Analysis of a meningococcal meningitis outbreak in Niger - potential effectiveness of reactive prophylaxis.
Adolescent
Adult
Anti-Bacterial Agents
/ administration & dosage
Chemoprevention
/ methods
Child
Child, Preschool
Computer Simulation
Disease Outbreaks
Disease Transmission, Infectious
/ prevention & control
Female
Health Services Administration
Humans
Male
Mass Drug Administration
/ methods
Mass Vaccination
/ methods
Meningitis, Meningococcal
/ epidemiology
Meningococcal Vaccines
/ administration & dosage
Neisseria meningitidis, Serogroup C
/ isolation & purification
Niger
/ epidemiology
Rural Population
Young Adult
Journal
PLoS neglected tropical diseases
ISSN: 1935-2735
Titre abrégé: PLoS Negl Trop Dis
Pays: United States
ID NLM: 101291488
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
06
12
2018
accepted:
21
02
2019
revised:
21
03
2019
pubmed:
12
3
2019
medline:
23
4
2019
entrez:
12
3
2019
Statut:
epublish
Résumé
Seasonal epidemics of bacterial meningitis in the African Meningitis Belt carry a high burden of disease and mortality. Reactive mass vaccination is used as a control measure during epidemics, but the time taken to gain immunity from the vaccine reduces the flexibility and effectiveness of these campaigns. Targeted reactive antibiotic prophylaxis could be used to supplement reactive mass vaccination and further reduce the incidence of meningitis, and the potential effectiveness and efficiency of these strategies should be explored. Data from an outbreak of meningococcal meningitis in Niger, caused primarily by Neisseria meningitidis serogroup C, is used to estimate clustering of meningitis cases at the household and village level. In addition, reactive antibiotic prophylaxis and reactive vaccination strategies are simulated to estimate their potential effectiveness and efficiency, with a focus on the threshold and spatial unit used to declare an epidemic and initiate the intervention. There is village-level clustering of suspected meningitis cases after an epidemic has been declared in a health area. Risk of suspected meningitis among household contacts of a suspected meningitis case is no higher than among members of the same village. Village-wide antibiotic prophylaxis can target subsequent cases in villages: across of range of parameters pertaining to how the intervention is performed, up to 220/672 suspected cases during the season are potentially preventable. On the other hand, household prophylaxis targets very few cases. In general, the village-wide strategy is not very sensitive to the method used to declare an epidemic. Finally, village-wide antibiotic prophylaxis is potentially more efficient than mass vaccination of all individuals at the beginning of the season, and than the equivalent reactive vaccination strategy. Village-wide antibiotic prophylaxis should be considered and tested further as a response against outbreaks of meningococcal meningitis in the Meningitis Belt, as a supplement to reactive mass vaccination.
Sections du résumé
BACKGROUND
Seasonal epidemics of bacterial meningitis in the African Meningitis Belt carry a high burden of disease and mortality. Reactive mass vaccination is used as a control measure during epidemics, but the time taken to gain immunity from the vaccine reduces the flexibility and effectiveness of these campaigns. Targeted reactive antibiotic prophylaxis could be used to supplement reactive mass vaccination and further reduce the incidence of meningitis, and the potential effectiveness and efficiency of these strategies should be explored.
METHODS AND FINDINGS
Data from an outbreak of meningococcal meningitis in Niger, caused primarily by Neisseria meningitidis serogroup C, is used to estimate clustering of meningitis cases at the household and village level. In addition, reactive antibiotic prophylaxis and reactive vaccination strategies are simulated to estimate their potential effectiveness and efficiency, with a focus on the threshold and spatial unit used to declare an epidemic and initiate the intervention. There is village-level clustering of suspected meningitis cases after an epidemic has been declared in a health area. Risk of suspected meningitis among household contacts of a suspected meningitis case is no higher than among members of the same village. Village-wide antibiotic prophylaxis can target subsequent cases in villages: across of range of parameters pertaining to how the intervention is performed, up to 220/672 suspected cases during the season are potentially preventable. On the other hand, household prophylaxis targets very few cases. In general, the village-wide strategy is not very sensitive to the method used to declare an epidemic. Finally, village-wide antibiotic prophylaxis is potentially more efficient than mass vaccination of all individuals at the beginning of the season, and than the equivalent reactive vaccination strategy.
CONCLUSIONS
Village-wide antibiotic prophylaxis should be considered and tested further as a response against outbreaks of meningococcal meningitis in the Meningitis Belt, as a supplement to reactive mass vaccination.
Identifiants
pubmed: 30856166
doi: 10.1371/journal.pntd.0007077
pii: PNTD-D-18-01915
pmc: PMC6428357
doi:
Substances chimiques
Anti-Bacterial Agents
0
Meningococcal Vaccines
0
Banques de données
Dryad
['10.5061/dryad.67st708']
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0007077Subventions
Organisme : NIGMS NIH HHS
ID : U54 GM088558
Pays : United States
Déclaration de conflit d'intérêts
ML has received consulting/honoraria from Pfizer, Merck, Antigen Discovery, and Affinivax, and research support through his institution from Pfizer.
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