MenAfriVac

MenAfriVac is a vaccine developed for use in sub-Saharan Africa that protects people 1 to 29 years of age against meningococcal bacterium Neisseria meningitidis group A. MenAfriVac costs under US$0.50 per dose and reduces carriage of the bacteria from one person to another. The Meningitis Vaccine Project, a partnership between the Program for Appropriate Technology in Health (PATH) and the World Health Organization, worked with a consortium of international partners to develop the vaccine.

History
The largest meningitis epidemic in African history swept across sub-Saharan Africa from 1996 to 1997, numbering 250,000 new cases of the disease and taking 25,000 lives. Three years later, the World Health Organization held a technical consultation in Cairo, Egypt with African ministers of health and global health leaders to discuss meningitis and the development of a new vaccine. At that meeting, representatives from eight African countries issued a statement saying that the development of a meningococcal vaccine to prevent epidemics was a high priority for them, and concluded that a conjugate meningococcal vaccine would have the potential to prevent future epidemics. They estimated that the new vaccine could become available in three to seven years for US$ 0.40 to $ 1 a dose, providing protection for at least ten years.

A year later, in 2001, the Bill & Melinda Gates Foundation provided a ten-year, $70 million grant to establish the Meningitis Vaccine Project, a partnership between PATH and the World Health Organization. The foundation charged the new project with development, testing, licensure, and mass introduction of a meningococcal conjugate vaccine. In 2002, the newly funded collaboration supported reinforced meningitis surveillance activities in 12 countries in Africa: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Ethiopia, Ghana, Mali, Niger, Nigeria, and Togo. Data from the surveillance indicated an increased risk of outbreaks in the future and the continued need for a conjugate A meningitis vaccine. MenAfriVac is available for widespread use in African meningitis belt countries in 2010.

Manufacture
The Meningitis Vaccine Project partnered with SynCo Bio Partners, a Dutch biotech company, and the US government’s Center for Biologics Evaluation and Research to develop MenAfriVac, and the Serum Institute of India to manufacture it.

MenAfriVac is a freeze-dried vaccine of a polysaccharide from a type of Neisseria meningitidis called group A. The polysaccharide has been purified by affinity chromatography and bound to a carrier protein called tetanus toxoid. The TT is prepared by extraction by ammonium sulfate precipitation and the toxin is inactivated with formalin the toxin from cultures of Clostridium tetani grown in a modified Mueller-Hinton agar.

Post launch effectiveness evaluation
In a 2013 article published in The Lancet, the MenAfriVac vaccination campaign in Chad is reported to reduce the meningitis incidence by 94%. Three regions of Chad, approximately 1.8 million people from one to 29 years old received a single dose of the vaccine in December 2011. Monitoring the meningitis incidence in Chad during the 2012 meningitis season finds no cases of the meningococcus sub-type serogroup A caused disease in places where mass vaccination took place. Carriers of serogroup A are also found to reduce by more than 97% post vaccination. The plan is to roll out the vaccination campaign across the meningitis belt of Africa. Surveillance is needed to continue for several more years to establish the length of effective period of the vaccine and whether other meningococci serogroups may surge to replace the eradicated serogroup A.