A new vaccine will change the balance of the fight against meningitis - World Health Organization (WHO)

Evariste Wendyam Ringtoumda emerged in 2018 as a teen advocate in Burkina Faso for people who have, with difficulty, learned to live with disabilities, and in his case, it came like a thunderbolt -at only age 7 he was stricken with meningitis. He fainted on his way to school.

He lived, but meningitis robbed him of his hearing and speech. For a time, he had to guess what his own parents were saying to him by watching their mouths move. Over time and by struggling through hard work and difficulties in school, he learned sign language and started reclaiming more and more of his young life.

With the expected rollout of a new vaccine coming soon, children in the so-called 'meningitis belt' across central Africa may be spared the kind of struggles and challenges facing Evariste and millions like him affected by what can be a killer infection. According to the Institute for Health Metrics and Evaluation, in 2019, there were an estimated 236 000 deaths and 2.51 million incident cases due to meningitis globally (1). It is the second-highest cause of neurological disorders in Africa.

Meningitis comes in many forms, most often due to bacteria or viruses, but meningitis can also be due to other causes including fungi and parasites. Bacterial meningitis can be the most lethal and is an infection of the membranes surrounding the brain and spinal cord. The meningitis belt is a geographical region in sub-Saharan Africa particularly prone to seasonal meningitis epidemics, and the area carries the highest burden of the disease globally. The belt covers 26 countries stretching from Senegal in west Africa to Ethiopia in the east.

In July 2023 WHO pre-qualified a novel meningococcal conjugate vaccine developed by the Serum Institute of India and the global health nonprofit PATH that protects against meningitis together with research sites across Africa, India, and the USA. It's expected to be more affordable and accessible to meningitis belt countries than current multivalent meningococcal vaccines, which are by and large too expensive for these countries to include in routine vaccination programs (2).

WHO's Strategic Advisory Group of Experts on Immunization (SAGE) reviewed the evidence of clinical trials, epidemiology, and strategic modelling research in September 2023. SAGE then advised all countries in the meningitis belt to introduce the new vaccine, which it described as Men5CV, into their routine immunization programmes: a single dose scheduled at 9 to 18 months of age.

The vaccine Men5CV has the potential to drastically change the landscape of the fight against meningitis in what is one of the poorer and under-resourced parts of the world, and it feeds the hope that this debilitating disease can one day—soon—be done away with. Effective delivery and distribution of the vaccine will be instrumental in eliminating epidemic bacterial meningitis by 2030. This is the first visionary goal of the WHO Global Road Map for Defeating Meningitis by 2030 which was endorsed by the World Health Assembly in November 2020 during the depths of the COVID-19 pandemic; the road map was then launched in September 2021.

Its introduction will also affect the near-term strategies and efforts aimed at rolling back the disease. For countries in the African meningitis belt, SAGE advice on Men5CV calls to roll out Men5CV through their routine immunization schedules; it also advises high-risk countries and countries with high-risk districts——to launch a mass campaign with the new vaccine that would target everyone aged between 1 and 19.

The burden of meningitis goes much further than its threat as a potential killer or getting through what can be a serious infection. Its secondary effects can be devastating and life-altering: hearing loss, brain damage, seizures, limb loss or other disabilities can follow in one in five. It mostly strikes younger people, but adults also can develop infection. And even though effective vaccines against a number of meningitis-causing bacteria are available in wealthier countries, some younger people remain unprotected.

But advances in the meningitis field—and in the efforts to defeat it—are happening on a number of fronts (3). There is increasing public awareness of the clinical features of meningitis and the need to seek rapid treatment; progress is being made (4) in clinical and molecular-based diagnosis. Advances are also seen in developing a vaccine (5) against Group B Streptococcus, which is the main cause (6) of sepsis and meningitis in babies under 3 months of age in high-income countries. The new pentavalent meningitis vaccine builds on those that came before it: a monovalent meningococcal conjugate vaccine against serogroup A, MenACV, started rolling out in 2010. It led to the control of meningitis A in the meningitis belt and its virtual elimination. The last case of meningitis A in the belt was confirmed in 2017. But it could rebound if efforts tail off.

Defeating vaccine-preventable bacterial meningitis would transform lives in a large part of the world, averting the deaths of children and saving the huge costs in time, resources, money and the burden that comes with the disabilities caused by infection.

As Evariste Ringtoumda recounts, his family stood together as he recovered from his illness and struggled to adjust, but it wasn't easy. Many people, in poorer and wealthier countries alike, but especially in lower-income countries, don't have access to appropriate support. Care and support is and will remain an urgent need to meet for people who must live the rest of their lives with the aftereffects of infection.

++ with credit and courtesy to UNICEF, African Union and People Initiative Foundation for Africa Dialogues 2018, Ouagadougou, Burkina Faso 

References

1. GBD 2019 Meningitis Antimicrobial Resistance Collaborators. Global, regional, and national burden of meningitis and its aetiologies, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology. 19 July 2023. doi: 10.1016/S1474-4422(23)00195-3.

2. Hausdorff, Bill and Katie Regan. A new vaccine could stop meningitis epidemics in Africa—for good. Path.org. https://www.path.org/articles/a-new-vaccine-could-stop-meningitis-epidemics-in-africafor-good/

3. Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 115, Issue 10, October 2021, Pages 1099–1101, https://doi.org/10.1093/trstmh/trab133

4. Xu H, Chen P, Guo S, Shen X and Lu Y (2023) Progress in etiological diagnosis of viral meningitis. Front. Neurol. 14:1193834. doi: 10.3389/fneur.2023.1193834

5. Baker Carol J.. (2023) Group B Streptococcal Vaccine — Sisyphus Reconciled. N Engl J Med 389:3, 275-277.

6. Group B Streptococcus Oxford Vaccine Group, The University of Oxford. 28 January 2022.

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