Nigeria introduces new vaccine against meningitis

Nigeria has become the first country in the world to roll out a new vaccine (called Men5CV) recommended by the World Health Organisation (WHO), which protects people against five strains of the meningococcus bacteria.

The vaccine and emergency vaccination activities are funded by Gavi, the Vaccine Alliance, which funds the global meningitis vaccine stockpile, and supports lower-income countries with routine vaccination against meningitis.

Nigeria is one of the 26 meningitis hyper-endemic countries of Africa, situated in the area known as the African Meningitis Belt. Last year, there was a 50 per cent jump in annual meningitis cases reported across Africa.

In Nigeria, an outbreak of Neisseria meningitidis (meningococcus) serogroup C outbreak led to 1,742 suspected meningitis cases, including 101 confirmed cases and 153 deaths in seven of 36 Nigerian states between October 1, 2023 and March 11, 2024.

Rollout of new vaccine

• To quell the deadly outbreak, a vaccination campaign was undertaken on March 25-28, 2024 to initially reach more than one million people aged 1-29 years.

• The  new vaccine offers a powerful shield against the five major strains of the meningococcal bacteria (A, C, W, Y and X) in a single shot. All five strains cause meningitis and blood poisoning. This provides broader protection than the current vaccine used in much of Africa, which is only effective against the A strain.

• The new vaccine has the potential to significantly reduce meningitis cases and advance progress in defeating meningitis. This is especially important for countries like Nigeria where multiple serogroups are prevalent. 

• The new vaccine uses the same technology as the meningitis A conjugate vaccine (MenAfriVac), which wiped out meningococcal A epidemics in Nigeria.

• This new multivalent conjugate vaccine was 13 years in the making and was based on a partnership between PATH and the Serum Institute of India.

• In July 2023, WHO prequalified the new Men5CV vaccine (which has the brand name MenFive) and in October 2023 issued an official recommendation to countries to introduce the new vaccine. Gavi allocated resources for the Men5CV rollout in December 2023.

• The rollout in Nigeria represents one step closer towards the goal of total elimination by 2030.

Meningitis disease

• Meningitis is a life-threatening disease caused by inflammation of the membranes (meninges) that surround the brain and spinal cord.

• There are multiple causes of meningitis, including viral, bacterial, fungal and parasitic pathogens. 

• Acute bacterial meningitis is one of the deadliest and most disabling forms of this illness. It can cause epidemics, lead to death within 24 hours and leave one in five people with lifelong disability after infection. 

There are four main causes of acute bacterial meningitis:

i) Neisseria meningitidis (meningococcus)

ii) Streptococcus pneumoniae (pneumococcus)

iii) Haemophilus influenzae

iv) Streptococcus agalactiae (group B streptococcus)

• These bacteria are responsible for more than half of the deaths from meningitis globally and they cause other severe diseases like sepsis and pneumonia.

• Although meningitis affects all ages, young children are most at risk. 

• Newborn babies are at most risk from Group B streptococcus, young children are at higher risk from meningococcus, pneumococcus and Haemophilus influenzae. 

• Adolescents and young adults are at particular risk of meningococcal disease while the elderly are at particular risk of pneumococcal disease.

• People all over the world are at risk of meningitis. The highest burden of disease is seen in a region of sub-Saharan Africa, known as the African Meningitis Belt, especially recognised to be at high risk of epidemics of meningococcal but also pneumococcal meningitis.

Transmission

• Most bacteria that cause meningitis such as meningococcus, pneumococcus and Haemophilus influenzae are carried in the human nose and throat. They spread from person to person by respiratory droplets or throat secretions. 

• Group B streptococcus is often carried in the human gut or vagina and can spread from mother to child around the time of birth.

Symptoms

• Common symptoms of meningitis are neck stiffness, fever, confusion or altered mental status, headaches, nausea and vomiting.

• Less frequent symptoms are seizures, coma and neurological deficits (for example hearing or vision loss, cognitive impairment, or weakness of the limbs).

• There are effective treatments and vaccines against some of the main bacterial causes of meningitis. However, meningitis remains a significant threat around the world.

• In 2019, WHO and partners launched the global roadmap to defeating meningitis by 2030. The roadmap sets a comprehensive vision towards a world free of meningitis, and has three goals:

i) Elimination of bacterial meningitis epidemics.

ii) Reduction of cases of vaccine-preventable bacterial meningitis by 50 per cent and deaths by 70 per cent. 

iii) Reduction of disability and improvement of quality of life after meningitis due to any cause.