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1. Risk factors for acquisition of meningococcal carriage in the African meningitis belt

Author

Brian Greenwood, Caroline Trotter, Musa Hassan-King, Samba O. Sow, Abraham Hodgson, Arouna Woukeu, Abraham Aseffa, Laura V Cooper, Daniel Chandramohan, Doumagoum M. Daugla, Aldiouma Diallo, Jean-Marc Collard, Olivier Manigart, Babatunji A. Omotara, Maria Claudia Nascimento, James M. Stuart, Ray Borrow, Anna Robson, Jean-François Jusot, Martin C. J. Maiden, University of Cambridge [UK] (CAM), Armauer Hansen Research Institute (AHRI), Centre de Recherche Médicale et Sanitaire (Niamey, Niger) (CERMES), Réseau International des Instituts Pasteur (RIIP), Unité de Bactériologie Expérimentale [Antananarivo, Madagascar] (IPM), Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Centre de Support en Santé Internationale [N'Djamena, Tchad] (CSSI), Institut de recherche pour le développement [Dakar, Sénégal] (IRD Hann Maristes), Navrongo Health Research Centre [Navrongo, Ghana] (NHRC), University of Maiduguri, London School of Hygiene and Tropical Medicine (LSHTM), Vaccine Evaluation Unit [Manchester], Manchester Medical Microbiology Partnership [United Kingdom] (MMMP)-Public Health England [London], University of Oxford, The work of the MenAfriCar Consortium was supported by grants from the Bill & Melinda Gates Foundation and from the Wellcome Trust., Institutions and individual members of the MenAfriCar consortium who contributed to this study. Armauer Hansen Research Institute, Addis Ababa, Ethiopia: Oumer Ali, Abraham Aseffa (PI), Ahmed Bedru, Tsehaynesh Lema, Tesfaye Moti, Yenenesh Tekletsion, Alemayehu Worku, Haimanot Guebre Xabher (deceased), Lawrence Yamuah. Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger (Member of the International Network of Pasteur Institutes): Rahamatou Moustapha Boukary, Jean-Marc Collard (PI), Ibrahim Dan Dano, Ibrahim Habiboulaye, Bassira Issaka, Jean-François Jusot, Sani Ousmane, Issoufa Rabe. Centre de Support en Santé International (CSSI), N'Djamena, Chad: Doumagoum Moto Daugla (PI), Jean Pierre Gami, Kadidja Gamougam, Lodoum Mbainadji, Nathan Naibei, Maxime Narbé, Jacques Toralta. Centre pour les Vaccins en Développement, Bamako, Mali: Abdoulaye Berthe, Kanny Diallo, Mahamadou Keita, Uma Onwuchekwa, Samba O. Sow (PI), Boubou Tamboura, Awa Traore, Alou Toure. Centers for Disease Control, Atlanta, USA: Tom Clark, Leonard Mayer. Department of Community Medicine, University of Maiduguri, Maiduguri, Nigeria: Mary Amodu, Omeiza Beida, Galadima Gadzama, Babatunji Omotara (PI), Zailani Sambo, Shuaibu Yahya. Faculty of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK: Daniel Chandramohan, Brian M. Greenwood (PI), Musa Hassan-King, Olivier Manigart, Maria Nascimento, James M. Stuart, Arouna Woukeu. Princeton University, USA: Nicole E. Basta. Public Health England Vaccine Evaluation Unit, Manchester, UK: Xilian Bai, Ray Borrow, Helen Findlow. Institut de Recherche pour le Développement, Dakar, Senegal: Serge Alavo, Hubert Bassene, Aldiouma Diallo (PI), Marietou Dieng, Souleymane Doucouré, Jules François Gomis, Assane Ndiaye, Cheikh Sokhna, Jean François Trape. Navrongo Health Research Centre, Navrongo, Ghana: Bugri Akalifa (deceased), Abudulai Forgor (deceased), Abraham Hodgson (PI), Isaac Osei, Stephen L. Quaye, John Williams, Peter Wontuo. University of Bristol, UK: Thomas Irving. University of Cambridge, UK, Caroline L. Trotter. University of Oxford, UK: Julia Bennett, Dorothea Hill, Odile Harrison, Martin C.J. Maiden, Lisa Rebbetts, Eleanor Watkins., and University of Oxford [Oxford]

