Dr Doumagoum Moto Dagula's presentation at Meningitis Research Foundation's 2013 conference Meningitis & Septicaemia in Adults

1. IMPACT OF SEROGROUP A MENINGOCOCCAL
CONJUGATE VACCINE (MENAFRIVAC) ON
MENINGOCOCCAL MENINGITIS AND CARRIAGE IN
CHAD
Caroline Trotter
University of Cambridge

2. GREETINGS FROM CHAD
Centre de Support en Santé Internationale (CSSI)
Dr Gamougam,
Microbiologist
Dr Daugla,
Director

3. MENINGITIS IN CHAD 1930-2011
Cases of meningitis
Conjugate
vaccine
Polysaccharide
vaccines
Sulphonamides
Whole cell
vaccines
Year

4. THE AIMS OF MENAFRICAR
•
To define the pattern of meningococcal carriage across the
African meningitis belt and rates of acquisition and loss of
carriage.
•
To measure the impact of a new group A meningococcal
conjugate vaccine (MenAfriVac) on carriage and disease.

5. MENAFRICAR CENTRES
Centre pour le Développement
des Vaccins (CVD-Mali), Mali
Institut de Recherche
pour le Développement,
Senegal
Centre de Recherche
Médicale et Sanitaire
(CERMES), Niger
University of
Maiduguri, Nigeria
The Navrongo Health
Research Centre, Ghana
Centre de Support en
Santé Internationale
(CSSI), Chad
Armauer Hansen Research
Institute (AHRI), Ethiopia

6. MENAFRICAR SURVEYS IN 2010
• First cross sectional studies performed July-December 2010
in seven countries.
• Group A meningococci identified only in carriers in Chad.
• Vaccine evaluation activities originally planned for Mali and
Niger moved to Chad.

7. CARRIAGE STUDIES IN CHAD
• MenAfriCar standard protocols
• Rural area of Mandelia
• First survey
•
September-November 2010, N= 998
• Pre-vaccination survey
•
• August- October 2011, N=4278
Post-vaccination survey
• April-June 2012, N=5001

8. Mandelia district - address by the Chef

9. Mandelia
carriage survey
- collecting a swab

10. Microbiology laboratory
National hospital, N’Djamena

11. THE MENINGITIS VACCINE PROJECT
Aim
Production of an affordable,
serogroup A
meningococcal conjugate
vaccine for use in Africa
WHO + PATH
Established in 2001 with support from
the Bill and Melinda Gates Foundation

12. MVP – ACHIEVEMENTS
•
Efficient conjugation method developed and transferred
successfully to an Indian manufacturer.
•
Phase 2 trials showed the vaccine to be safe and highly
immunogenic in children (Gambia and Mali) and young adults
(Mali, Senegal, Gambia).
•
•
•
Vaccine safe and immunogenic in infants (Ghana).
Vaccine licensed in India in 2009 and prequalified by WHO in 2010.
Mass campaigns commenced in Burkina Faso, Mali and Niger
in those aged 1 – 29 years at the end of 2010.
< 10 YEARS FROM VACCINE DEVELOPMENT TO DEPLOYMENT

13. VACCINE MANUFACTURE
Serum Institute, Pune, India
MenAfriVac

14. MENAFRIVAC IMMUNISATION IN CHAD
•
1.8 million 1-29 year olds immunised in a planned
vaccination campaign in 3 regions in and around N’Djamena
over 10 days in December 2011.
•
Reactive vaccination campaigns February - May 2012
- 9 districts exceeding the epidemic threshold
- 3 other adjacent districts.

15. VACCINATED DISTRICTS IN CHAD 2012
N’Djaména
Districts in epidemic/ alert in 2012
Districts vaccinated with
“MenAfriVac” in December 2011
Mandelia
Moissala

16. MENINGITIS SURVEILLANCE
•
Clinically diagnosed meningitis cases and deaths
reported to district medical officer  Ministry of
Health  WHO.
•
CSF samples  N’Djamena.
•
Enhanced surveillance in 2012 in 3 vaccinated regions
(MenAfriCar).
•
Surveillance also enhanced in Moissala district, where
reactive vaccination was undertaken in 2012 (MSF).

17. IMPACT OF MENAFRIVAC ON THE EPIDEMIc
94% difference in
vaccinated
compared to the
unvaccinated areas
[Adjusted incidence rate ratio =0.096 (95% CI 0.046, 0.198)]

18. REACTIVE VACCINATION IN MOISSALA DISTRICT
60
Nombre de cas
50
a
Vaccination
campagne de
campaign
vaccination
40
Confirmed cases
Cas confirmés
30
Cas probables
Probable cases
20
Cases of meningitis by
week of admission
Moissala district, Chad,
2012 (n = 334)
(a)all probable and
confirmed cases
10
0
50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
2011
(b)cases by serogroup
(N=78). *
2012
Semaine épidémiologique
15
Nombre de cas
b
Vaccination
campaign
Vaccination
campagne de
10
campaign
vaccination
No serogroup identified
W Non isolé
A
5
0
50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
2011
2012
Semaine epidémiologique
W135
A

19. CARRIAGE RESULTS (1)
Percentage
carriage
VACCINATION
All meningococci
Epidemic strain
Pre-vaccination
Post-vaccination
(Daugla et al. Lancet 2013; electronic publication)

20. CARRIAGE RESULTS (2)
•
32/4278 group A carriers* in 2011 pre-vaccine survey.
•
Only 1/5001 group A carrier post-vaccination.
•
98% difference in group A carriage prevalence.
•
Adjusted Odds Ratio 0.019, 95% CI 0.002, 0.14.
* serogroup A capsule region, rplF allele 1 (rplF-1), and a porA gene
encoding the subtype P1.20,9

21. CARRIAGE RESULTS (3)

22. CONCLUSIONS
•
MenAfriVac was highly effective at preventing serogroup A
invasive meningococcal disease and carriage in Chad
during an epidemic.
•
Together with previous studies from Burkina Faso, this
study provides strong evidence of vaccine impact.
•
Further work is required to evaluate the duration of
protection and the influence of vaccination on other
serogroups.

23. ACKNOWLEDGEMENTS
Centre de Support en Santé International (CSSI), N’Djamena, Chad: DM Daugla, JP Gami,
K Gamougam, N Naibei, L Mbainadji, M Narbé, J Toralta, B Kodbesse
Ministere de la Santé Publique, N’Djamena, Chad: C Ngadoua
Epicentre, Médecins sans Frontières, Paris, France: ME Coldiron, F Fermon U, A-L Page
WHO Intercountry Support Team, Ougadougou, Burkina Faso: MH Djingarey
Department of Pandemic and Epidemic Diseases, WHO, Geneva, Switzerland: S Hugonnet
Department of Zoology, University of Oxford, Oxford, UK: OB Harrison, LS Rebbetts, Y Tekletsion,
ER Watkins, D Hill, MCJ Maiden
Norwegian Institute for Public Health, Oslo, Norway: D Caugant
Department of Veterinary Medicine, University of Cambridge, Cambridge, UK: C Trotter
Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK:
D Chandramohan, M Hassan-King, O Manigart, M Nascimento, A Woukeu,
JM Stuart, BM Greenwood
MenAfriCar is funded by The Bill & Melinda Gates Foundation & The Wellcome
Trust