Meningococcal Disease in Other Countries

Many countries suffer from endemic meningococcal disease at an annual attack rate of around 1 to 3 per 100,000 of the population. Some of these countries, mostly in the developing world, suffer from repeated epidemics of meningococcal disease.

In temperate regions the number of cases increases in winter and spring. Serogroups B and C together account for a large majority of cases in Europe and the Americas. Several local outbreaks due to Neisseria meningitidis serogroup C have been reported in Canada and the United States (1992-93) and in Spain (1995-97). Major African epidemics are associated with Neisseria meningitidis serogroup A, which is usually the cause of meningococcal disease in Asia.

There is increasing evidence of serogroup W being associated with outbreaks of considerable size. In 2000 and 2001 several hundred pilgrims attending the Hajj in Saudi Arabia were infected with Neisseria meningitidis W. Then in 2002, W emerged in Burkina Faso, striking 13,000 people and killing 1,500.

Meningococcal Disease Epidemics in Africa

Studies show that:

• Epidemic meningococcal disease has been present on the African continent for about 100 years
• The disease prevails in the sub-Saharan meningitis belt
• Epidemics there occur in the dry season (December to June), ending during the intervening rainy season
• Epidemics usually take place in irregular cycles every 5-12 years
• Serogroup A meningococci account for about 80-85% of all cases
• In 2002 there was a major outbreak of meningococcal disease in Burkina Faso with about 80% of cases due to serogroup W

The size of these epidemics can be enormous. In major African epidemics, the attack rate ranges from 100 to 800 per 100,000 population, but individual communities have reported rates as high as 1 per 100. In comparison, the average attack rate in industrialized nations is around 1 to 3 per 100,000 population.

Between 1988 and 1997, 704,000 cases and more than 100,000 deaths were reported in Africa, some 20,000 occurring in 1996, the largest epidemic year ever recorded. Between 1998 and 2002, African countries within the meningitis belt reported more than 224,000 new cases of meningococcal disease. However, the true disease burden is likely to be greater because routine reporting systems break down during epidemics. In addition, many people die before reaching a health center and thus remain unrecorded in official statistics.

While all the risk factors for meningococcal outbreaks in Africa are not understood, several conditions have been associated with the development of epidemics in the meningococcal belt. They include:

• Medical conditions: immunological susceptibility of the population
• Demographic conditions: travel and large population displacements
• Socioeconomic conditions: poor living conditions and overcrowded housing
• Climatic conditions: drought and dust storms

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Vaccine Introduction in Africa

The Meningitis Vaccine Project is working to eliminate meningitis as a public health problem in sub-Saharan Africa through the development, testing, introduction, and widespread use of a conjugate meningococcal vaccine (MenAfriVac™). Burkina Faso became the first African country to introduce MenAfriVac™ nationwide and immunized more than 11 million people from December 6-15, 2010.

The Meningitis Vaccine Project and its partners hope to vaccinate some 300 million people throughout the African "meningitis belt" by 2015, thereby ridding the region of a disease that has caused havoc for more than a century. Learn more about the Meningitis Vaccine Project

Source: Meningococcal Vaccine Project

Resources

• CDC's Integrated Disease Surveillance and Response (IDSR)
  IDSR strategy aims to improve the availability and use of surveillance and laboratory data.
• CDC Traveler’s Health: Meningococcal Disease
  Meningococcal recommendations for travelers.
• Meningococcal Vaccine Project (MVP)
  A partnership between the World Health Organization (WHO) and the Program for Appropriate Technology in Health (PATH) with a goal to eliminate epidemic meningococcal as a public health problem in Sub-Saharan Africa.
• Pediatric Bacterial Meningitis Surveillance Network—African Region, 2002—2008
• Sentinel Surveillance for Pediatric Bacterial Meningitis in the World Health Organization African Region, 2001 - 2009 [260 KB, 4 pages]
• Meningococcal Outbreaks
  Link to WHO List Archive of Meningococcal Outbreaks

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