vaccination against measles and meningitis outbreaks in Niger
Miriam Alía, vaccination and epidemic response lead at Médecins Sans Frontières (MSF), discusses the meningitis C and measles outbreaks that struck Niger in early 2018.
Why did the meningitis C and measles outbreaks occur?
In 2018, Niger faced severe outbreaks of meningitis C and measles, both highly contagious and life-threatening diseases. While vaccination campaigns should have prevented these epidemics, each case posed unique challenges.
Meningitis C: a global vaccine shortage
No single affordable vaccine covers all meningitis serogroups. Global production shortages, driven by pharmaceutical companies’ limited interest in these markets, force reactive rather than preventive vaccination campaigns. By the time an outbreak is declared, delays in vaccine deployment hinder effective immunization efforts.
Despite the measles vaccine being part of routine immunization programs since 1974, coverage rates in Niger remain insufficient to halt transmission. Only by achieving 95% population immunity can outbreaks be prevented.
Why is meningitis C vaccine production so limited?
Meningitis comes in multiple serogroups (A, B, C, W135, X), and no vaccine covers all. The most effective option available is the tetravalent conjugate vaccine, which protects against the four most common serogroups but remains prohibitively expensive. The Serum Institute of India is developing a more affordable pentavalent vaccine (A, C, Y, W-135, X), expected in 2020. Until then, manufacturers hesitate to invest in new vaccines due to uncertain demand.
How did MSF respond to the meningitis C outbreak in Niger?
Working with Niger’s Ministry of Health, MSF vaccinated over 30,000 people in the Tahoua region and supported patient care. Unexpectedly high cases of serogroup X—a strain without a vaccine—highlighted a critical gap for future preparedness.
New prevention strategies for meningitis C
In 2017, Niger tested a preventive approach using ciprofloxacin, an antibiotic administered to entire rural communities. A 2018 PLOS Medicine study found this method significantly reduced transmission. Future research will assess its impact in urban settings, offering a potential tool for small-scale outbreaks.
95%
To stop measles outbreaks in Niger, at least 95% of the population must be immunized—a target difficult to achieve amid low vaccination coverage.
Why isn’t Niger’s routine measles vaccination program stopping outbreaks?
Niger’s national protocol mandates measles vaccination up to 23 months, but GAVI-supplied vaccines only cover children under 12 months. The 15-month booster dose is excluded, and older unvaccinated children miss out. Additionally, nomadic populations and conflict-affected areas face limited access to healthcare, making 95% coverage nearly impossible to maintain.
How can vaccination coverage be improved?
Extending the vaccination schedule to age 5 and integrating catch-up campaigns during every healthcare visit could boost coverage. Multi-antigen campaigns, like the ongoing measles response in Arlit (Agadez), simultaneously deliver vaccines for multiple diseases—including the pentavalent and pneumococcal vaccines—to maximize protection.
MSF also leverages every opportunity to administer the tetanus vaccine to pregnant women or women of childbearing age, offering critical protection for both mother and newborn. With limited vaccine supplies, seizing every chance to immunize against deadly diseases is essential.
Since early 2018, MSF—partnering with Niger’s Ministry of Health—has vaccinated 179,460 people:
- 145,843 children aged 6 months to 15 years against measles in Tahoua and Agadez regions;
- 33,620 people aged 2 to 29 against meningitis C in Tahoua;
- An ongoing measles campaign in Arlit (Agadez) aims to vaccinate 50,000 children under 5, with pentavalent and pneumococcal vaccines for those under 1 year.