Subjects
Male, Neisseria meningitidis, Logistic regression, Afrique, 0302 clinical medicine, Neisseria meningitidis, Serogroup A, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Smoke, Dry season, Sore throat, Medicine, risk factors, Child, Respiratory Tract Infections, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Respiratory tract infections, Smoking, acquisition, Pharyngitis, Middle Aged, Anti-Bacterial Agents, Infectious Diseases, Child, Preschool, Carrier State, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Original Article, Female, Seasons, African meningitis belt, medicine.symptom, Meningitis, facteurs de risque, Adult, Wet season, Adolescent, 030231 tropical medicine, Meningitis, Meningococcal, Young Adult, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Humans, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Africa South of the Sahara, Aged, business.industry, Public Health, Environmental and Occupational Health, Infant, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Cross-Sectional Studies, Logistic Models, Meningococcal carriage, Africa, Parasitology, business, Original Research Papers, Demography
Abstract

To investigate potential risk factors for acquisition in seven countries of the meningitis belt.Households were followed up every 2 weeks for 2 months, then monthly for a further 4 months. Pharyngeal swabs were collected from all available household members at each visit and questionnaires completed. Risks of acquisition over the whole study period and for each visit were analysed by a series of logistic regressions.Over the course of the study, acquisition was higher in: (i) 5-to 14-year olds, as compared with those 30 years or older (OR 3.6, 95% CI 1.4-9.9); (ii) smokers (OR 3.6, 95% CI 0.98-13); and (iii) those exposed to wood smoke at home (OR 2.6 95% CI 1.3-5.6). The risk of acquisition from one visit to the next was higher in those reporting a sore throat during the dry season (OR 3.7, 95% CI 2.0-6.7) and lower in those reporting antibiotic use (OR 0.17, 95% CI 0.03-0.56).Acquisition of meningococcal carriage peaked in school age children. Recent symptoms of sore throat during the dry season, but not during the rainy season, were associated with a higher risk of acquisition. Upper respiratory tract infections may be an important driver of epidemics in the meningitis belt.Investiguer les facteurs de risque potentiels d'acquisition dans sept pays de la ceinture de la méningite. MÉTHODES: Des ménages ont été suivis toutes les deux semaines pendant deux mois, puis tous les mois pendant quatre mois. Des prélèvements pharyngés sur écouvillons ont été collectés auprès de tous les membres disponibles du ménage à chaque visite et des questionnaires ont été remplis. Les risques d'acquisition sur l'ensemble de la période d’étude et pour chaque visite ont été analysés par une série de régressions logistiques. RÉSULTATS: Au cours de l’étude, l'acquisition a été plus élevée chez: (i) les 5-14 ans, par rapport à ceux âgés de 30 ans ou plus (OR = 3,6; IC95%: 1,4-9,9); (ii) les fumeurs (OR = 3,6; IC95%: 0,98-13); et (iii) les personnes exposées à la fumée de bois à la maison (OR = 2,6; IC95%: 1,3-5,6). Le risque d'acquisition d'une visite à l'autre était plus élevé chez les personnes signalant un mal de gorge pendant la saison sèche (OR = 3,7; IC95%: 2,0-6,7) et plus faible chez celles signalant une utilisation d'antibiotique (OR = 0,17; IC95%: 0,03-0,56).L'acquisition du portage du méningocoque a culminé chez les enfants d’âge scolaire. Les symptômes récents de maux de gorge pendant la saison sèche, mais pas pendant la saison des pluies, étaient associés à un risque d'acquisition plus élevé. Les infections des voies respiratoires supérieures pourraient être un facteur important d’épidémies dans la ceinture de la méningite.

Published
2019
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2. The Diversity of Meningococcal Carriage Across the African Meningitis Belt and the Impact of Vaccination With a Group A Meningococcal Conjugate Vaccine

