Introduction of the meningococcal A conjugate vaccine 10 short years after development is a public health success story and is already showing promise of significant impact. With the Meningitis Vaccine Project coming to a close in December 2014, we celebrate MRC Unit The Gambia’s role in the project, working in partnership with the Gambian Government and the people of The Gambia.
Studies performed at MRC Unit The Gambia, and other African sites, including CVD-Mali, Navrongo Health Research Center in Ghana and Institut de Recherche pour le Développement in Senegal, have resulted in the successful development of a vaccine to the highest scientific, professional, and ethical standards for the public health of people across Africa. “This affordable vaccine has been developed and tested in record time to combat meningitis A, one of the most threatening infectious diseases, which periodically affects people living within the 'meningitis belt'," said Professor Beate Kampman, Principal Investigator of the trial at MRC Unit The Gambia.

“When meningitis A comes along, it has a devastating impact on people of all ages and causes death and disability. It shows that big goals can be achieved when funders, developers and sites pull together.

“We are proud to have played an important role in the study. We are also delighted that this vaccine now protects people in The Gambia, as it was introduced here swiftly by the Government of The Gambia into its vaccination program.”

Introduction of the vaccine

Thanks to the Meningitis Vaccine Project, more than 200 million people have now been vaccinated with the meningococcal A conjugate vaccine, MenAfriVac, and are protected against meningitis A. The mass vaccination campaign was launched first in Burkina, and soon after in Mali and Niger, in 2010. The vaccine was introduced in The Gambia a year ago resulting in almost complete national coverage in a mass vaccination campaign.

Some initial trials for the vaccine and an antibody persistence trial were held at MRC Unit The Gambia’s Basse Field Station. This included two safety and immunogenicity trials in one to 29 year old Gambians and later a study which investigated antibody persistence up to five years after initial vaccination with MenAfriVac; this is important in order to know how often the vaccine has to be given.

About the Meningitis Vaccine Project

The Meningitis Vaccine Project was born from a partnership between WHO and Program for Appropriate Technology in Health (PATH) with funding from the Bill and Melinda Gates Foundation in 2001. The goal of the project was the elimination of epidemic meningitis in sub-Saharan Africa where it was posing a great public health crisis. This was to be done through development, testing and licensure of a conjugate meningococcal vaccine.

Effective and affordable

This vaccine has proven to be both effective and affordable and has the added advantage of being able to travel outside the cold chain. MenAfriVac induces better immune responses than the previously available vaccines and achieves antibody persistence at five years post-vaccination. The vaccine offers herd protection and, although still in the early days, the impact of vaccination has already been observed within the African meningitis belt.

Dr Olubukola Idoko, Study Clinician on the initial trials and Trial Coordinator/Local PI for the persistence project at MRC Unit The Gambia, said: “It was a real joy to be able to see the vaccine introduced into the region and here in The Gambia in particular. The introduction in The Gambia was accelerated by the fact that the country participated in the original trials. This is further testimony to the unique role of The Unit.

“The region has suffered these devastating epidemics of meningitis periodically and in the short time that the vaccine has been introduced there's already significant impact. Another notable highlight for me was seeing the significant indirect impact our studies can have. Entire communities were educated on the use of locally available items to prepare healthy weaning meals, in response to a clustering of malnutrition among study participants. Following this, malnutrition rates in our study population dropped significantly.”

Next steps

The definition of success for the Meningitis Vaccine Project is the elimination of epidemic meningitis in sub-Saharan countries that introduce the meningococcal A conjugate vaccine. MRC Unit The Gambia is supporting the evaluation plan by assessing the impact of the introduction of MenAfriVac in The Gambia.

Monitoring is being carried out, in collaboration with the London School of Hygiene and Tropical Medicine, through a series of carriage studies to evaluate the impact of the vaccine on the transmission of meningococcal infection. MenAfriCar (the African Meningococcal Carriage Consortium) is a global research effort to study how meningococcal meningitis is spread in Africa, and to document the impact of a new meningitis vaccine on meningococcal carriage and meningitis.

Find out more at http://www.meningvax.org/