What caused the meningitis C and measles outbreaks in Niger?

Niger faced multiple outbreaks of meningitis C and measles in recent years—both highly contagious and potentially fatal diseases. While vaccination programs should have prevented these crises, each outbreak presented unique challenges that complicated containment efforts.

Why does Niger struggle with meningitis C vaccine shortages?

Unlike measles, which has a widely available vaccine, meningitis C presents significant hurdles. No single affordable vaccine covers all serogroups of the disease. Global production shortages, driven by limited pharmaceutical interest in these markets, force health authorities to react only after outbreaks are declared. These delays hinder timely vaccination campaigns.

Meanwhile, the measles vaccine—part of routine immunization since 1974—faces coverage gaps. Despite its inclusion in national programs, insufficient vaccination rates fail to stop transmission, leaving communities vulnerable.

Has the meningitis C situation improved in the meningitis belt?

The meningitis belt in Africa saw fewer cases this year, but supply shortages persist. The International Coordinating Group (ICG) on Vaccine Provision maintains a minimum stock of five million meningitis C vaccines. However, production constraints made this target unattainable. As a result, vaccinations occur only after epidemic thresholds are crossed—not preemptively, as recommended when alert levels rise.

What’s causing the meningitis C vaccine shortage in Niger?

Meningitis comes in multiple serogroups—A, B, C, W135, and X—each requiring different vaccines. The most accessible option, the tetravalent conjugate vaccine, covers four common serogroups but remains costly. The Serum Institute of India is developing a pentavalent vaccine (A, C, Y, W-135, X) expected by 2020, though affordability and efficacy remain uncertain. Until then, pharmaceutical companies hesitate to invest in new vaccines due to uncertain demand.

How did Niger respond to the meningitis C outbreak?

In partnership with the Ministry of Health, MSF vaccinated over 30,000 people in the Tahoua region and provided medical care for patients. A concerning discovery was the high number of cases linked to serogroup X, for which no vaccine exists—posing a major risk for future outbreaks.

Can antibiotics help prevent meningitis C?

A 2017 pilot in Niger tested ciprofloxacin, an antibiotic administered to entire rural communities. Findings, published in PLOS Medicine (June 2018), showed a significant reduction in transmission. Further studies will assess its effectiveness in urban settings—potentially offering a supplementary tool for localized outbreaks.

Why does Niger’s routine measles vaccination fail to stop epidemics?

Niger’s national protocol mandates measles vaccination up to 23 months, but GAVI-supported vaccines only cover children under 12 months. The 15-month booster dose is excluded, leaving unvaccinated children over one year old. Additionally, nomadic populations and conflict zones face limited access to health centers. Achieving 95% coverage is a persistent challenge.

How can vaccination coverage be improved in Niger?

Expanding the vaccination schedule to age five and integrating catch-up campaigns during all health visits could boost coverage. Multi-antigen campaigns, like the one in Arlit (Agadez), combine measles shots with pentavalent and pneumococcal vaccines, maximizing protection.

MSF, in collaboration with Niger’s Ministry of Health, has vaccinated 179,460 people since 2018: 145,843 children (6 months–15 years) against measles in Tahoua and Agadez, and 33,620 people (2–29 years) against meningitis C in Tahoua. Current efforts in Arlit (Agadez) aim to immunize 50,000 children under five, including pentavalent and pneumococcal vaccines for those under one. Every health interaction must be leveraged to vaccinate against deadly diseases.

[1] Alert and epidemic thresholds are set at 5 and 15 cases per 100,000 inhabitants weekly in areas with over 30,000 people. Epidemic thresholds may drop to 10 cases/100,000/week in high-risk zones.

[2] Diphtheria, pertussis, tetanus, Haemophilus influenzae type B, and hepatitis B.