Author

Consortium, MenAfriCar, Collard, Jean-Marc, Centre de Recherche Médicale et Sanitaire (Niamey, Niger) (CERMES), Réseau International des Instituts Pasteur (RIIP), This work was supported by the Bill and Melinda Gates Foundation (to the MenAfriCar Consortium), the Wellcome Trust (to the MenAfriCar Consortium), and the National Institutes of Health (grant DP5OD009162 to N. B.)., Institutions and individual members of the MenAfriCar consortium who contributed to this study are as follows: Armauer Hansen Research Institute, Addis Ababa, Ethiopia: Oumer Ali, Abraham Aseffa (principal investigator [PI]), Ahmed Bedru, Tsehaynesh Lema, Tesfaye Moti, Yenenesh Tekletsion, Alemayehu Worku, Haimanot Guebre Xabher (deceased), and Lawrence Yamuah, Centre de Recherche Médicale et Sanitaire, Niamey, Niger (member of the International Network of Pasteur Institutes): Rahamatou Moustapha Boukary, Jean-Marc Collard (PI), Ibrahim Dan Dano, Ibrahim Habiboulaye, Bassira Issaka, Jean-François Jusot, Sani Ousmane, and Issoufa Rabe, Centre de Support en Santé International, N'Djamena, Chad: Doumagoum Moto Daugla (PI), Jean Pierre Gami, Kadidja Gamougam, Lodoum Mbainadji, Nathan Naibei, Maxime Narbé, and Jacques Toralta, Centre pour les Vaccins en Développement, Bamako, Mali: Abdoulaye Berthe, Kanny Diallo, Mahamadou Keita, Uma Onwuchekwa, Samba O. Sow (PI), Boubou Tamboura, Awa Traore, and Alou Toure, Centers for Disease Control and Prevention, Atlanta, Georgia: Tom Clark and Leonard Mayer, Department of Community Medicine, University of Maiduguri, Nigeria: Mary Amodu, Omeiza Beida, Galadima Gadzama, Babatunji Omotara (PI), Zailani Sambo, and Shuaibu Yahya, Faculty of Infectious Disease, London School of Hygiene and Tropical Medicine, United Kingdom: Daniel Chandramohan, Brian M. Greenwood (PI), Musa Hassan-King, Olivier Manigart, Maria Nascimento, James M. Stuart, and Arouna Woukeu, Princeton University, New Jersey: Nicole E. Basta, Public Health England Vaccine Evaluation Unit, Manchester, United Kingdom: Xilian Bai, Ray Borrow, and Helen Findlow, Institut de Recherche pour le Développement, Dakar, Senegal: Serge Alavo, Hubert Bassene, Aldiouma Diallo (PI), Marietou Dieng, Souleymane Doucouré, Jules François Gomis, Assane Ndiaye, Cheikh Sokhna, and Jean François Trape, Navrongo Health Research Centre, Ghana: Bugri Akalifa, Abudulai Forgor, Abraham Hodgson (PI), Isaac Osei, Stephen L Quaye, John Williams, and Peter Wontuo, University of Bristol, United Kingdom: Thomas Irving, University of Cambridge, United Kingdom: Caroline L. Trotter (formerly of the University of Bristol), and and University of Oxford, United Kingdom: Julia Bennett, Dorothea Hill, Odile Harrison, Martin C. Maiden, Lisa Rebbetts, and Eleanor Watkins.

Subjects
Adult, Male, Adolescent, Genotype, MESH: Geography, Meningococcal Vaccines, Meningitis, Meningococcal, Neisseria meningitidis, Mass Vaccination, MESH: Neisseria meningitidis, MESH: Meningococcal Vaccines, MESH: Genotype, Major Articles and Brief Reports, Young Adult, MESH: Cross-Sectional Studies, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, MESH: Child, Prevalence, Humans, MESH: Africa South of the Sahara, MESH: Genetic Variation, Child, Africa South of the Sahara, MESH: Prevalence, carriage, MESH: Adolescent, MESH: Humans, Bacteria, Geography, MESH: Child, Preschool, MESH: Meningitis, Meningococcal, Genetic Variation, Infant, meningitis, MESH: Adult, MESH: Infant, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, MESH: Male, Cross-Sectional Studies, MESH: Young Adult, Child, Preschool, meningococcus, Carrier State, Africa, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Mass Vaccination, MESH: Carrier State, MESH: Female
Abstract

International audience; Background. Study of meningococcal carriage is essential to understanding the epidemiology of Neisseria meningitidis infection.Methods. Twenty cross-sectional carriage surveys were conducted in 7 countries in the African meningitis belt; 5 surveys were conducted after introduction of a new serogroup A meningococcal conjugate vaccine (MenAfriVac). Pharyngeal swab specimens were collected, and Neisseria species were identified by microbiological and molecular techniques.Results. A total of 1687 of 48 490 participants (3.4%; 95% confidence interval [CI], 3.2%–3.6%) carried meningococci. Carriage was more frequent in individuals aged 5–14 years, relative to those aged 15–29 years (adjusted odds ratio [OR], 1.41; 95% CI, 1.25–1.60); in males, relative to females (adjusted OR, 1.17; 95% CI, 1.10–1.24); in individuals in rural areas, relative to those in urban areas (adjusted OR, 1.44; 95% CI, 1.28–1.63); and in the dry season, relative to the rainy season (adjusted OR, 1.54; 95% CI, 1.37–1.75). Forty-eight percent of isolates had genes encoding disease-associated polysaccharide capsules; genogroup W predominated, and genogroup A was rare. Strain diversity was lower in countries in the center of the meningitis belt than in Senegal or Ethiopia. The prevalence of genogroup A fell from 0.7% to 0.02% in Chad following mass vaccination with MenAfriVac.Conclusions. The prevalence of meningococcal carriage in the African meningitis belt is lower than in industrialized countries and is very diverse and dynamic, even in the absence of vaccination.

