African Meningitis Epidemic Would Have Serious Global Repercussions

Although virtually eradicated in some parts of the developed world, spinal meningitis remains a significant healthcare challenge in the so-called “African meningitis belt,” a region of 26 countries that stretches from Senegal to Ethiopia.

During an April 22nd press conference in Abidjan, Ivory Coast organized by drug-maker Sanofi, physicians and healthcare experts representing eight of these central and west African nations told the media that the disease still poses a threat to approximately 450 million people. The announcement follows on the heels of the World Health Organization’s (WHO) December 2015 warning that several of these countries—particularly Niger and Nigeria—could see new outbreaks this year.

“[This area] experiences seasonal epidemics of Neisseria meningitides, also known as meningococcus,” Bradford D. Gessner, MD, MPH, scientific director, Agence de Medecine Preventive and a recognized expert in meningitis explained to Contagion. “Socioeconomic and geopolitical factors contribute to essentially all health outcomes, and meningitis in Africa and the African meningitis belt is no different.”

Indeed, according to Dr. Gessner, the development of the MenAfriVac vaccine against a meningococcal subset (serogroup A) has “substantially reduced the risk of the main cause of these epidemics.” However, other causes remain, such as other bacterial meningococcal serogroups (W, C, X) and pneumococcus, he said.

The population of the nations in the “belt” are particularly vulnerable, Dr. Gessner added, due to limited access to healthcare facilities and well-trained clinicians, as well as both “supportive” (IV fluids and oxygen) or “therapeutic” (antibiotics) interventions. Overall, pneumococcal meningitis has a mortality rate of 30 to 50% in the “belt,” which is much higher than that of developed countries, but meningococcal meningitis has a mortality rate of 10% in the region, which is similar to rates found in western European countries; therefore, outcomes are also dependent upon what Dr. Gessner described as “host factors” (pre-existing immunity and genetic/epigenetic factors), “pathogen factors” (virulence, antibiotic resistance) and “environmental factors.”

He continued, “[For example], hot dry Sahalian winds may increase the ability of nasopharyngeal germs to invade and also increase inoculum size. Management in Africa is highly dependent on where one is seen, whether a peripheral health center, district hospital or referral hospital. Patients will not even receive a lumbar puncture, but [they will] be diagnosed clinically and treated empirically. Treatment is usually chloramphenicol or ceftriaxone, but may be dictated by what antibiotics are actually in stock as stock-outs are frequent.”

According to WHO figures, meningococcal meningitis affects 1.2 million people worldwide annually; 135,000 people die from the disease each year. Elia Gilbernair, MD, a medic at Sanofi who spoke at the conference, told the press that mortality could be reduced if countries in the “belt” stockpiled vaccines earlier, before an epidemic is formally declared. Other speakers at the press conference called for a mass vaccination program in the region.

Dr. Gessner said the problems in Africa are relevant to the west because serious epidemics could de-stabilize governments and local economies and pose risks to travelers to the regions affected. Of course, there is also a humanitarian component.

“It is always in our best interest to help developing countries deal with their local health issues,” added Nancy Crum-Cianflone, MD, an infectious disease specialist at Scripps Mercy Hospital in San Diego, California who has published research on meningitis in Africa. “Ebola is a good case-in-point. We have millions of travelers to these areas annually and this would be a way to help protect our own citizens who work or travel there.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.