Needed: a meningitis vaccine. (In Burkina Faso).

A meningitis outbreak that began in January 2002 in the eastern district of Diapaga in Burkina Faso, believed to be linked to the return of pilgrims from the holy site of Mecca in Saudi Arabia two years ago, has as of 15 May claimed 1,447 lives out of the 12,587 cases reported in all the country's 53 districts, according to its Health Ministry. "People sleep in close quarters when they're travelling to Mecca, and the virus was circulated among them", says lain Simpson of the World Health Organization (WHO). What is unusual in Burkina Faso this year is the strain of the disease, not the deaths, which is caused by the W-135 bacteria and is usually found only in Saudi Arabia.

Very little vaccine had been made because it had never reached epidemic levels before. A single dose costs almost $55, making it prohibitively expensive for most African nations, says WHO. Because the vaccine for the W-135 strain was unavailable in Burkina Faso, health officials were vaccinating against the other two strains of the disease, which are more widespread in the country. However, the Ministry stopped this large-scale vaccination and concentrated on treating victims with chloramphenicol drugs, which can cure all three forms of meningitis with a single dose of the long-acting form. The International Committee of the Red Cross and Medecins Sans Frontieres set up cots in classrooms and under tarps, handing out medications.

In September, WHO convened in Burkina Faso a top priority meeting of experts from Africa and around the world to tackle the W-135 vaccine-resistant strain. They agreed that the most important tool required is a vaccine that can tackle all future outbreaks of meningitis in Africa and would have to cover the three different strains. It was concluded that a readily available supply of affordable vaccine is vital for the success of a new action plan to tackle the W-135 strain.

Negotiations are under way to bring down the price of the vaccine. Other measures to be taken in preparation for the next potential outbreak include improved disease surveillance, a better linked network of laboratories that would serve as an early warning system, urgent testing of new medicines, and an enhanced capacity to get the vaccines quickly to where they are needed. An additional requirement is the financial and political commitment of the affected countries and their neighbours, as well as the international donor community, to pool resources and work together.

In 1997, the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG) was established to regulate and coordinate the procurement of meningococcal vaccine, after large epidemics in sub-Saharan Africa in 1995/1996 largely exhausted global vaccine stocks. In order for ICG to function properly, timely information on meningococcal disease from each country is required, which has accelerated improvements in the surveillance system in African countries, which now have an increased incentive to report cases.

Meningitis is a contagious bacterial disease caused by the men ingococcus and has high-case fatality rates. Even when it is diagnosed early and adequate therapy put into effect, the fatality rate is between 5 and 10 percent, and may exceed 50 per cent in the absence of treatment. It can cause deafness, mental retardation, paralysis and loss of limbs. Transmission is by direct contact through respiratory droplets from the nose and throat of infected persons, and up to 10 per cent of the population may be asymptomatic carriers. Most infections are subclinical and many infected people become symptomless carriers, making it crucial to the spread of the disease, as most cases are acquired through exposure to them. A small minority who contract the disease will develop an acute inflammation of the membranes covering the brain and the spinal cord. While the highest disease rates are found in young children, during epidemics older children, teenagers and young adults are also affected.

Overcrowding and climatic conditions, such as the dry season or prolonged drought and dust storms, favour epidemics. The largest occurrences are in sub-Saharan Africa within an area that is referred to as the "meningitis belt", which extends from Ethiopia to Senegal, and usually strike in the early months of the dry season. According to Mr. Simpson, because it is cyclical, the cause for concern is for next year, and they are trying to work out how to, protect against the strain.

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