Preventive immunisation could reduce the risk of meningococcal epidemics in the African meningitis belt

Control of meningitis epidemics is based on early case detection followed b y mass campaigns of immunisation. However, this strategy showed severe inad equacies during recent outbreaks in Africa. In Niamey, Niger, meningococcal vaccinations began in 1978 and detailed bac teriological and epidemiological surveillance of meningitis started in 1981 . When vaccine coverage rates were higher than 50%, the prevalences of Neis seria meningitidis A meningitis were low in Niamey, although there was a co ncurrent epidemic in rural Niger. A massive outbreak of meningitis in Niame y in 1994-1995 followed a 6-year period during which the mean rate of vacci ne coverage remained < 25%. The data indicate that, in the meningitis belt, preventive immunisation should avoid a great number of deaths and be less expensive than mass immunisation campaigns performed after epidemics have b egun.