Whole-Genome Characterization of Epidemic Neisseria meningitidis Serogroup C and Resurgence of Serogroup W, Niger, 2015.

In 2015, Niger reported the largest epidemic of Neisseria meningitidis serogroup C (NmC) meningitis in sub-Saharan Africa. The NmC epidemic coincided with serogroup W (NmW) cases during the epidemic season, resulting in a total of 9,367 meningococcal cases through June 2015. To clarify the phylogenetic association, genetic evolution, and antibiotic determinants of the meningococcal strains in Niger, we sequenced the genomes of 102 isolates from this epidemic, comprising 81 NmC and 21 NmW isolates. The genomes of 82 isolates were completed, and all 102 were included in the analysis. All NmC isolates had sequence type 10217, which caused the outbreaks in Nigeria during 2013-2014 and for which a clonal complex has not yet been defined. The NmC isolates from Niger were substantially different from other NmC isolates collected globally. All NmW isolates belonged to clonal complex 11 and were closely related to the isolates causing recent outbreaks in Africa.

Emergence of epidemic Neisseria meningitidis serogroup C in Niger, 2015: an analysis of national surveillance data.

BACKGROUND: To combat Neisseria meningitidis serogroup A epidemics in the meningitis belt of sub-Saharan Africa, a meningococcal serogroup A conjugate vaccine (MACV) has been progressively rolled out since 2010. We report the first meningitis epidemic in Niger since the nationwide introduction of MACV. METHODS: We compiled and analysed nationwide case-based meningitis surveillance data in Niger. Cases were confirmed by culture or direct real-time PCR, or both, of cerebrospinal fluid specimens, and whole-genome sequencing was used to characterise isolates. Information on vaccination campaigns was collected by the Niger Ministry of Health and WHO. FINDINGS: From Jan 1 to June 30, 2015, 9367 suspected meningitis cases and 549 deaths were reported in Niger. Among 4301 cerebrospinal fluid specimens tested, 1603 (37·3%) were positive for a bacterial pathogen, including 1147 (71·5%) that were positive for N meningitidis serogroup C (NmC). Whole-genome sequencing of 77 NmC isolates revealed the strain to be ST-10217. Although vaccination campaigns were limited in scope because of a global vaccine shortage, 1·4 million people were vaccinated from March to June, 2015. INTERPRETATION: This epidemic represents the largest global NmC outbreak so far and shows the continued threat of N meningitidis in sub-Saharan Africa. The risk of further regional expansion of this novel clone highlights the need for continued strengthening of case-based surveillance. The availability of an affordable, multivalent conjugate vaccine may be important in future epidemic response. FUNDING: MenAfriNet consortium, a partnership between the US Centers for Disease Control and Prevention, WHO, and Agence de Médecine Preventive, through a grant from the Bill & Melinda Gates Foundation.

Progress on the Acceleration of Health Sector HIV Prevention in the WHO African Region

In 2005; the WHO Regional Committee for Africa called upon countries to accelerate HIV prevention and to declare 2006 as the Year of Acceleration of HIV Prevention in the African Region. The strategy document that was developed by WHO Regional Office was adopted by the Region's ministers of health in August 2006. The strategy proposed targets to be met by 2010; in line with universal access targets; in areas of HIV testing and counselling; prevention of mother-to-child transmission of HIV; prevention and control of sexually-transmitted infections; blood safety; and access to comprehensive prevention; treatment and care. Specifically; it was envisaged that; by 2010; all districts will provide HIV testing and counselling services; 100100 safe blood and blood products will be ensured; at least 80of pregnant women attending antenatal care will access prevention of mother-to-child transmission of HIV services; at least 80of patients with sexually-transmitted infections will access comprehensive STI management; at least 80of people living with HIV/AIDS will have access to comprehensive prevention; treatment and care services; and condom use in high-risk sexual encounters will reach at least 60. This paper describes the progress made in accelerating key health sector HIV prevention interventions in the Region toward these targets and issues that should be taken into consideration for moving forward the HIV prevention agenda in the health sector

HIV/AIDS: Strategy for the African Region

More than 30 years into the pandemic; HIV/AIDS remains a long-term development challenge in the WHO African Region which bears 69 of the global burden and has accounted for more than 70 of the world's AIDS-related deaths. While there has been a decline in the number of new HIV infections; prevalence in the Region remains unacceptably high; estimated at 4.8 in 2011 but much higher in southern Africa. There has been unprecedented political and financial commitment globally and in the Region towards the HIV response. This has led to scaling up of HIV/ AIDS prevention; treatment and care interventions in all countries. The results are encouraging as the number of new infections is decreasing in some countries and there is a reduction in HIV-related mortality as reported in 2010. To consolidate these gains; the Region will need to intensify efforts in HIV response by mobilizing domestic resources; optimizing the synergies between HIV and other health programmes and contributing to health system strengthening. A new WHO Global Health Sector Strategy (GHSS) on HIV/AIDS was adopted by the World Health Assembly in May 2011. The regional HIV/AIDS strategy provides directions for implementing the GHSS in the WHO African Region; taking into account the key regional specificities. The interventions proposed include scaling up prevention; eliminating new HIV infections in children; and expanding access to HIV testing and treatment. It is expected that this strategy will contribute to eliminating new infections among children; reducing new infections among young people and reducing HIV-related deaths. Strengthening health systems and reducing co-morbidities such as TB/HIV will be crucial to achieving the targets set in the regional strategy