Published
2015
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3. Meningococcal carriage in the African meningitis belt

Author

Odile Harrison, Abraham Aseffa, Martin Maiden, Kanny Diallo, Caroline Trotter, Dan Dano Ibrahim, Centre de Recherche Médicale et Sanitaire (Niamey, Niger) (CERMES), Réseau International des Instituts Pasteur (RIIP), Bill & Melinda Gates Foundation and the Wellcome Trust, The MenAfriCar consortium : Armauer Hansen Research Institute, Addis Ababa, Ethiopia: Oumer Ali, Abraham Aseffa (PI), Ahmed Bedru, Tsehaynesh Lemma, Tesfaye Moti, Alemayehu Worku, Haimanot Guebre Xabher, Lawrence Yamuah. Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger (Member of the International Network of Pasteur Institutes): Rahamatou Moustapha Boukary, Jean-Marc Collard (PI), Ibrahim Dan Dano, Ibrahim Habiboulaye, Bassira Issaka, Jean-François Jusot, Sani Ousmane, Issoufa Rabe. Centers for Disease Control, Atlanta, USA: Tom Clark, Leonard Mayer. Centre de Support en Santé International (CSSI), N'Djamena, Chad: Jean Pierre Gami, Kadidja Gamougam, Boulotigam Kodbesse, Nathan Naibei, Cyriaque Ngadoua, Lodoum Mbainadji, Daugla Doumagoum Moto (PI), Maxime Narbé, Jacques Toralta. Centre pour les Vaccins en Développement, Bamako, Mali: Abdoulaye Berthe, Mahamadou Keita, Kanny Diallo, Uma Onwuchekwa, Samba O Sow (PI), Boubou Tamboura, Awa Traore, Alou Toure. Department of Community Medicine, University of Maiduguri, Maiduguri, Nigeria: Mary Amodu, Omeiza Beida, Galadima Gadzama, Babatunji Omotara (PI), Zailani Sambo, Shuaibu Yahya. Faculty of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK: Daniel Chandramohan, Brian Greenwood, Musa Hassan-King, Olivier Manigart, Maria Nascimento, James Stuart, Arouna Woukeu. Health Protection Agency Vaccine Evaluation Unit, Manchester, UK: Xilian Bai, Ray Borrow, Helen Findlow. Institut de Recherche pour le Développement, Dakar, Senegal: Serge Avalo, Hubert Bassene, Aldiouma Diallo (PI), Marietou Dieng, Souleymane Doucouré, Jules François Gomis, Assane Ndiaye, Cheikh Sokhna, Jean François Trape. Navrongo Health Research Centre, Navrongo, Ghana: Bugri Akalifa, Abudulai Forgor, Abrahan Hodgson (PI), Isaac Osei, Stephen Quaye, John Williams, Peter Wontuo. Princeton University USA: Nicole Basta (Formerly University of Washington)(supported by NIH grants 2R37A1032042 and R03A1092121). School of Social and Community Medicine, University of Bristol, Bristol, UK: Thomas Irving, and Caroline Trotter. University of Oxford, UK: Julia Bennett, Marietou Dieng, Dorothea Hill, Odile Harrison, Lisa Rebbetts, Martin Maiden, Yenenesh Tekletsion, Eleanor Watkins.

Subjects
MESH: Vaccines, Conjugate, International Cooperation, Pilot Projects, Meningococcal Disease, MESH: Pharynx, Neisseria meningitidis, MESH: Africa, MESH: Immunization Programs, Polymerase Chain Reaction, MESH: Meningococcal Vaccines, 0302 clinical medicine, Neisseria meningitidis, Serogroup A, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, MESH: Child, 030212 general & internal medicine, Child, 0303 health sciences, MESH: Program Evaluation, MESH: Meningitis, Meningococcal, MESH: Enzyme-Linked Immunosorbent Assay, MESH: Infant, 3. Good health, Infectious Diseases, MESH: Young Adult, Child, Preschool, meningococcus, Carrier State, MESH: Carrier State, Adult, Adolescent, MenAfriCar, Enzyme-Linked Immunosorbent Assay, Meningitis, Meningococcal, Specimen Handling, 03 medical and health sciences, Young Adult, MESH: Cross-Sectional Studies, meningococcal carriage, MESH: Neisseria meningitidis, Serogroup A, Humans, MESH: Specimen Handling, Epidemics, MESH: Epidemics, 030304 developmental biology, MESH: Adolescent, Vaccines, Conjugate, MESH: Humans, Immunization Programs, MESH: Child, Preschool, Public Health, Environmental and Occupational Health, Infant, MESH: Adult, MESH: Polymerase Chain Reaction, meningococcal vaccines, MESH: Pilot Projects, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, MESH: International Cooperation, Cross-Sectional Studies, Africa, Pharynx, Parasitology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Program Evaluation
Abstract

