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A serogroup A meningococcal polysaccharide-tetanus toxoid conjugate vaccine PsA-TT MenAfriVac was licensed in India in 2009 and pre-qualified by WHO in 2010 on the basis of its safety and immunogenicity This vaccine is now being deployed across the African meningitis belt We studied the effect of PsA-TT on meningococcal meningitis and carriage in Chad during a serogroup A meningococcal meningitis epidemic We obtained data for the incidence of meningitis before and after vaccination from national records between January 2009 and June 2012 In 2012 surveillance was enhanced in regions where vaccination with PsA-TT had been undertaken in 2011 and in one district where a reactive vaccination campaign in response to an outbreak of meningitis was undertaken Meningococcal carriage was studied in an age-stratified sample of residents aged 1-29 years of a rural area roughly 13-15 and 2-4 months before and 4-6 months after vaccination Meningococci obtained from cerebrospinal fluid or oropharyngeal swabs were characterised by conventional microbiological and molecular methods Roughly 1 8 million individuals aged 1-29 years received one dose of PsA-TT during a vaccination campaign in three regions of Chad in and around the capital N Djamena during 10 days in December 2011 The incidence of meningitis during the 2012 meningitis season in these three regions was 2 48 per 100 000 57 cases in the 2 3 million population whereas in regions without mass vaccination incidence was 43 8 per 100 000 3809 cases per 8 7 million population a 94 difference in crude incidence p 0 0001 and an incidence rate ratio of 0 096 95 CI 0 046-0 198 Despite enhanced surveillance no case of serogroup A meningococcal meningitis was reported in the three vaccinated regions 32 serogroup A carriers were identified in 4278 age-stratified individuals 0 75 living in a rural area near the capital 2-4 months before vaccination whereas only one serogroup A meningococcus was isolated in 5001 people living in the same community 4-6 months after vaccination adjusted odds ratio 0 019 95 CI 0 002-0 138 p 0 0001 PSA-TT was highly effective at prevention of serogroup A invasive meningococcal disease and carriage in Chad How long this protection will persist needs to be established The Bill Melinda Gates Foundation the Wellcome Trust and M decins Sans Front res Copyright 2014 Daugla et al Open Access article distributed under the terms of CC BY Published by Elsevier Ltd All rights reserved

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Effect of a serogroup A meningococcal conjugate vaccine (PsA-TT) on serogroup A meningococcal meningitis and carriage in...