Costs of Neisseria meningitidis Group A Disease and Economic Impact of Vaccination in Burkina Faso

Burkina Faso is one of the few countries whose boundaries lie wholly within the African “meningitis belt,” and thus experiences a particularly high incidence of meningococcal meningitis, with epidemics occurring regularly [1, 2]. In 2010, Burkina Faso successfully implemented a nationwide preventive campaign with a new conjugate vaccine, known as MenAfriVac, against Neisseria meningitidis group A (MenA) [3, 4]. There have been no confirmed cases due to MenA in Burkina Faso since 2010 [2–5], and a substantial overall reduction in the meningitis burden [6], although group W remains a threat [7]. To sustain population-level protection against MenA following the 2010 introductory campaign, the country plans to incorporate MenAfriVac into the routine infant immunization schedule with 1 dose at the age of 9 months in late 2015 or early 2016 together with a single campaign among cohorts of children born since the campaign. This follows the recommendation made by the Strategic Advisory Group of Experts (SAGE) of the World Health Organization (WHO) in October 2014, which advised that meningitis belt countries should introduce MenAfriVac into the routine childhood immunization program within 5 years of campaign completion, together with a one-time catch-up campaign for young children born since the initial mass vaccination who would be outside the age window when the routine immunization program starts [8]. Prior to MenAfriVac introduction in 2010, the public health response to MenA relied on the detection of localized epidemics through surveillance and subsequent reactive immunization campaigns with polysaccharide vaccines [9] (as it still does for disease due to other meningococcal serogroups [10]). The effectiveness of this strategy is limited, largely because when vaccination campaigns are implemented, the epidemic may already be beyond its peak [11, 12]. Because this strategy does not prevent cases and epidemics from occurring, health systems can be severely disrupted and costs to the affected households can amount to one-third of the annual gross domestic product (GDP) per capita in Burkina Faso [13, 14]. This study aims to estimate the costs and savings of alternative preventive immunization strategies with MenAfriVac in Burkina Faso over a 26-year time period, compared with a reactive vaccination strategy.