Serogroup A meningococcal conjugate vaccines: building sustainable and equitable vaccine strategies.

Introduction : For well over 100 years, meningococcal disease due to serogroup A Neisseria meningitidis (MenA) has caused severe epidemics globally, especially in the meningitis belt of sub-Saharan Africa. Areas covered : The article reviews the background and identification of MenA, the current and past global and molecular epidemiology of MenA, and the outbreaks of MenA in the African meningitis belt. The implementation (2010) of an equitable MenA polysaccharide-protein conjugate vaccine (Ps A -TT, MenAfriVac) and the strategy to control MenA in sub-Saharan Africa is described. Further, the development of a new multi-serogroup meningococcal conjugate vaccine (NmCV-5) that includes serogroup A is highlighted. The PubMed database (1996-2019) was searched for studies relating to MenA outbreaks, vaccine, and immunization strategies; and the Neisseria PubMLST database of 1755 MenA isolates (1915-2019) was reviewed. Expert opinion : Using strategies from the successful MenAfriVac campaign, expanded collaborative partnerships have been built to develop and implement (anticipated 2023) a novel, low-cost multivalent component meningococcal vaccine that includes serogroup A. This vaccine promises greater sustainability and is directed toward global control of meningococcal disease in the African meningitidis belt and beyond. The new WHO global roadmap addresses the continuing problem of bacterial meningitis, including meningococcal vaccine prevention, and provides a framework for further reducing the devastation of MenA and other acute bacterial meningitis pathogens.