Combating measles and meningitis: an update on vaccination efforts in Niger

Miriam Alía, who oversees vaccination and epidemic response for Médecins Sans Frontières, provides an overview of the meningitis C and measles outbreaks that have impacted Niger since the beginning of 2018.

Understanding the persistence of meningitis C and measles outbreaks

Niger has once again faced epidemics of measles and meningitis C, two highly infectious and potentially fatal diseases. While these outbreaks are technically preventable through immunization, the reasons they persist differ for each condition.

Regarding meningitis, there is a lack of affordable and effective vaccines covering all known serogroups. Furthermore, global production remains low because pharmaceutical companies show limited interest in these specific markets. This often forces health organizations to use vaccines reactively only after an epidemic is officially declared, creating delays that hinder the success of immunization drives.

In contrast, the measles vaccine has been part of routine health programs since 1974. However, the percentage of the population currently vaccinated remains too low to effectively halt the spread of the virus.

Addressing the global shortage of meningitis vaccines

While this year has been relatively quiet across the African meningitis belt, a critical shortage in vaccine production continues to pose a threat. The International Coordinating Group on Vaccine Provision, which manages limited stocks to ensure equitable distribution, set a target of five million doses for meningitis C this year. Unfortunately, this goal was not met. As a result, vaccination teams are still forced to wait until epidemic thresholds are reached rather than acting preventively when early warning signs appear.

The complexity of vaccine development

Meningitis is categorized into several serogroups, including A, B, C, W135, and X, and no single vaccine protects against all of them. The most effective option currently available is the quadrivalent conjugate vaccine, which targets four common strains but remains prohibitively expensive. While the Serum Institute of India is developing a more affordable pentavalent vaccine (covering A, C, Y, W-135, and X), it is not expected until 2020. Many laboratories hesitate to invest in new production lines for fear that these high-cost products will not find a market.

The emergency response in Niger

Working alongside the Ministry of Health, medical teams vaccinated over 30,000 individuals against meningitis C in the Tahoua region while providing clinical care for those infected. A significant concern emerged during this period: a high prevalence of serogroup X cases, for which no vaccine currently exists. This represents a major public health challenge for the future.

Innovative prevention and measles coverage gaps

New preventative tactics are being explored, such as the use of the antibiotic ciprofloxacin. A study conducted in Niger and published in PLOS Medicine in June 2018 demonstrated that administering a single dose to all residents in a rural area significantly lowered disease transmission. Further research is needed to see if this strategy works in urban settings, but it could serve as a vital tool for managing smaller outbreaks.

95%: To stop the spread of measles, at least 95% of the population must be immune. Maintaining such high coverage is extremely difficult in mobile or vulnerable populations.

Barriers to effective measles immunization

The current vaccination schedule in Niger is quite restrictive. National protocols focus on children up to 23 months old, yet vaccines supplied by GAVI often only cover infants under 12 months. This leaves out the 15-month booster shot and older children who visit health centers. Additionally, many people in Niger are nomadic or live in regions affected by conflict, making it difficult for them to reach stationary health facilities.

Strategies for improving immunization rates

Health experts suggest that the childhood vaccination window should be expanded to include all children up to the age of five. Every interaction a child has with the healthcare system should be viewed as a chance to update their immunizations. Furthermore, multi-antigen campaigns are being utilized to maximize protection. For instance, during a measles response in Arlit (Agadez), teams are also administering pentavalent and pneumococcal vaccines.

Whenever possible, tetanus shots are provided to pregnant women or those of childbearing age. Because this requires five doses, many women in Niger do not complete the full course. It is vital to capitalize on every opportunity to provide protection against these deadly diseases.

Since the start of 2018, MSF and the Ministry of Health have immunized more than 179,460 people across Niger. This includes 145,843 children vaccinated against measles in the Tahoua and Agadez regions, and 33,620 individuals protected against meningitis C in Tahoua. A current initiative in Arlit aims to reach 50,000 more children, providing those under one year old with additional protection against pneumonia and other bacterial infections.