International Activity Report 2001
Meningitis: Deadly Annual Epidemic in Africa's "Meningitis Belt"

MSF Assists in Vaccination

MSF's four-person meningitis vaccination team makes its way by bicycle to a small village in Gounou-Gaya, Chad. Each team included one person to vaccinate, two to prepare the syringes, and another to record the number and ages of those vaccinated. (© Dieter Telemans/MSF)

Meningococcal disease is responsible for about 135,000 deaths globally each year, with over one million cases. Most frequently hit are 18 countries in sub-Saharan Africa's so-called "meningitis belt." This is an area where the disease is endemic: meningitis is "silently" present, and there are always a few cases. When the number of cases passes five per population of 100,000 in one week, teams are on alert. Epidemic levels are reached when there have been 100 cases per 100,000 population over several weeks. In 2001, MSF responded to epidemics of meningitis in Burkina Faso, Cameroon, Niger, Chad, and Ethiopia.

Meningitis is a disease of the meninges, a membrane that covers the brain and spinal cord like a sheath. It is caused by either a bacterial or viral germ; Neisseria meningitidis, commonly called meningococcus, is the only bacterium that causes epidemics. It invades the tissues of the nose and throat and eventually reaches the brain. The normally clear fluid that surrounds the brain quickly becomes cloudy and more viscous, increasing the pressure within the skull. The fatality rate of meningococcal meningitis is 50% when untreated.

MSF, working with local health authorities, responded to the epidemics of 2001 with mass vaccination campaigns—the only way to halt an epidemic. In the five countries, MSF assisted in the vaccination of over four and a half million people, and also provided treatment for infected patients.

Besides the unpredictability of these epidemics, response can be hindered by lack of available vaccine doses and their cost. During the epidemic season in spring 2001, unavailability of vaccines on the commercial markets led to requests for eight million vaccines from affected countries from the ICG emergency supplies. The ICG (the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control) had only 7.5 million vaccines in stock. The shortfall was made up through partial replenishment of stocks during the epidemic season. All justified requests were accepted and supplied, which would not have been possible if the epidemics had been of a larger scale. This demonstrated the essential role of the ICG contingency stock and the need to increase it to ten million doses.