Mohammed Idris, Iliyasu Garba, Habib Abdulrazaq Garba
a Federal Teaching Hospital Gombe , Gombe , Nigeria.
b Infectious Disease Unit, Department of Medicine, College of Health Science , Bayero University Kano , Kano , Nigeria.
Pathog Glob Health. 2017 Feb;111(1):1-6. doi: 10.1080/20477724.2016.1274068. Epub 2017 Jan 12.
For more than a century, meningitis epidemics have regularly recurred across sub-Saharan Africa, involving 19 contiguous countries that constitute a 'meningitis belt' where historically the causative agent has been serogroup A meningococcus. Attempts to control epidemic meningococcal meningitis in Africa by vaccination with meningococcal polysaccharide (PS) vaccines have not been successful. This is largely because PS vaccines are poorly immunogenic in young children, do not induce immunological memory, and have little or no effect on the pharyngeal carriage. Meningococcal PS-protein conjugate vaccines overcome these deficiencies. Conjugate meningococcal vaccine against serotype A (MenAfriVac) was developed between 2001 and 2009 and deployed in 2010. So far, 262 million individuals have been immunized across the meningitis belt. The public health benefits of MenAfriVac have already been demonstrated by a sharp decline in reported cases of meningococcal disease in the countries where it has been introduced. However, serogroup replacement following mass meningitis vaccination has been noted, and in 2015 an epidemic with a novel strain of serogroup C was recorded in Niger and Nigeria for the first time since 1975. This has posed a serious challenge toward elimination of meningococcal meningitis epidemics in the African. For an effective control of meningococcal meningitis in the African meningitis belt, there is a need for an effective surveillance system, provision of rapid antigen detection kits as well as affordable vaccine that provides protection against the main serogroups causing meningitis in the sub-region.
一个多世纪以来，撒哈拉以南非洲地区脑膜炎疫情定期复发，涉及19个毗邻国家，这些国家构成了一条“脑膜炎带”，从历史上看，病原体一直是A群脑膜炎奈瑟菌。通过接种脑膜炎球菌多糖（PS）疫苗来控制非洲流行性脑膜炎球菌性脑膜炎的尝试并不成功。这主要是因为PS疫苗在幼儿中的免疫原性较差，不会诱导免疫记忆，对咽部携带几乎没有影响。脑膜炎球菌PS-蛋白结合疫苗克服了这些缺陷。2001年至2009年间研发出了针对A血清型的结合脑膜炎球菌疫苗（MenAfriVac），并于2010年投入使用。到目前为止，脑膜炎带地区已有2.62亿人接种了疫苗。MenAfriVac对公共卫生的益处已通过引入该疫苗的国家中脑膜炎球菌病报告病例的急剧下降得到了证明。然而，大规模脑膜炎疫苗接种后出现了血清型替换情况，2015年，自1975年以来首次在尼日尔和尼日利亚记录到了C群新型菌株的疫情。这对在非洲消除脑膜炎球菌性脑膜炎疫情构成了严峻挑战。为有效控制非洲脑膜炎带地区的脑膜炎球菌性脑膜炎，需要建立有效的监测系统，提供快速抗原检测试剂盒以及可负担得起的疫苗，以针对该次区域引起脑膜炎的主要血清型提供保护。
