What caused the meningitis C and measles outbreaks in Niger?

In recent years, Niger has faced recurrent meningitis C and measles outbreaks, both highly contagious and life-threatening diseases. While vaccination programs should have prevented these epidemics, each outbreak presents unique challenges.

Why is there a shortage of effective meningitis vaccines?

Meningitis C outbreaks persist due to multiple factors. No affordable, universally effective vaccine exists for all meningitis serogroups. Global vaccine production shortages, driven by pharmaceutical companies’ limited interest in these markets, force reactive vaccination campaigns only after an epidemic is declared. These delays undermine efforts to implement timely preventive measures.

Additionally, while measles vaccines have been part of routine immunization programs since 1974, vaccination coverage remains insufficient to halt transmission. Many communities, particularly in rural or conflict-affected areas, lack access to healthcare centers where vaccines are administered.

Is the meningitis C situation improving in the region?

The meningitis belt in Africa has seen relatively fewer cases this year, but critical vaccine shortages persist. The International Coordination Group for Vaccine Provision, which manages low-production vaccines based on epidemiological and equity criteria, aimed to stock five million meningitis C vaccines in 2018. However, this target was not met. Vaccination campaigns remain reactive, triggered only when epidemic thresholds are crossed rather than preemptively during alert phases.

What are the challenges in meningitis C vaccine production?

Meningitis manifests in multiple serogroups—A, B, C, W135, and X—each requiring different vaccines. The most widely available vaccine, a tetravalent conjugate, covers the four most common serogroups but at a prohibitively high cost. The Serum Institute of India is developing a pentavalent conjugate vaccine (A, C, Y, W-135, X) expected by 2020, which would be more affordable, effective, and safe. Until then, vaccine scarcity persists as pharmaceutical companies hesitate to invest in new products due to uncertain market demand.

How did Niger respond to the meningitis C outbreak?

In partnership with the Ministry of Health, over 30,000 people in the Tahoua region were vaccinated against meningitis C, alongside patient care support. Notably, a significant proportion of cases involved serogroup X, for which no vaccine currently exists—a major concern for future outbreaks.

Are there alternative meningitis prevention strategies?

Emerging prevention methods, such as administering a single dose of the antibiotic ciprofloxacin, have shown promise. A 2017 Niger trial, published in PLOS Medicine (June 2018), demonstrated that mass ciprofloxacin distribution in rural areas significantly reduced transmission. Further studies will assess its effectiveness in urban settings, potentially offering a supplementary tool for small-scale outbreaks.

Why does Niger’s routine measles vaccination fail to control outbreaks?

The national immunization schedule is rigid: children are vaccinated up to 23 months, but vaccines provided by GAVI only cover those under 12 months. The 15-month booster dose is excluded, and children over one year old visiting health centers often remain unvaccinated. Additionally, nomadic populations and conflict-affected communities face limited access to vaccination services. Achieving the 95% coverage threshold required to stop measles transmission remains a persistent challenge.

How can vaccination coverage be improved?

Flexible immunization schedules extending to age five, coupled with opportunistic vaccination during any healthcare contact, could enhance coverage. Multivalent vaccination campaigns—such as the current measles response in Arlit (Agadez)—offer opportunities to administer the pentavalent vaccine and pneumococcal vaccine alongside measles immunization.

Where possible and when vaccines are available, tetanus vaccination is also provided to pregnant women or women of childbearing age. As the full five-dose regimen is rarely completed in contexts like Niger, these opportunities ensure protection for both mothers and newborns. Every chance to vaccinate against deadly diseases must be seized.

Since early 2018, MSF, in collaboration with Niger’s Ministry of Health, has vaccinated 179,460 people: 145,843 children aged 6 months to 15 years against measles across nine health centers in Tahoua and Agadez regions, and 33,620 people aged 2 to 29 against meningitis C in three centers in Tahoua. Currently, a measles vaccination campaign is underway in Arlit, Agadez, aiming to immunize over 50,000 children under five; infants under one will also receive the pentavalent and pneumococcal vaccines.

[1] Alert and epidemic thresholds are set at 5 and 15 cases per 100,000 inhabitants per week in localities with over 30,000 people. The epidemic threshold may be lowered to 10 cases/100,000 inhabitants/week in high-risk areas.

[2] Diphtheria, pertussis, tetanus, Haemophilus influenzae type B, and hepatitis B.