A review of the epidemiology of invasive meningococcal disease and vaccination strategies in North Africa

Objective: This narrative review considered the epidemiology of invasive meningococcal disease (IMD) in North Africa and the adequacy of current preventive measures to provide guidance for future vaccination strategies. Methods: Literature searches were conducted using PubMed for articles published from 1998 onwards to identify publications on IMD in North Africa. Additional relevant articles not included within the search results and data sources were identified from the reference lists of identified publications, authors? personal files and publicly available government or regional surveillance data. Results: Although IMD is an endemic and notifiable disease in several North African countries, inadequacies exist regarding each country?s surveillance, vaccination strategies and disease understanding. Studies showed that bacterial meningitis in North Africa caused by Neisseria meningitidis mostly affected young children (aged <5 years), with meningococcal serogroup B (MenB) being the most frequently identified serotype. Importantly, MenB isolates were genetically heterogeneous. Serogroup A incidence and meningococcal outbreaks decreased over time in Morocco and Egypt, possibly because of their nationwide or school-based vaccination programs. Within the region, meningococcal vaccines were only included in the national immunization program of Egypt. Conclusions: Improving IMD diagnosis and surveillance would provide a reliable estimate of IMD burden, leading to better vaccination strategies.

Automated summary

The epidemiology of invasive meningococcal disease (IMD) in North Africa and the adequacy of preventive measures vary across countries in the region. The most frequently identified serotype in young children under 5 years was meningococcal serogroup B (MenB), which showed genetic heterogeneity. National vaccination programs in Morocco and Egypt contributed to a decrease in serogroup A incidence and meningococcal outbreaks.