ImpactofMenAfriVaconmeningococcalcarriageinBurkinaFaso
PaulA.Kris;ansenDominiqueA.CaugantWHOCollabora+ngCentreforReferenceandResearchonMeningococciNorwegianIns+tuteofPublicHealth,Oslo,Norway
Primaryobjec;ve
Toexplorewhethermassvaccina;onwithMenAfriVaccouldimpactthecarriageprevalenceofgroupAmeningococci,asareflec;onofherdimmunity
Samplingframe• OropharyngealsamplesbeforeandaLervaccina;on(2009-2012):10campaigns
• Eachcampaign:5000samples-4weeks-3districts
2009 2010 2011 2012
Dandé: CHU Souro Sanou
Bogodogo: CHUP Charles de Gaulle
Kaya: CHR Kaya /CHU Yalgado
Overallcarriageprevalence
18.23 20.05
17.9 18.93
17.12 18.19
17.35 17.53 18.21 18.76
4.10 5.27
3.37 3.17
10.31
7.76 6.24
4.70 3.29
7.87
0
5
10
15
20
25
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10
Car
riage
pre
vale
nce
(%)
Sampling campaign
N lactamica
N meningitidis
2009 20112010 2012
Kris;ansenPA,DiomandéF,OuédraogoR,etal.JClinMicobiol2012;50:4020-27
Laboratoryqualitycontrol
0 10 20 30 40 50 60 70 80 90
100
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10
%
Sampling campaign
Sensitivity
Specificity
Kris;ansenPA,OuédraogoAS,SanouI,etal.TransRSocTropMedHyg2012;106:289-297
• Significantreduc;onofserogroupAcarriage• bothamongvaccinatedandunvaccinated• immediatelyandupto2yearsaLervaccina;on
0,00%
0,39%
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
pre-5 pre-4 pre-3 pre-2 pre-1 post1 post2 post3 post4 post5
Car
riage
pre
vale
nce
(%)
Bogodogo district Dandé district Kaya district Overall Prevalence
Vaccination
Pre-vaccination (N=20 325)
Post-vaccination (N=27 062)
0,02%
post6
ImpactofMenAfriVaconserogroupAcarriageprevalence
Kris;ansenPA,DiomandéF,BaKiA,etal.ClinInfectDis2013;56:354-63Kris;ansenPA,DiomandéF,OuédraogoR,etal.BMCInfectDis.2013;13:363
Carriageprevalencebyserogroup
0
1
2
3
4
5
6
7
8
9
Jan/
yy
Apr
/yy
Jul/y
y
Oct
/yy
Jan/
yy
Apr
/yy
Jul/y
y
Oct
/yy
Jan/
yy
Apr
/yy
Jul/y
y
Oct
/yy
Jan/
yy
Apr
/yy
Jul/y
y
Oct
/yy
Car
riage
pre
vale
nce
(%) Nm Y (%)
Nm X (%)
Nm A (%)
Nm W (%)
Vaccination
Bogodogo Dandé
Kaya
ST-11ST-181
S4 2009 2010
Kris;ansenPA,DiomandéF,BaKiA,etal.ClinInfectDis2013;56:354-63Kris;ansenPA,DiomandéF,OuédraogoR,etal.BMCInfectDis.2013;13:363
2011 2012
ST-7
ST-2859
CarriageprevalenceofmajorSTcomplexes
Dandé Bogodogo
Kaya
Fig. 2
0,0
0,1
1,0
10,0
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10
ST-23complex
DandéBogodogoKaya
2009 2010 2011 2012
0,1
1,0
10,0
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10
ST-181complex
DandéBogodogoKaya
2009 2010 2011 2012
0,0
0,1
1,0
10,0
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10
ST-11complex
DandéBogodogoKaya
2009 2010 2011 2012
Kris;ansenPA,DiomandéF,OuédraogoR,etal.BMCInfectDis.2013;13:363
TheserogroupXST-181clone
P1.5-1,10-1;F1-31P1.5-1,10-1;F5-69
Bogodogo
Mastenga Tamdogo
Koledougou
WGSof95invasiveandcarriageisolates,allNmX,ST-181(2009-2012)
Otherresults
Fig. 3
0
5
10
15
20
25
30
1-4 5-9 10-14 15-19 20-24 25-29Prop
ortio
nofcarrie
rs(%
)
Agegroup(years)
NmA(n=85)
NmX(n=1,354)
NmW(n=512)
NmY(n=686)
NmNG(n=195)
Agedistribu;on
Riskfactorsforcarriage NoCarriage
(n=43,370) Carriage(n=2456)
aOR 95%CI
District
Bogodogo 15123 284 Ref -- Dandé 14847 562 2.64 1.46-3.52 Kaya 13400 1610 6.16 3.89-9.74 Season Rainy 24159 1261 Ref -- Dry 19211 1195 1.24 1.13-1.35
Sex
Female 24679 1198 Ref -- Male 18691 1258 1.39 1.28-1.51
Age
1-4 10457 385 Ref -- 5-9 11637 841 1.82 1.60-2.07 10-14 7984 628 2.00 1.74-2.30 15-19 5629 335 2.00 1.70-2.34 20-24 4285 162 1.60 1.32-1.95 25-29 3378 105 1.30 1.03-1.63 Householdsize 1-6 8059 244 Ref -- 7-10 12201 526 1.16 0.99-1.36 11-15 10149 604 1.30 1.11-1.52 16+ 12961 1082 1.41 1.21-1.64
ImpactofMenAfriVac
• Directeffectonburdenofdisease
• Impactoncarriage:ü Transmissionofthepathogenisstoppedü Thewholepopula;onisprotected,alsothenon-vaccinated–herd
protec;on
ü Nocapsuleswitch
ü IncreaseofserogroupXcarriageanddiseasestartedbeforeMenAfriVac
ü IncreaseofserogroupWcarriageanddiseaseaLerMenAfriVacwascausedbyaclonenotfoundin2009-2010
ü BecauseoflowgroupAcarriage(0.4%),serogroupreplacementcannotbeaconsequenceofMenAfriVacvaccina;on
Studyteam Burkina Faso (50 persons) Rasmata Ouédraogo Lassana Sangaré Idrissa Sanou Ky Ba Absatou Abdoul-Salam Ouédraogo Didier C. Ouédraogo Sylvestre Tiendrebeogo Pascal Kaboré Manoudou Tamboura Maxime Kienou Siakka Traoré
WHO Marie-Pierre Préziosi Mamoudou Djingarey Fabien Diomandé Denis Kandolo Flavien Aké Eric Sankara Idrissa Kamaté Ali Robert Traoré MVP Marc LaForce Musa Hassan-King
NIPH Dominique A. Caugant Paul A. Kristiansen Inger Marie Saga Ida Andreasson Martha Bjørnstad Lisa Nome Lisbeth Næss Berit Nyland Elisabeth Fritzsønn Torill Alvestad Anne-Marie Klem Jan Oksnes CDC Thomas A. Clark Lara Misegades Jennifer Dolan Thomas Cynthia P. Hatcher Stacey Martin Stanley Wei Leonard Mayer Nancy Messonnier
Newunvaccinatedbirthcohorts
• Surveyconductedin2012inBurkinaFaso,2yearsaLermass-vaccina;on.• 1-29years:78.8%vaccineuptake
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 91011121314151617181920212223242526272829Men
AfriV
acvaccina
Uoncoverage(%
)
Age
Now,5yearsaLervaccina;on
• Needtovaccinatetheyoungercohorts• Catch-upcampaigns• Includeinchildhoodimmuniza;onprogram