Emergency vaccination against epidemic meningitis in Ghana: implications for the control of meningococcal disease in West Africa
Emergency vaccination against epidemic meningitis in Ghana: implications for the control of meningococcal disease in West Africa
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DOI：
10.1016/s0140-6736(99)03366-8
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发表时间：
2000-01-01
期刊：
影响因子：
168.9
通讯作者：
Rosenstein, NE
中科院分区：
文献类型：
--
作者：
Woods, CW;Armstrong, G;Rosenstein, NE
背景：自1912年对脑膜炎的描述以来，非洲脑膜炎带不断报道脑膜炎球菌病的反复流行，脑膜炎球菌多糖疫苗可以有效预防疾病，但在这种情况下使用的最佳策略一直存在争议。我们使用1997年加纳北部脑膜炎球菌病暴发的数据来评估不同疫苗接种策略的潜在效果。方法我们确定了所有报告的脑膜炎球菌性脑膜炎病例，并通过使用简单的数学模型估计了可以通过接种疫苗预防的病例和死亡人数。然后，我们评估了不同疫苗接种策略的潜在影响以及这些策略对公共卫生系统的负担。在1996年11月至1997年5月期间，在加纳北部的三个受影响地区报告了18 703例病例和1356例死亡。疫苗接种从2月第三周开始，一直持续到4月，覆盖了72%的高危人群，估计预防了23%的病例和18%的死亡。如果在大流行之前实现并保持同样的疫苗覆盖率，儿童和成人常规免疫战略本可预防61%的病例。如果按照世卫组织指南目前所提倡的那样，在1月份疫情爆发后开始接种疫苗，本可预防的病例比例也类似（61%）。在能够阻断脑膜炎奈瑟菌传播的长效结合疫苗被纳入常规婴儿免疫计划之前，在西非预防脑膜炎地方性疾病流行将是困难的。在此之前，世卫组织倡导的监测和应对战略与目前可用的多糖疫苗常规儿童和成人疫苗接种战略一样有效和更实用。
Background Recurrent epidemics of meningococcal disease have been reported throughout the African meningitis belt since description of the disease in 1912, Meningococcal polysaccharide vaccines can effectively prevent disease but the optimum strategy for their use in this setting has been controversial. We used data from an outbreak of meningococcal disease in northern Ghana in 1997 to assess the potential effect of different vaccination strategies.Methods We identified all reported cases of meningococcal meningitis and estimated the number of cases and deaths that could have been prevented by vaccination through use of a simple mathematical model. We then assessed the potential effect of different vaccination strategies and the burden of these strategies on the public-health system.Findings In the three affected regions in northern Ghana there were 18 703 cases and 1356 deaths reported between November, 1996, and May, 1997. Vaccination began in the third week of February and continued to April, reaching 72% of the at-risk population and preventing an estimated 23% of cases and 18% of deaths. A strategy of routine childhood and adult immunisation would have prevented 61% of cases had this same rate of vaccine coverage been achieved and maintained before the epidemic. If vaccination had started after the onset of the epidemic in January, as currently advocated by WHO guidelines, a similar proportion (61%) of cases could have been prevented.Interpretation Prevention of epidemics of meningococal disease in west Africa will be difficult until long-lasting conjugate vaccines capable of interrupting transmission of Neisseria meningitidis can be incorporated into routine infant-immunisation schedules, Until then, the strategy of surveillance and response advocated by WHO is as effective and more practical than a strategy of routine childhood and adult vaccination with currently available polysaccharide vaccines.