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The impact of MenAfriVac on serogroup A invasive meningococcal disease and carriage in Chad
 

The impact of MenAfriVac on serogroup A invasive meningococcal disease and carriage in Chad

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Dr Doumagoum Moto Dagula's presentation at Meningitis Research Foundation's 2013 conference Meningitis & Septicaemia in Adults

Dr Doumagoum Moto Dagula's presentation at Meningitis Research Foundation's 2013 conference Meningitis & Septicaemia in Adults

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  • This figure shows meningitis epidemiology in Chad – this is typical of the meningitis belt with periodic but irregular epidemics <br />

The impact of MenAfriVac on serogroup A invasive meningococcal disease and carriage in Chad The impact of MenAfriVac on serogroup A invasive meningococcal disease and carriage in Chad Presentation Transcript

  • IMPACT OF SEROGROUP A MENINGOCOCCAL CONJUGATE VACCINE (MENAFRIVAC) ON MENINGOCOCCAL MENINGITIS AND CARRIAGE IN CHAD Caroline Trotter University of Cambridge
  • GREETINGS FROM CHAD Centre de Support en Santé Internationale (CSSI) Dr Gamougam, Microbiologist Dr Daugla, Director
  • MENINGITIS IN CHAD 1930-2011 Cases of meningitis Conjugate vaccine Polysaccharide vaccines Sulphonamides Whole cell vaccines Year
  • THE AIMS OF MENAFRICAR • To define the pattern of meningococcal carriage across the African meningitis belt and rates of acquisition and loss of carriage. • To measure the impact of a new group A meningococcal conjugate vaccine (MenAfriVac) on carriage and disease.
  • MENAFRICAR CENTRES Centre pour le Développement des Vaccins (CVD-Mali), Mali Institut de Recherche pour le Développement, Senegal Centre de Recherche Médicale et Sanitaire (CERMES), Niger University of Maiduguri, Nigeria The Navrongo Health Research Centre, Ghana Centre de Support en Santé Internationale (CSSI), Chad Armauer Hansen Research Institute (AHRI), Ethiopia
  • MENAFRICAR SURVEYS IN 2010 • First cross sectional studies performed July-December 2010 in seven countries. • Group A meningococci identified only in carriers in Chad. • Vaccine evaluation activities originally planned for Mali and Niger moved to Chad.
  • CARRIAGE STUDIES IN CHAD • MenAfriCar standard protocols • Rural area of Mandelia • First survey • September-November 2010, N= 998 • Pre-vaccination survey • • August- October 2011, N=4278 Post-vaccination survey • April-June 2012, N=5001
  • Mandelia district - address by the Chef
  • Mandelia carriage survey - collecting a swab
  • Microbiology laboratory National hospital, N’Djamena
  • THE MENINGITIS VACCINE PROJECT Aim Production of an affordable, serogroup A meningococcal conjugate vaccine for use in Africa WHO + PATH Established in 2001 with support from the Bill and Melinda Gates Foundation
  • MVP – ACHIEVEMENTS • Efficient conjugation method developed and transferred successfully to an Indian manufacturer. • Phase 2 trials showed the vaccine to be safe and highly immunogenic in children (Gambia and Mali) and young adults (Mali, Senegal, Gambia). • • • Vaccine safe and immunogenic in infants (Ghana). Vaccine licensed in India in 2009 and prequalified by WHO in 2010. Mass campaigns commenced in Burkina Faso, Mali and Niger in those aged 1 – 29 years at the end of 2010. < 10 YEARS FROM VACCINE DEVELOPMENT TO DEPLOYMENT
  • VACCINE MANUFACTURE Serum Institute, Pune, India MenAfriVac
  • MENAFRIVAC IMMUNISATION IN CHAD • 1.8 million 1-29 year olds immunised in a planned vaccination campaign in 3 regions in and around N’Djamena over 10 days in December 2011. • Reactive vaccination campaigns February - May 2012 - 9 districts exceeding the epidemic threshold - 3 other adjacent districts.
  • VACCINATED DISTRICTS IN CHAD 2012 N’Djaména Districts in epidemic/ alert in 2012 Districts vaccinated with “MenAfriVac” in December 2011 Mandelia Moissala
  • MENINGITIS SURVEILLANCE • Clinically diagnosed meningitis cases and deaths reported to district medical officer  Ministry of Health  WHO. • CSF samples  N’Djamena. • Enhanced surveillance in 2012 in 3 vaccinated regions (MenAfriCar). • Surveillance also enhanced in Moissala district, where reactive vaccination was undertaken in 2012 (MSF).
  • IMPACT OF MENAFRIVAC ON THE EPIDEMIc 94% difference in vaccinated compared to the unvaccinated areas [Adjusted incidence rate ratio =0.096 (95% CI 0.046, 0.198)]
  • REACTIVE VACCINATION IN MOISSALA DISTRICT 60 Nombre de cas 50 a Vaccination campagne de campaign vaccination 40 Confirmed cases Cas confirmés 30 Cas probables Probable cases 20 Cases of meningitis by week of admission Moissala district, Chad, 2012 (n = 334) (a)all probable and confirmed cases 10 0 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 2011 (b)cases by serogroup (N=78). * 2012 Semaine épidémiologique 15 Nombre de cas b Vaccination campaign Vaccination campagne de 10 campaign vaccination No serogroup identified W Non isolé A 5 0 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 2011 2012 Semaine epidémiologique W135 A
  • CARRIAGE RESULTS (1) Percentage carriage VACCINATION All meningococci Epidemic strain Pre-vaccination Post-vaccination (Daugla et al. Lancet 2013; electronic publication)
  • CARRIAGE RESULTS (2) • 32/4278 group A carriers* in 2011 pre-vaccine survey. • Only 1/5001 group A carrier post-vaccination. • 98% difference in group A carriage prevalence. • Adjusted Odds Ratio 0.019, 95% CI 0.002, 0.14. * serogroup A capsule region, rplF allele 1 (rplF-1), and a porA gene encoding the subtype P1.20,9
  • CARRIAGE RESULTS (3)
  • CONCLUSIONS • MenAfriVac was highly effective at preventing serogroup A invasive meningococcal disease and carriage in Chad during an epidemic. • Together with previous studies from Burkina Faso, this study provides strong evidence of vaccine impact. • Further work is required to evaluate the duration of protection and the influence of vaccination on other serogroups.
  • ACKNOWLEDGEMENTS Centre de Support en Santé International (CSSI), N’Djamena, Chad: DM Daugla, JP Gami, K Gamougam, N Naibei, L Mbainadji, M Narbé, J Toralta, B Kodbesse Ministere de la Santé Publique, N’Djamena, Chad: C Ngadoua Epicentre, Médecins sans Frontières, Paris, France: ME Coldiron, F Fermon U, A-L Page WHO Intercountry Support Team, Ougadougou, Burkina Faso: MH Djingarey Department of Pandemic and Epidemic Diseases, WHO, Geneva, Switzerland: S Hugonnet Department of Zoology, University of Oxford, Oxford, UK: OB Harrison, LS Rebbetts, Y Tekletsion, ER Watkins, D Hill, MCJ Maiden Norwegian Institute for Public Health, Oslo, Norway: D Caugant Department of Veterinary Medicine, University of Cambridge, Cambridge, UK: C Trotter Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK: D Chandramohan, M Hassan-King, O Manigart, M Nascimento, A Woukeu, JM Stuart, BM Greenwood MenAfriCar is funded by The Bill & Melinda Gates Foundation & The Wellcome Trust