Niger vaccination: fighting measles and meningitis outbreaks
Niger vaccination: fighting measles and meningitis outbreaks
Miriam Alía, MSF’s vaccination and epidemic response coordinator, discusses the meningitis C and measles outbreaks that struck Niger since early 2018.
Why did Niger face meningitis C and measles outbreaks?
Niger experienced multiple outbreaks of meningitis C and measles in recent years—two deadly, highly contagious diseases. While vaccination programs aim to prevent these crises, implementation challenges and coverage gaps often lead to widespread transmission.
Meningitis C vaccine challenges
Unlike measles, meningitis C lacks a widely affordable vaccine covering all serogroups. Global production shortages—driven by limited pharmaceutical interest in low-income markets—force delayed reactive campaigns once outbreaks are declared. This reactive approach undermines timely prevention.
Meanwhile, the measles vaccine has been part of routine immunization since 1974, yet coverage rates remain insufficient to halt transmission in Niger.
2018 meningitis C situation in the meningitis belt
The African meningitis belt saw relatively mild activity in 2018. However, vaccine production constraints persist. The International Coordinating Group on Vaccine Provision, which manages low-production vaccines for equitable distribution, aimed to stock five million meningitis C vaccines—but fell short. Consequently, teams respond reactively when thresholds are crossed rather than implementing preventive vaccination at alert levels.
Why is meningitis C vaccine supply so limited?
Meningitis comprises multiple serogroups—A, B, C, W135, and X—each requiring different vaccines. The current best option is a tetravalent conjugate vaccine effective against four common serogroups, but it’s prohibitively expensive. The Serum Institute of India is developing a pentavalent vaccine (A, C, Y, W-135, X) expected by 2020, yet many labs avoid investing due to uncertain demand.
How did Niger respond to the 2018 meningitis C outbreak?
MSF collaborated with Niger’s Ministry of Health to vaccinate over 30,000 people in Tahoua against meningitis C and support patient care. Notably, cases of serogroup X—currently without a vaccine—surfaced, raising concerns for future outbreaks.
Preventive strategies beyond vaccination
New approaches like mass administration of ciprofloxacin have shown promise. A 2017 Niger trial, published in PLOS Medicine (June 2018), demonstrated significant transmission reduction when the antibiotic was distributed to entire rural populations. Future studies will assess urban applicability, potentially offering a supplementary tool for localized outbreaks.
95%
Measles requires at least 95% population immunity to prevent spread, yet coverage remains challenging in Niger’s mobile and conflict-affected communities.
Why does Niger’s measles vaccination fail to curb outbreaks?
Routine immunization mandates vaccination by 23 months, but GAVI-funded vaccines only cover children under 12 months. The 15-month booster dose is excluded, and older unvaccinated children miss protection entirely. Additionally, nomadic populations and conflict zones face limited access to health centers, making herd immunity targets nearly impossible to achieve.
How can vaccination coverage improve?
Expanding the immunization schedule to age five and updating vaccination records during every health visit would boost protection. Multi-antigen campaigns—like the current response in Arlit (Agadez)—combine measles vaccines with pentavalent and pneumococcal vaccines to maximize disease prevention.
Where feasible, teams also administer the tetanus vaccine to pregnant women or women of childbearing age. Given the five-dose requirement and missed opportunities in Niger, integrating this vaccine during campaigns protects both mothers and newborns. Every health interaction is a chance to prevent deadly diseases.
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. Currently, MSF is running a measles vaccination campaign in Arlit (Agadez) targeting over 50,000 children under five, with pentavalent and pneumococcal vaccines for those under one year.
Thresholds: Alert at 5 cases/100,000/week; epidemic at 15 cases/100,000/week in areas with over 30,000 inhabitants (10 cases/100,000/week if high-risk conditions exist). Pentavalent vaccine components: diphtheria, pertussis, tetanus, Haemophilus influenzae type B, and hepatitis B.