Towards understanding the epidemiology of Neisseria meningitidis in the African meningitis belt: a multi-disciplinary overview

1. Introduction

1.1. Epidemiological context

Meningococcal meningitis is an acute bacterial disease characterized by the sudden onset of fever, intense headache, nausea, stiff neck, and photophobia.1 The meningococcus Neisseria meningitidis is found only in humans and is transmitted from person to person by airborne droplets of respiratory or throat secretions.2 Most infections with Nm result in a period of asymptomatic pharyngeal carriage and only occasionally lead to severe invasive disease.3 Meningococcal meningitis is a serious public health problem because of its high case fatality rate4 and, in some regions, its propensity for epidemics.

The African meningitis belt is a region stretching from Senegal to Ethiopia with an estimated population exceeding 400 million people. A high seasonal incidence of meningitis has been recorded in the area for decades,5, 6 with epidemic waves occurring periodically but irregularly every 5–12 years.7 Seasonal hyperendemicity is observed every dry season between January and May, when weekly incidence rates rise up to 10/100 000 population throughout the African meningitis belt and can locally exceed 100/100 000 population.8, 9 Even with swift and........