A meningococcal serogroup A polysaccharide/tetanus toxoid conjugate vaccine (PsA-TT) (MenAfriVac#x2122;) is being deployed in countries of the African meningitis belt. Experience with other polysaccharide/protein conjugate vaccines has shown that an important part of their success has been their ability to prevent the acquisition of pharyngeal carriage and hence to stop transmission and induce herd immunity. If PsA-TT is to achieve the goal of preventing epidemics, it must be able to prevent the acquisition of pharyngeal carriage as well as invasive meningococcal disease and whether PsA-TT can prevent pharyngeal carriage needs to be determined. To address this issue, a consortium (the African Meningococcal Carriage (MenAfriCar) consortium) was established in 2009 to investigate the pattern of meningococcal carriage in countries of the African meningitis belt prior to and after the introduction of PsA-TT. This article describes how the consortium was established, its objectives and the standardised field and laboratory methods that were used to achieve these objectives. The experience of the MenAfriCar consortium will help in planning future studies on the epidemiology of meningococcal carriage in countries of the African meningitis belt and elsewhere. Un vaccin conjugué contenant un polysaccharide du sérogroupe A méningococcique et une anatoxine du tétanos (PsA-TT) (MenAfriVac™) est en cours de déploiement dans les pays de la ceinture africaine de la méningite. L’ expérience avec d’ autres vaccins conjugués polysaccharide/protéine a montré qu’ une partie importante de leur succès a été leur capacité à empêcher l’ acquisition du portage pharyngé et donc à arrêter la transmission et à induire une immunité de group. Si PsA-TT doit d’ atteindre l’ objectif de prévenir les épidémies, il devrait être en mesure d’ empêcher l’ acquisition du portage pharyngé ainsi que la méningococcie invasive et le fait que PsA-TT puisse empêcher le portage pharyngé devrait être déterminé. Pour résoudre ce problème, le consortium MenAfriCar (Consortium Africain du Portage Méningococcique) a été établi en 2009 pour étudier le mode de portage du méningocoque dans les pays de la ceinture africaine de la méningite avant et après l’ introduction de PsA-TT. Cet article décrit comment le consortium a été établi, ses objectifs et les méthodes de laboratoire et de terrain standardisées qui ont été utilisées pour atteindre ces objectifs. L’ expérience du consortium MenAfriCar aidera à planifier les futures études sur l’ épidémiologie du portage du méningocoque dans les pays de la ceinture africaine de la méningite et d’ ailleurs. Se está utilizando una vacuna meningocócica conjugada (MenAfriVac™) de polisacárido del serogrupo A / tétano toxoide (PsA-TT) en países del cinturón Africano de meningitis. Las experiencias obtenidas con otras vacunas conjugadas polisacárido/proteína han demostrado que una parte importante de su éxito se debe a su habilidad para prevenir la colonización faríngea de los portadores, acabando por lo tanto con la transmisión, y a la de inducir la protección de rebaño. Si PsA-TT ha de cumplir el objetivo de prevenir epidemias, debe ser capaz de prevenir el estado de portador faríngeo, al igual que la enfermedad invasiva por meningococo, y para ello es necesario determinar si la PsA-TT puede prevenir la colonización faríngea. Con el fin de abordar esta cuestión se estableció un consorcio africano en el 2009 - el MenAfriCar (African Meningococcal Carriage Consortium) – para investigar los patrones del estado de portador de meningococo en países del cinturón Africano de la meningitis, antes y después de la introducción de PsA-TT. Este artículo describe como se estableció el consorcio, sus objetivos y los métodos estandarizados de campo y de laboratorio que se utilizaron para alcanzarlos. La experiencia del consorcio MenAfriCar ayudará en la planificación de estudios futuros sobre la epidemiología del estado de portador de meningococo, tanto en países del cinturón Africano de la meningitis como en otros lugares del mundo.

Published
2013
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