Meningococcal disease in the Middle East and Africa: Findings and updates from the Global Meningococcal Initiative

Preventing invasive meningococcal disease (MD) through education, research, and cooperation is the mission of the scientists, clinicians, and public health officials comprising the Global Meningococcal Initiative (GMI). The GMI roundtable meeting for the Middle East and Africa, held in Lisbon, Portugal, October 2016, produced two recommendations: vaccination of attendees should be considered for some types of mass-gathering events, as some countries mandate for the Hajj, and vaccination of people with human immunodeficiency virus, because of increased MD risk. Differences exist between Middle Eastern and African countries regarding case and syndrome definitions, surveillance, and epidemiologic data gaps. Sentinel surveillance provides an overview of trends and prevalence of different capsular groups supporting vaccine selection and planning, whereas cost-effectiveness decisions require comprehensive disease burden data, ideally counting every case. Surveillance data showed importance of serogroup B MD in North Africa and serogroup W expansion in Turkey and South Africa. Success of MenAfriVac® in the African “meningitis belt” was reviewed; the GMI believes similar benefits may follow development of a low-cost meningococcal pentavalent vaccine, currently in phase 1 clinical trial, by 2022. The importance of carriage and herd protection for controlling invasive MD and the importance of advocacy and awareness campaigns were also highlighted.