Niger vaccination campaigns: addressing measles and meningitis outbreaks
Miriam Alía, Vaccination and Outbreak Response Manager at Médecins Sans Frontières, discusses the C meningitis and measles epidemics that have affected Niger since early 2018.
Why did C meningitis and measles outbreaks occur?
The Niger has faced multiple outbreaks of C meningitis and measles—both deadly and highly contagious diseases. While vaccination should have prevented these epidemics, each case presents unique challenges.
In the case of meningitis, there is no affordable and effective vaccine for all serogroups. Additionally, global production shortages, driven by pharmaceutical companies’ limited interest in these markets, restrict vaccination to reactive measures once an outbreak is declared. These delays hinder effective vaccination campaigns.
Moreover, measles vaccines have been part of routine immunization programs since 1974, yet vaccination coverage remains insufficient to halt disease transmission.
Has the situation improved for C meningitis in recent years?
The year saw relative calm in the region often called Africa’s meningitis belt. However, vaccine production shortages persist. The International Coordinating Group on Vaccine Provision, which manages low-production vaccines for equitable distribution, aimed for a stockpile of five million C meningitis vaccines in 2018. This target was not met, leaving vaccination efforts reliant on reactive responses once epidemic thresholds are crossed rather than proactive measures.
Why is there a shortage of meningitis vaccines?
Meningitis has multiple serogroups—A, B, C, W135, and X—and no single vaccine covers all. The leading available option is a tetravalent conjugate vaccine effective against the four most common serogroups, but its cost remains prohibitive. The Serum Institute of India is developing a pentavalent conjugate vaccine (A, C, Y, W-135, X) expected in 2020, but until then, vaccine production shortfalls persist. Pharmaceutical companies hesitate to invest in new vaccines due to high costs and uncertain demand.
How did Niger respond to the C meningitis outbreak?
In partnership with the Ministry of Health, over 30,000 people in the Tahoua region were vaccinated against C meningitis, alongside patient care. A surprising number of cases involved serogroup X, for which no vaccine exists—a major concern for future outbreaks.
Are there alternative meningitis C prevention strategies?
New prevention methods, such as administering the antibiotic ciprofloxacin, have been tested. In 2017, Niger trialed mass ciprofloxacin distribution in rural areas, with a PLOS Medicine study (June 2018) showing a significant reduction in transmission. Future studies will assess its impact in urban settings, potentially offering an additional tool against localized outbreaks.
95%
To prevent measles spread, population protection must reach a minimum of 95%. Achieving these coverage rates is challenging in Niger.
Why does the routine measles vaccination schedule fail to curb epidemics?
Niger’s national protocol mandates vaccination up to 23 months, but GAVI-supplied vaccines only cover children under 12 months. The 15-month booster dose is excluded, leaving older children unvaccinated. Additionally, nomadic populations and conflict-affected areas face limited access to healthcare, making 95% coverage—a critical threshold for herd immunity—difficult to sustain.
How can vaccination coverage be improved?
The childhood vaccination schedule should extend to age five, and every healthcare interaction should include vaccine updates. Multiantigen campaigns, such as those in Arlit (Agadez), combine measles, pentavalent, and pneumococcal vaccines to maximize protection.
Where possible, tetanus vaccines are included for pregnant women or women of childbearing age. With five required doses and low completion rates in Niger, these opportunities provide critical protection for mothers and newborns. Every chance to vaccinate against deadly diseases must be seized.
Since early 2018, MSF and Niger’s Ministry of Health have vaccinated 179,460 people: 145,843 children aged 6 months to 15 years against measles in Tahoua and Agadez regions; and 33,620 people aged 2 to 29 against C meningitis in Tahoua. Currently, a measles vaccination campaign in Arlit (Agadez) aims to immunize over 50,000 children under five, with pentavalent and pneumococcal vaccines also administered to infants.
[1] Alert and epidemic thresholds are set at 5 and 15 cases per 100,000 inhabitants per week in areas with over 30,000 people. The epidemic threshold may drop to 10 cases/100,000/week in high-risk zones.
[2] Diphtheria, pertussis, tetanus, Haemophilus influenzae type B, and hepatitis B.
