Meningitis in Africa
I’m Rachel Perrin, MRF’s International Development Officer.
My role is to expand the work we’re doing to fight meningitis and septicaemia in Africa where epidemics like this are commonplace and huge numbers of lives are lost every year.
We’re hoping to increase the scope of our international research projects and help increase awareness of the symptoms of these diseases in sub-Saharan Africa.
An African overview
- In Africa meningitis and septicaemia kill 1,000 people a day.
- Bacterial meningitis accounts for 2% of child deaths worldwide, but the burden of meningococcal meningitis is highest in the African meningitis belt (see map below), which saw almost 80,000 cases and over 4,000 reported deaths in the 2009 epidemic season alone.
- In epidemic years in the African meningitis belt, as many as a quarter of a million people can be affected in a single year.
- Historically, most meningococcal disease in Africa is caused by Meningococcal Group A (MenA), and accounts for about 80 to 85 percent of all cases.
Burkina Faso 2010: When epidemics strike
A large meningitis outbreak hit the West African country of Burkina Faso at the start of 2010. By April there had been 4,421 recorded cases resulting in 630 deaths, up from 389 in the same period the previous year. Six of Burkina Faso’s 13 regions were at epidemic level.
Burkina Faso lies within the African Meningitis Belt, an area plagued by large epidemics of meningitis and septicaemia.
Home to around 450 million people, the meningitis belt extends across the dry, savannah parts of sub-Saharan Africa, stretching from Senegal in the west to Ethiopia in the east.
During the annual dry season between December and June, meningococcal meningitis rates skyrocket. The largest epidemic ever recorded in history swept across the entire region in 1996–1997, causing over 250,000 cases and 25,000 deaths.
Historically, most meningococcal disease in Africa is caused by MenA, and accounts for about 80 to 85 percent of all cases.
But a previously rare strain – MenX, is the strain responsible for the Burkina Faso outbreak, where it has caused just over half the new cases.
Meningitis vaccine strategies in the developing world tend to be reactive. That means people only get immunized in an emergency situation once an outbreak starts.
But last year, the World Health Organization (WHO) approved a new vaccine that could stop outbreaks before they even begin.
Recently Burkina Faso, one of the countries hardest hit by the deadly disease, became the first country to introduce the new vaccine - MenAfriVac™ - developed by the Meningitis Vaccine Project.
Introduction of this new MenA vaccine in the African meningitis belt could make epidemic meningitis a thing of the past.
MenAfriVac™ protects against serogroup A meningitis, the strain responsible for most outbreaks of meningococcal disease in Africa.
Costing less than 50 cents a dose, this “conjugate” vaccine will be much more immunogenic than the older (polysaccharide) vaccines currently used in Africa, and can be given to infants.
Because conjugate vaccines prevent carriage and transmission of bacteria from person to person, it should protect the entire population (through herd immunity).
What are MRF doing to combat meningitis in Africa?
We are committed to increasing our work in the developing world – by investing in more research and by campaigning for increased awareness and better treatment.
Currently four of our research projects are working to tackle the problems caused by meningitis and septicaemia in Africa.
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Meningitis is especially common in babies and without treatment is almost always fatal.
In Blantyre, Malawi, the death rate of meningitis in infants less than two months of age is almost 50%.
Survival depends on accurate diagnosis and the early administration of appropriate antibiotics, both of which are hard to achieve in resource-poor settings. The aim of this clinical trial is to improve treatment of infants with meningitis, by giving the antibiotic ceftriaxone. This treatment is more appropriate than the currently used medications in Malawi, because it targets more infections, and only requires one injection per day (compared to the 3-4 injections needed with current therapy) meaning that the full course of treatment is more likely to be completed.
The difference you can make
This project costs £77,049. Please help us to support this important work.
With your help we can improve treatment and outcomes of infants in Malawi with bacterial meningitis.
This project could bring about a change in clinical practice that could save many lives in Malawi and other African countries where the burden of meningitis is high.
- £5 Lab tests are done in hospital to confirm that a child has meningitis. This costs £5 per patient.
- £10 The antibiotic treatment (ceftriaxone) at Queen Elizabeth Central Hospital costs ₤10 for one baby.
- £65 As the general wards at QECH are too full and understaffed to undertake clinical research, patients enrolled in this trial are admitted to a special research ward to receive their care and treatment. MRF pays a daily ward fee for each patient. It costs around £65 per day to care for each child with meningitis on this ward.
- £2,000 Deafness is the most frequent severe after effect of meningitis and it’s important to check for hearing loss soon after the illness. £2,000 will buy a new hand-held device to assess hearing loss.
