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

Methods

Kris;ansenPA,DiomandéF,WeiSC,etal.ClinVaccineImmunol2011;18:435-43.

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

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90

100

0 1 2 3 4 5 6 7 8 91011121314151617181920212223242526272829Men

AfriV

acvaccina

Uoncoverage(%

)

Age

Now,5yearsaLervaccina;on

•  Needtovaccinatetheyoungercohorts•  Catch-upcampaigns•  Includeinchildhoodimmuniza;onprogram