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The call is unpublished. The World Health Organization (WHO) and its partners launched, Tuesday, September 28, the very first global roadmap for “Conquer meningitis by 2030”. Characterized by inflammation of the meninges (the membranes that protect the brain and spinal cord), this disease most often of viral or bacterial origin is transmitted by droplets of respiratory or pharyngeal secretions of infected people. It kills nearly 250,000 people every year, especially in sub-Saharan Africa.
The latest outbreak in Tshopo province in the northeast of the Democratic Republic of the Congo has affected at least 261 people and caused 129 deaths, according to the WHO. “Confirmatory tests carried out by the Institut Pasteur in Paris detected Neisseria meningitidis (also known as meningococcus), one of the bacteria causing the most frequent meningitis and which has the potential to cause large epidemics ”, said the international agency in early September.
By relying on the deployment of effective vaccines already available or in development, the WHO aims to eliminate, by 2030, these epidemics of bacterial meningitis, to halve the number of cases and reduce deaths by 70%. Its strategy: to attack first of all acute bacterial meningitis – the most dangerous – which are caused by four bacteria: meningococcus, but also pneumococcus, Haemophilus influenzae type b (Hib) and group B streptococcus. in fact alone were responsible in 2019 for more than half of the meningitis deaths recorded worldwide.
The initiative echoes the call launched in 2017 by the twenty-six countries of the “African meningitis belt”, recalls Antoine Durupt, WHO project manager. The region, which goes from Senegal to Ethiopia, is in fact particularly affected by epidemics of meningococcal meningitis. Each year, from January to May, it undergoes a “Meningitis season” who can be ” very severe “, notes the expert, recalling the epidemic of 1996-1997 which caused 250,000 contaminations and 25,000 deaths.
Vaccination cannot solve everything
“People have become accustomed to living with this fear of meningitis. This is something that is very much in mind [et qui] can put health systems completely flat, it’s devastating ”, deplores Antoine Durupt, specifying that during the last decade, “More than 10 million cases” have been identified in the area.
With the large-scale deployment of multivalent conjugate vaccines targeting several meningococcal serogroups, as the WHO wishes in its roadmap, the expert foresees “The end of more than a century of epidemic” in this region. “Mass vaccination provides both direct and collective protection, by reducing the carriage and circulation of the bacteria”, he points out, drawing in particular on the lessons learned by the introduction in these countries, in 2010, of a conjugate vaccine against meningococcus A: “There have been no confirmed cases since 2017 in the entire meningitis belt, whereas previously 80 to 85% of cases were caused by serogroup A.”
WHO is therefore focusing on obtaining high vaccination coverage in all countries with the vaccines already available (which target meningococcus, pneumococcus and Haemophilus influenzae type b), on the development of new, more affordable vaccines that can be supported and deployed by the Gavi Vaccine Alliance, and on improving strategies to prevent and control disease outbreaks.
But vaccination cannot solve everything. The international agency stresses the need for strengthening rapid diagnosis and access to treatment for patients, better epidemiological surveillance to detect cases and guide prevention and control efforts, as well as better monitoring of patients and their sequelae, the disease leading in 20% of cases to long-term disability.
The fifth and last pillar of the strategy relates to raising public awareness, empowering actors in the implementation of national plans and affirming the right to prevention, care and follow-up services. According to Antoine Durupt, the WHO is planning an annual monitoring of the global implementation of this roadmap, which was adopted by all Member States at the World Health Assembly in November 2020.