The UN World Health Organization’s meningitis vaccine stockpile programme has already tapped into its inventory, weeks before the worst of the deadly illness’s peak season.

“These requests [from governments for vaccines] typically come in at week 12 [end March],” said WHO’s Alejandro Costa with the Epidemic Readiness and Interventions team. “But this year we have already received four requests from Nigeria.”

The International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control was created following the 1995-96 meningitis outbreak in sub-Saharan African countries dubbed the “meningitis belt”- spanning from Senegal to Ethiopia - to ensure adequate stock of the vaccine.
Current vaccines, which unlike many other immunisations, are not administered routinely because they offer at most three years of protection.

WHO’s recommendation for outbreak control has therefore been to do mass vaccinations in every area in an epidemic phase (10 infections per 100,000 residents) and neighbouring districts that are in alert phase (five infections per 100,000 residents).

Managed by Médecins sans Frontières (MSF), International Federation of the Red Cross and Red Crescent Societies, UN Children’s Fund (UNICEF) and WHO, ICG has distributed almost 39 million meningitis vaccines in Africa since 1997.

Perpetual shortage

“There is always a shortage since there is no way of forecasting demand,” said WHO’s Costa. “Unlike other childhood immunisations, this one is administered only at the time of the outbreak. Vaccine manufacturers produce what they think might be enough, but we are never sure.”

Costa said epidemiologists have not been able to explain why outbreaks vary from one year to the next. “This makes it even harder [for governments] to keep stock on hand,” Costa told IRIN.

He said ICG gave out two million doses in 2008 to Burkina Faso, Central African Republic, Mali, Niger and Nigeria, compared to the seven million distributed in 2007 to Burkina Faso, Chad, Democratic Republic of Congo, Sudan, Togo, and Uganda.

Costa said countries must provide lab confirmation of an epidemic before receiving vaccines at no cost.

He said the stockpile has earmarked 12 million doses to distribute in 2009.

First request

Nigeria’s government had purchased 1.5 million meningitis vaccines but that was not enough, according to Muhammad Ali Pate, the executive director of Nigeria's National Primary Health Care Development Agency. “We need twice as much,” he told IRIN.

Since 1 January, Nigeria’s government has reported more than 5,200 people infected with meningitis, mostly in the north, and more than 320 deaths.

ICG and UNICEF are providing 1.7 million additional vaccines, with the final one million doses expected to arrive by 7 March, said Costa.

Niger

Five districts in neighbouring Niger have reached WHO’s epidemic threshold and eight others are on alert, according to WHO. The government reports 2,041 cases with 85 deaths since 1 January.

“This year, the intensity and number of cases are worse than last year,” said Stéphane Quinton, head of the European Commission’s Humanitarian Aid Department (ECHO) for West Africa. “If thousands are infected and we have an average of 10 percent mortality, the situation can become quite serious.”

Quinton told IRIN the US$2.5 million ECHO set aside to fight infectious diseases in West Africa in 2009 might not be enough. “We are meeting in Brussels today [5 March] to learn if we can raise emergency funds.”

He added that ECHO is supporting Médecins sans Frontières (MSF) France to help the Nigerian government control meningitis, and that additional MSF country sections may join an eventual cross-border vaccination campaign in Nigeria and Niger.

Health workers estimate some two million people may require vaccinations in the border region, but say this number may grow as it is still early in the season.

ECHO’s Quinton said MSF France is expected to donate medical kits to health facilities, help improve epidemiological surveillance and set up more than 40 mobile vaccination units in two heavily affected northern Nigerian states – Katsina and Jigawa.

Togo

In Togo, 74 meningitis cases and 11 deaths have been reported since the beginning of the year in the Haho district 100km northeast of the capital Lomé, according to WHO. The near 15-percent mortality rate in Togo falls under WHO’s 90-percent survival threshold for “successful treatment rates”.

Bacteria that cause meningitis attack the spinal cord or brain lining, potentially leading to paralysis, deafness, nervous disorders or death.

IRIN