Meningitis is one of the leading causes of mortality and morbidity, especially in the meningitis belt of sub-Saharan Africa, with a recorded disease burden of over 2.5 million cases globally and children under five disproportionately impacted. (see map below)
(Meningitis is a leading cause of mortality and morbidity, particularly in the meningitis belt of sub-Saharan Africa. Globally, the disease burden exceeds 2.5 million cases, with children under five being disproportionately affected. (See map below).)
In 2021, WHO launched a global road map to “defeat meningitis by 2030”, after its approval by the World Health Assembly at its Seventy-third session in November 2020.
The road map addresses the 4 main causes of acute bacterial meningitis: Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis and Streptococcus agalactiae, as well as the sequelae and after-effects that can occur from meningitis of any cause (as well as the potential sequelae and lasting effects that can result from meningitis, regardless of the cause.)
The 3(three) visionary goals to be achieved by 2030 are:
(1) elimination of bacterial meningitis epidemics.
(2) reduction by 50% in the number of cases and by 70% in the number of deaths from vaccine-preventable meningitis.
(3) And a reduction in disability and an improvement in the quality of life after meningitis of any cause.
The recent development and introduction of novel pentavalent (Men5CV) meningococcal conjugate vaccine will be discussed here under.
Recurrent meningitis outbreaks across the meningitis belt have resulted in significant mortality over decades. A great turning point in the fight against the serogroup A epidemic was the deployment of MenAfriVac, which resulted in declining cases of Men A. Anyway, the bad news are that serogroups C, W, and X continue to generate epidemic problems (Unfortunately, serogroups C, W, and X continue to cause epidemic challenges.)
To circumvent the limitations of the monovalent MenAfriVac (serogroup A) vaccine and logistic challenges with integrating quadrivalent vaccines (A, C, W, and Y), researchers explored pentavalent options. The outcome of these efforts is the development and rollout of the Men5CV vaccine, which holds immense potential for further mitigating the burden of meningitis. The conjugate meningitis vaccine Men5CV is the product of a 13-year collaborative effort between PATH and the Serum Institute of India Pvt. Ltd (SIIPL), a research project funded by the WHO and the UK government’s Foreign, Commonwealth and Development Office (FCDO).
Men5CV vaccine has emerged as a remarkable advancement in the fight against meningitis, with its safety and effectiveness against a variety of serogroups, including the elusive serogroup X, demonstrated in clinical trials. Its prequalification by the World Health Organization (WHO), and subsequent recommendation for incorporation into routine immunization programs issued a new era with the potential for meningitis eradication. Nigeria now sets a benchmark for other nations in the meningitis zone (belt), becoming the first country in the world to roll out the new Men5CV vaccines. Funding from organizations like Gavi, the Vaccine Alliance, highlights the importance of coordinated international efforts aligned with the WHO’s roadmap for meningitis elimination by 2030.
The first pentavalent meningococcal ACWYX conjugate Men5CV, the only vaccine to include Nm X, was prequalified by WHO in July 2023. The development and prequalification of this affordable vaccine marks a significant milestone in the fight against meningitis. In September 2023, the Strategic Advisory Group of Experts on immunization (SAGE) reviewed the evidence and issued recommendations on use of Men5CV in the meningitis belt. The recommendations were adopted by WHO and published in January 2024 as an addendum to the WHO position paper on meningococcal vaccines.
WHO recommends that all countries in the African meningitis belt introduce Men5CV into their routine immunization programs in a single-dose schedule for infants and young children aged 9–18 months.
In high-risk countries and countries with high-risk districts, a one-off mass preventive campaign with Men5CV should also be conducted at the time of Men5CV introduction, targeting all individuals aged 1–19 years or 2–19 years (depending on age groups covered by routine immunization programs).
The recommendation states that countries that have already introduced MenACV into their routine immunization programs should switch to use of Men5CV and that countries that have not yet introduced MenACV should do so as soon as possible to avoid the risk of a resurgence of Nm A (The recommendation advises that countries already using MenACV in their routine immunization programs should transition to Men5CV. Additionally, countries that have not yet introduced MenACV are urged to do so as soon as possible to prevent the risk of a resurgence of Nm A.). The recommendations also include updates on outbreak response vaccination strategies.
Notably, they advocate for reactive vaccination in high-risk areas that neighbor epidemic areas (regions) and for extension of reactive vaccination to areas (geographic zones) at increased risk of an outbreak during the upcoming epidemic season.
The aim of these updates is to create a cohesive strategy that bridges the reactive and preventive uses of vaccines, maximizing their public health impact across the African meningitis belt.
Stakeholder involvement, extensive immunization campaigns, and a strong healthcare infrastructure are all practical (essential) recommendations for public health integration.
The global road map for “Defeating meningitis by 2030” sets a path for improving diagnostic and surveillance capacity in the African Region and worldwide, as well as strengthening advocacy, engagement, epidemic prevention and control, treatment, support and care for people affected by meningitis. The African Region continues to take important steps, with regional strategic plans and support to countries in developing national plans to defeat meningitis.
As engagement continues towards achieving the goals of the global road map, (improved) surveillance, monitoring, and evaluation should be supported in at-risk countries in all regions. This will enable public health policies and actions at national, regional and global levels towards a world free of meningitis.
