This document discusses optimal schedules for controlling pneumococcal infection in countries with high and low carriage. It notes that the African Meningitis Belt has seen sub-optimal pneumococcal conjugate vaccine (PCV) coverage due to geopolitical factors and vulnerable populations. Outbreaks in Ghana pre- and post-PCV introduction show that herd protection may be inadequate. Research is needed to better understand pneumococcal biology and prevention. Improving PCV access and coverage, including schedules with boosters and catch-up campaigns targeting 5-29 year olds, may help prevent outbreaks. Strengthening surveillance systems allows rapid response.

1. DIVISION OF INFECTION AND IMMUNITY
NIHR GLOBAL HEALTH RESEARCH UNIT ON MUCOSAL PATHOGENS
Prevention of ST-1 pneumococcal
outbreaks in the meningitis belt
Panel Discussion
Optimal schedules for control of pneumococcal infection in countries with high and low
carriage
Meningitis Research Foundation 2021 13th International Conference
Wednesday 3rd November
Brenda Anna Kwambana Adams

2. The African Meningitis Belt

3. Sub-optimal PCV Coverage
▪ Geopolitical factors
▪ Vulnerable and displaced populations
▪ Disruptions to immunization programmes

4. Is there inadequate herd protection?
Ghana pneumococcal meningitis outbreak
pre-PCV introduction 2000 – 2003,
Leimkugel et al. 2005
Ghana pneumococcal meningitis outbreak post-PCV
introduction 2016, Kwambana-Adams et al. 2016
Case
count

5. Coverage vs. direct protection
0
10
20
30
40
50
60
70
80
90
100
Northern Ghana Central African Republic
Percentage
(%)
0-59m
5-29yrs
>30yrs
Adapted from Franklin
et al. 2021
88-93% PCV coverage
(2015-2017)
47% PCV coverage
(2017)
PCV intro 2011
PCV intro 2012

6. PCV Scheduling
PCV Scheduling without booster

7. Research to probe Spn1 basic biology

8. Implications for the prevention of
pneumococcal outbreaks
➢Improving PCV access and coverage
Chad, South Sudan, Guinea and Somalia yet to introduce PCVs
➢Reactive vaccination campaigns likely to be of limited benefit (Cooper et al.,
2019)
➢Schedules including a booster protection?
Schedules with a booster dose (e.g 2+1)
➢PCV programmes with catch-up campaigns
Targeting the remaining burden of disease (5-29 years old)
➢“Bacterial Meningitis Conjugate Vaccine”
Pentavalent Men + Spn1
➢Strengthening of surveillance systems and vaccine impact monitoring
Rapid response and efficient data collection