30 March 2007

Meningococcal meningitis activity and revised vaccine recommendations

Meningococcal disease occurs throughout the world with seasonal variations. The highest burden of disease occurs in the semi-arid area of sub-Saharan Africa known as the ‘meningitis belt’.  This extends from Senegal in the west to Ethiopia in the east. During epidemics, this region has a disease incidence rate ranging from 100 to 800 cases per 100,000 population, but individual communities have reported rates as high as 1,000 per 100,000 [1].

In 2002, countries further south of the belt in the Great Lakes region, including Tanzania, Rwanda, and Burundi reported outbreaks of meningococcal disease [2].

Epidemics in the meningitis belt countries usually occur in the dry season between November and May/June. The serogroups most commonly associated with the African meningitis belt are A and C, however, serogroup W135 emerged in Burkina Faso in 2002 [3].

During the current season, the World Health Organization has reported cases of meningococcal disease from several countries including Uganda, Democratic Republic of the Congo, Burkina Faso, and Sudan. [4-7].

Advice for travellers

Meningococcal meningitis is transmitted via the respiratory route, often in crowded conditions or during close contact with infected persons. Most travellers are at low risk; those at higher risk include healthcare workers, those visiting friends and relatives and long stay travellers who will have close contact with the local population in areas of risk.  

Travellers to areas of risk should avoid crowded conditions wherever possible.

Vaccination using the quadrivalent ACW135Y vaccine should be given to travellers whose planned activities put them at higher risk.

NaTHNaC have revised the recommendations for vaccine based on surveillance data of outbreaks and cases of meningococcal meningitis reported during the previous five years. Countries considered to be a potential risk destination in Africa are listed below, however, outbreaks may also occur in countries not listed and recommendations may be subject to change.

Angola

Benin

Burkina Faso

Burundi

Cameroon

Central African Republic

Chad

Côte d’Ivoire

Democratic Republic of the Congo

Eritrea

Ethiopia

The Gambia

Ghana

Guinea

Kenya

Mali

Niger

Nigeria

Rwanda

Senegal

Somalia

Sudan

Tanzania

Togo

Uganda

Zambia

References

1. World Health Organization. Meningococcal meningitis fact sheet no. 141. Revised May 2003. [accessed 30 March 2007] Available at http://www.who.int/mediacentre/factsheets/fs141/en/

2. World Health Organization. Meningococcal disease in the Great Lakes area (Burundi, Rwanda, United Republic of Tanzania) 23 August 2002. [cited 30 March 2007] Available at http://www.who.int/csr/don/2002_08_23a/en/index.html

3. World Health Organization. 2002 Meningococcal disease in the African meningitis belt – update 2. 6 May 2002. [cited 30 March 2006] Available at http://www.who.int/csr/don/2002_05_06/en/index.html

4. World Health Organization. Meningococcal disease in Uganda. 24 January 2007. [accessed 30 March 2007] Available at http://www.who.int/csr/don/2007_01_24/en/index.html

5. World Health Organization. Meningococcal disease in the Democratic Republic of the Congo. 2 February 2007. [accessed 30 March 2007] Available at http://www.who.int/csr/don/2007_02_02/en/index.html

6. World Health Organization. Meningococcal disease in Burkina Faso. 19 March 2007. [accessed 30 March 2007] Available at http://www.who.int/csr/don/2007_03_19a/en/index.html

7. World Health Organization. Meningococcal disease in Sudan. 15 March 2007. [accessed 30 March 2007] Available at http://www.who.int/csr/don/2007_3_15a/en/index.html

Links

Centers for Disease Control and Prevention (CDC)

Meningococcal disease and international travel.

http://www.cdc.gov/travel/other/2007/mening_in_the_

news_2007.htm