Niger faces ongoing measles and meningitis vaccination challenges
Miriam Alía, Vaccination and Outbreak Response Manager for Médecins Sans Frontières (MSF), examines the meningitis C and measles outbreaks that have affected Niger since early 2018.
What triggered the meningitis C and measles outbreaks in Niger?
Niger has faced recurrent outbreaks of meningitis C and measles, two deadly and highly contagious diseases. Despite vaccination programs, these epidemics persist due to multiple challenges. Each outbreak presents unique obstacles that hinder effective control.
Why does meningitis C remain difficult to prevent?
Meningitis C is one of several serogroups (A, B, C, W135, X) for which no single vaccine is universally effective. The most widely used conjugate tetravalent vaccine covers the four most common serogroups but comes at a high cost. The Serum Institute of India is developing a pentavalent conjugate vaccine (A, C, Y, W-135, X), expected by 2020, but until then, production shortages persist. The International Coordination Group for Vaccine Provision, which manages low-production vaccines, set a minimum stock of five million doses for meningitis C in 2018—yet this target was not met.
How did Niger respond to the meningitis C outbreak?
In partnership with the Ministry of Health, MSF vaccinated over 30,000 people in the Tahoua region and supported patient care. Notably, a significant proportion of cases involved serogroup X, for which no vaccine currently exists—a major concern for future prevention strategies.
What prevention strategies exist for meningitis C?
A 2017 pilot in Niger tested administering ciprofloxacin, an antibiotic, to all residents in rural areas. A PLOS Medicine study (June 2018) found this approach significantly reduced transmission. Further research will assess its effectiveness in urban settings, potentially offering an additional tool for small-scale outbreaks.
95%
To prevent measles outbreaks, at least 95% vaccination coverage is required, a target difficult to achieve in Niger due to population mobility and conflict-affected regions.
Why does the measles vaccination schedule fail to stop outbreaks?
Niger’s national protocol mandates measles vaccination up to 23 months, but GAVI-provided vaccines only cover children under 12 months. The 15-month booster dose is excluded, leaving older children unvaccinated. Additionally, nomadic populations and conflict zones face limited access to health centers. Achieving the 95% coverage threshold remains a persistent challenge.
How can vaccination coverage be improved?
Expanding the vaccination schedule to age five and integrating multi-antigen campaigns could enhance protection. For example, during a measles outbreak in Arlit (Agadez), MSF combined measles, pentavalent, and pneumococcal vaccines in a single campaign, maximizing efficiency.
Opportunistic vaccination—such as administering tetanus shots to pregnant women—also strengthens immunity for mothers and newborns. Every healthcare interaction should be leveraged to update vaccination records.
Since early 2018, MSF and Niger’s Ministry of Health have vaccinated 179,460 people against measles and meningitis C. Efforts included:
- 145,843 children (6 months–15 years) against measles in Tahoua and Agadez regions;
- 33,620 people (2–29 years) against meningitis C in Tahoua;
- A current campaign in Arlit (Agadez) targeting 50,000 children under 5, with pentavalent and pneumococcal vaccines for infants under one.
Epidemic thresholds for meningitis are set at 5 cases per 100,000 inhabitants (alert) and 15 cases (epidemic), adjustable based on risk.
