Niger tackles measles and meningitis outbreaks with vaccination efforts
Miriam Alía, Vaccination and Epidemic Response Manager at Médecins Sans Frontières (MSF), provides insights into the measles and meningitis C outbreaks that have affected Niger since early 2018. These diseases, both highly contagious and life-threatening, have posed significant challenges to public health in the region.
Understanding the outbreaks of measles and meningitis
Why did these outbreaks occur?
While vaccination programs aim to prevent such outbreaks, each case presents unique challenges. For meningitis C, a major hurdle is the lack of affordable and universally effective vaccines covering all serogroups. Global vaccine production shortages, driven by pharmaceutical companies’ limited interest in these markets, often lead to reactive vaccination campaigns only after an epidemic is declared. These delays hinder the implementation of timely and effective vaccination drives.
Similarly, despite the measles vaccine being part of Niger’s routine immunization schedule since 1974, the vaccination coverage remains insufficient to halt disease transmission. The World Health Organization (WHO) recommends a 95% coverage rate to prevent measles outbreaks, a target difficult to achieve in populations with limited access to healthcare, such as nomadic communities and conflict-affected areas.
Challenges in meningitis C prevention and response
Why is there a shortage of meningitis vaccines?
Meningitis comes in various serogroups—A, B, C, W135, and X—none of which are covered by a single vaccine. The most widely available conjugate tetravalent vaccine protects against the four most common serogroups but at a high cost. The Serum Institute of India is developing a more affordable pentavalent vaccine (A, C, Y, W-135, X), expected by 2020, but until then, vaccine shortages persist. The International Coordinating Group (ICG) on Vaccine Provision, which manages low-production vaccines, struggled to secure five million doses of the meningitis C vaccine in 2018, falling short of its target. As a result, vaccination campaigns remain reactive, often initiated only after epidemic thresholds are crossed rather than preemptively.
In Niger’s Tahoua region, MSF, in collaboration with the Ministry of Health, vaccinated over 30,000 people against meningitis C. Notably, a high percentage of cases were attributed to serogroup X, for which no vaccine currently exists, raising concerns for future outbreaks.
Exploring alternative prevention strategies for meningitis
A promising approach involves administering a single dose of the antibiotic ciprofloxacin. A 2017 study in Niger, published in PLOS Medicine in June 2018, demonstrated that mass administration of ciprofloxacin in rural areas significantly reduced disease transmission. Further research is underway to assess its effectiveness in urban settings, potentially offering an additional tool for combating localized outbreaks.
Measles vaccination gaps and solutions
Why does the routine vaccination schedule fail to curb measles outbreaks?
Niger’s national protocol mandates measles vaccination up to 23 months, but vaccines provided by Gavi, the Vaccine Alliance only cover children under 12 months. This leaves a critical gap: the 15-month booster dose is excluded, and older children without prior vaccination are missed. Additionally, nomadic populations and those in conflict zones face limited access to healthcare facilities, further complicating vaccination efforts.
To achieve herd immunity and prevent measles transmission, at least 95% vaccination coverage is essential. However, maintaining such high coverage is challenging in Niger’s diverse and mobile communities.
Improving vaccination coverage in Niger
Flexible vaccination schedules extending up to age 5 and integrating vaccination into all healthcare contacts could enhance coverage. Multi-antigen campaigns, such as those in Arlit (Agadez), provide opportunities to vaccinate against multiple diseases simultaneously. For instance, recent campaigns included the pentavalent vaccine (diphtheria, pertussis, tetanus, Haemophilus influenzae type B, and hepatitis B) and the pneumococcal vaccine alongside measles vaccination.
MSF and the Ministry of Health have made significant strides in vaccination efforts. Since 2018, over 179,460 people have been vaccinated in Niger: 145,843 children aged 6 months to 15 years against measles in Tahoua and Agadez regions, and 33,620 people aged 2 to 29 against meningitis C in Tahoua. Current efforts in Arlit aim to vaccinate over 50,000 children under 5 against measles, with younger children also receiving the pentavalent and pneumococcal vaccines.
Every opportunity must be seized to vaccinate against deadly diseases, ensuring broader protection for vulnerable populations in Niger.