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Survival from meningitis is dependent on rapid diagnosis and early treatment. However, sufferers in African countries like Malawi often don’t reach health centres until late on into their illness. This leads to unacceptably high rates of death and disability.
Based at the Queen Elizabeth Central Hospital in Blantyre, Malawi, this 12-month study will use interviewing techniques to explore the barriers and facilitators to successful treatment of children and adults in urban Blantyre in the home, communities and within the health system itself. It will also look at how people interpret and deal with the symptoms of meningitis in the community, and whether symptoms are severe enough to seek medical help.
This study will give direct evidence as to why and how people with meningitis present late at hospital. Using this information, we can find ways to increase early recognition, provide timely treatment and ultimately improve outcomes from meningitis.
The difference you can make
This project costs £68,946. Please help us to support this important work.
With your support we can help to overcome the barriers to rapid treatment and improve the outcomes from meningitis in Malawi.
- £4 Hourly salary for a translator, to help with translations between local Malawi dialect (Chichewa) and English.
- £10 Hourly salary for a Malawian Graduate Social Scientist, responsible for most of the data collection and involved in research coding, analysis and writing up research findings.
- Misc £600 is needed to purchase a laptop, £600 for the Data analysis software, and £500 for Olympus Digital recording & transcription equipment.
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Meningitis epidemics periodically sweep across the African meningitis belt, which stretches from Senegal in the west to Ethiopia in the east, affecting up to 250,000 people in a single year.
These epidemics have been largely due to meningococcus A, and the introduction of a new MenA vaccine should reduce their severity. In the meantime,
MenX (previously a rare type of meningitis) has emerged as an increasingly major cause of the disease, and is not covered by any vaccine. MenX is not considered a rewarding target for research, since those affected by the disease are in countries that could not afford a vaccine.
This project addresses a major step in vaccine research by studying naturally acquired immunity against MenX bacteria in Togo, West Africa.
The difference you can make
This project costs £68,000. please help us to support this important work.
With your help, researchers will find out if the strategy used for developing many other successful vaccines, using the polysaccharide or ‘sugar’ coat of the meningococcus, will work for MenX.
- £10 Daily cost of laboratory reagents and consumables.
- £25 Cost of a lab test which tells us if a person has immunity to MenX (Serum Bactericidal Assay -measures the measure functional antibody levels in the blood).
- £45 One ELISA test to determine antibody concentrations.
- £2,000 is needed to purchase a centrifuge and a freezer - critical items needed for the laboratory.
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Between December and June, during the annual dry season in sub-Saharan Africa, meningococcal meningitis rates skyrocket. People cough and sneeze. Dry air and dusty winds allow bacteria to invade and the deadly infection travels rapidly from one person to the next. About 350 million people live at risk in this area, named the African Meningitis Belt.
During this 12-month study a rapid, low cost and reliable test will be developed to evaluate the prevalence of meningococcal meningitis strains in the African Meningitis Belt.
This improved surveillance will enable timely detection of epidemics, better use of existing vaccines and more appropriate treatment. Importantly, it will also help to evaluate the impact of the new serotype A vaccine, which was launched in several African countries late last year.
The difference you can make
This project costs £70,800
With your help we can improve our understanding of how meningococcal meningitis is spread in Africa, and learn more about the impact of the new meningitis vaccine.
- £30 cost of one meningococcal meningitis lab test (PCR)
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How our work has already helped
- Pneumococcal disease kills around 1.6 million people worldwide each year, one million of whom are young children and infants. Our research project in Boston has resulted in the development of a low-cost vaccine suitable for the developing world where the disease is a major killer.
- An MRF funded project showed the way in which waves of different meningococcal epidemics happen over wide areas, researchers also noticed a steady increase in the amount of pneumococcal disease seen. They indicate the need for a mass vaccination programme to protect against pneumococcal infection. The high fatality rate also stresses the need for improved treatment in these areas.
- A collaborative project looked at the nature of epidemics in the Southern region of Ethiopia, with the aim of developing a forecasting model to help predict future outbreaks. Results provided for the first time, large amounts of data on bacterial carriage, environmental factors for epidemics and the sensitivity of existing forecasting models. It also highlighted the problem of low reporting rates in many districts of Southern Ethiopia. This data and the model developed from it will be critical in assessing which populations are most at risk and the future risk of epidemics.
Latest News
An MRF team , consisting of Chief Executive Chris Head and trustees Beverley Pace and Kim Taylor, recently visited MRF funded projects in Malawi. Read the MRF in Malawi blog