Public health impact of MenAfriVac: the first four years
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1 1 Public health impact of MenAfriVac: the first four years Mamoudou Djingarey, WHO Ryan Novak, CDC James Stuart, LSHTM MVP Closure Conference, Addis Ababa, Ethiopia 23 February 2016
2 MACV Implementa;on Strategy Rapidly induce herd immunity ( ) Large scale mass campaigns targeted at 1 to 29 years of age (> 90% vaccine coverage achieved) Protect new birth cohorts Integrate into EPI schedule by 2015 Along with a one-xme catchup campaign <5 years Surveillance and epidemic response during the introducxon process
3 Strengthening surveillance capacity around MenAfriVac introduc;on Following introducxon of MenAfriVac, WHO recommended implementaxon of Case Based Surveillance (CBS) to monitor vaccine impact and disease/ serogroup trends. Development of CBS Regional Guidelines: Burkina Faso Case Based Surveillance SOPs 2009 WHO-AFRO Generic Guidelines 2010
4 Strengthening surveillance capacity around MenAfriVac introduc;on Build in-country laboratory and epidemiologic capacity for implementing and sustaining casebased surveillance for meningitis Assist countries to use this capacity to support evaluation of MenAfriVac performance and inform future vaccine program decisions Case study of Burkina Faso and Chad
5 Surveillance evaluaxon (2007-8) IdenXficaXon of priority improvements for casebased surveillance introducxon Capacity building ( ) Develop Case Based Surveillance SOPs Technology transfer (real-xme PCR) Case Based Surveillance Pilot 10 districts Case based surveillance ( ) Expansion to 63 districts Support for specimen transport, lab confirmaxon, and external quality assurance (EQA) MenAfriVac naxonal vaccinaxon campaign 2010 Surveillance Strengthening 5 Burkina Faso,
6
7 Case Based Surveillance 63 Districts Burkina Faso, 2011 Case Based Surveillance IDSR/aggregate case counts Case detection 41% % 2011 Specimen collection 11% % 2011 Pathogen confirmation 24% % 2011
8 Meningi;s cases by week Burkina Faso, MenAfriVac campaign
9 Incidence of meningi;s Burkina Faso, 2011 v Significant reduction in risk of meningitis (p<0 0001)
10 Incidence of meningi;s Burkina Faso, 2011 v % -21%
11 Reported meningi;s cases and propor;on serogroup A Burkina Faso, Year Meningi;s Cases % serogroup A , , , , , , Introduc;on of MenAfriVac in December , , , , , Average 86% NmA Average <0.2% NmA
12 The Lancet Infec,ous Disease, 2012 "These results, together with those of carriage studies to be reported, strongly suggest that PsA TT has been highly effec>ve in Burkina Faso...but several more years of observa>on across the meningi>s belt will be needed before the efficacy of this vaccine in preven>ng serogroup A meningococcal epidemics can be confirmed defini>vely. Dr. Brian Greenwood and James Stuart Commentary, The Lancet ID July 2012
13 13
14 Emergence of N. meningi>dis W epidemic Burkina Faso, Burkina Faso* ,957 cases; NmW & X; ICG vax ACWY ,732 cases; NmA & X; ICG vax AC ,723 cases; NmA; ICG vax AC 2010 NmW 2011 NmW Meningi;s Belt 2012 NmW Ref: MacNeil JR, Medah I, Koussoube D, Novak RT, Cohn AC, Diomande FV, et al. Neisseria meningi,dis serogroup W, Burkina Faso, Emerg Infect Dis Mar;20(3): PubMed PMID: Pubmed Central PMCID:
15 Case Based Meningi;s 15 Surveillance Burkina Faso, 2015 From: MenAfriNet Surveillance Annual Bulle,n 2015
16 Cas de NmA no;fiés au Burkina Faso 2015 N District Age Sexe Statut vaccinal 1 Tougan 12 M Non vacciné 2 Ouahigouya 7 F Non vacciné 3 Titao 5 M Non vacciné First case of NmA among children born since the 2010 MenAfriVac campaign Importance of EPI integraxon of MenAfriVac From: Burkina Faso Direc,on de LuYe contre la Maladie, MenAfriNet Partners Mee,ng, Niamey, Oct2015
17 MenAfriVac impact: the experience of Chad Kadidja Gamougam and Doumagoum Moto Daugla Centre du Support en Santé InternaXonale, Chad
18 Meningi;s in Chad before MenAfriVac Weeks 1-26, 2009 to Epidemic of serogroup A Neisseria meningi>dis Weekly incidence/100, N'Djamena Rest of Chad
19 Fig 1. Phased introduc;on of MenAfriVac in Chad N Djamena regions vaccinated 2011 Rest of Chad vaccinated 2012
20 Impact of MenAfriVac on meningi;s in Chad Weeks 1-26, 2009 to Weekly incidence/100, N'Djamena Rest of Chad N Djamena vaccinated % reduc;on in N Djamena regions
21 Impact of MenAfriVac on meningi;s in Chad Weeks 1-26, 2009 to Weekly incidence/100, N Djamena vaccinated 2011 Rest of Chad vaccinated
22 Meningi;s in Chad, The First Four Years aher MenAfriVac MenAfriVac campaign completed Weekly bullexn, WHO IST
23 Public heath impact of MenAfriVac on meningi;s: Examples from Burkina Faso and Chad Decrease in the number of NmA cases in Burkina Faso (ref: Novak et. al.) NmA epidemic stopped in Chad Drama;c reduc;on in meningi;s cases aher MenAfriVAc (refs: Daugla et. al.) Impact on carriage and herd protec;on to follow Decrease in the overall number of meningi;s suspect cases & epidemics (refs: Novak et. al.; WHO)
24 Acknowledgements Le Ministère de la Santé, DirecXon de la Lume contre la Maladie, Burkina Faso Centre hospitalier universitaire pédiatrique Charles De Gaulle & Centre Hospitalier Universitaire Yalgado Ouédraogo Dr Daugla et son équipe Le Ministère de la Santé Publique, Tchad Prof Brian Greenwood & MenAfriCar Le Projet Vaccins Méningite
25 BACK UP SLIDES 25
26 Case Based Surveillance aher MenAfriVac introduc;on : Laboratory confirmed serogroup A Burkina Faso Niger NmA unvaccinated; 3 imported NmA unvaccinated 4 NmA unvaccinated Cameroon - 29 NmA unvaccinated Chad - - Nigeria - - Senegal NmA unvaccinated NmA unknown status 1 NmA unvaccinated; imported
27 Serogroup Distribu;on, Meningi;s Belt Countries Serogroup A Serogroup W Serogroup C MACV roll-out Source: World Health Organiza,on; MenAfrINet
28 MACV rollout million people vaccinated
29 MenAfriVac vaccina;on in Chad 1.8 million 1-29 year olds immunised in a planned vaccinaxon campaign 3 regions in and around N Djamena over 10 days in December ReacXve vaccinaxon campaigns February - May districts >epidemic threshold 3 other adjacent districts
30 Meningi;s in Chad Cases of meningitis Conjugate vaccine Whole cell vaccines Sulphonamides Polysaccharide vaccines Year
31 31 Interna;onal/Regional Guidelines
32 32
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