suggested that the vaccine does not substantially affect carriage of serogroup A meningococci 1 year after vaccination and that it does not provide herd immunity. Without herd immunity, epidemics could continue even with the regimen proposed by Robbins et al since EPI coverage is low in many of the highest risk countries and those over 5 years are likely to need periodic revaccination. What public health approach should be used? First, because epidemics are unpredictable, a surveillance-based threshold disease rate that is sensitive and specific was identified and tested for early detection of epidemic disease and initiation of mass vaccination campaigns.3Rautonen N Pelkonen J Sipinen S Kayhty H Makela O Isotype concentrations of human antibodies to group A meningococcal polysaccharide.J Immunol. 1986; 137: 2670-2675PubMed Google Scholar This approach has not failed, as Robbins and co-workers suggest, for it has only just begun to be widely implemented among district health officers by the African regional office of WHO. Second, development of conjugate serogroup A vaccines (similar to the successful Haemophilus influenzae serotype b [Hib] conjugate vaccines) should be vigorously pursued.4Goldschneider I Gotschlich EC Artenstein MS Human immunity to the meningococcus. II Development of natural immunity.J Exp Med. 1969; 129: 1327-1347Crossref PubMed Scopus (549) Google Scholar A study of a Pasteur-Merieux Connaught conjugate serogroup A/C vaccine with a dose schedule compatible with EPI (ie, 6, 10, and 14 weeks) among infants in Niamey, Niger, showed levels of serogroup A meningococcal serum bactericidal antibodies far in excess of those elicited by the polysaccharide vaccine.5Frasch CE Meningococcal vaccines: past, present and future.in: Cartwright K Meningococcal disease. J Wiley, Chichester1995: 260-283Google Scholar This provides early evidence that conjugate serogroup A vaccines may elicit longlasting immunity and provide protection from carriage of serogroup A meningococci, and therefore herd immunity, in the same way as conjugate Hib vaccines have been shown to do. Until conjugate serogroup A meningococcal vaccines are licensed and widely available, countries will need to focus on early detection and prompt mass vaccination to reach high coverage in affected populations. Meningococcal vaccine in sub-Saharan AfricaAuthors' reply Full-Text PDF" @default.
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• W2016013835 title "Meningococcal vaccine in sub-Saharan Africa" @default.
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