Successful African introduction of a new Group A meningococcal conjugate vaccine: Future challenges and next steps
Successful African introduction of a new Group A meningococcal conjugate vaccine: Future challenges and next steps
复制标题
DOI：
10.1080/21645515.2017.1378841
复制
发表时间：
2018-01-01
影响因子：
4.8
通讯作者：
Preziosi, Marie-Pierre
中科院分区：
文献类型：
--
作者：
LaForce, F. Marc;Djingarey, Mamoudou;Preziosi, Marie-Pierre
引进一种新的a群脑膜炎球菌结合疫苗MenAfriVac(R)是一项重要的公共卫生成功。在所有在公共卫生范围内使用新的甲型男子结合疫苗的国家，甲型脑膜炎球菌性脑膜炎已经消失。然而，在撒哈拉以南非洲继续控制A群疾病将需要保持社区对A群脑膜炎球菌的免疫力。模型研究表明，除非维持群体免疫，否则A群脑膜炎球菌病将卷土重来。为确保非洲人口继续受到保护，出生队列必须在麻疹1型9个月大时接种MenAfriVac(R)（5微克）的扩大免疫制剂。此外，在最初的1-29岁运动之后出生的人口，因此尚未接种新的男子A结合疫苗，将必须在针对具体国家的追赶运动中进行免疫接种。扩大免疫覆盖率低（1型麻疹覆盖率< 60%）的国家可能需要每五年接种一次疫苗，目标是覆盖1-4岁的儿童。实施这些战略是确保A群脑膜炎球菌性脑膜炎不再流行的唯一可靠途径。需要紧急注意的第二个问题是应对撒哈拉以南非洲非A型脑膜炎球菌性脑膜炎流行病的挑战。C、W和X群脑膜炎球菌是撒哈拉以南非洲公认的流行毒株，是每年严重程度不同、规模和地理分布仍然不可预测的局灶性脑膜炎流行的原因。因此，必须开发和引进负担得起且适合非洲情况的多价脑膜炎球菌结合疫苗。这些新的脑膜炎球菌疫苗与更负担得起的肺炎球菌结合疫苗相结合，为撒哈拉以南非洲实现无脑膜炎提供了希望。
The introduction of a new Group A meningococcal conjugate vaccine, MenAfriVac(R), has been a important public health success. Group A meningococcal meningitis has disappeared in all countries where the new Men A conjugate vaccine has been used at public health scale. However, continued control of Group A disease in sub-Saharan Africa will require that community immunity against Group A meningococci be maintained. Modeling studies have shown that unless herd immunity is maintained Group A meningococcal disease will return.To ensure that African populations remain protected birth cohorts must be protected with an EPI formulation of MenAfriVac(R) (5 mcg) given at 9 months with Measles 1. In addition, populations born after the initial 1-29 year old campaigns and consequently not yet immunized with the new Men A conjugate vaccine, will have to be immunized in country-specific catch-up campaigns. Countries with poor EPI coverage (Measles 1 coverage < 60%) will likely need quinquennial vaccination campaigns aimed at covering 1-4 year olds. Implementing these strategies is the only sure way of ensuring that Group A meningococcal meningitis epidemics will not recur.A second problem that requires urgent attention is the challenge of dealing with Non-A meningococcal meningitis epidemics in sub-Saharan Africa. Groups C, W and X meningococci are well-established circulating strains in sub-Saharan Africa and are responsible for yearly focal meningitis epidemics that vary in severity and remain unpredictable as to size and geographic distribution. For this reason, polyvalent meningococcal conjugate vaccines that are affordable and appropriate for the African context must be developed and introduced. These new meningococcal vaccines when combined with more affordable pneumococcal conjugate vaccines offer the promise of a meningitis-free Sub-Saharan Africa.