How can increased meningococcal vaccination protect South Africa’s university students from this disease?
Meningococcal disease is a devastating illness that affects healthy young individuals, many of whom are tertiary students. It can result in sudden death or long-term sequelae such as blindness, deafness, or amputations.
Newly acquired meningococcal nasopharyngeal colonisation occurs frequently on tertiary campuses through close contact with others and may result in serious illness. Barely a year passes in South Africa without a report of a student found dead in their university residence showing signs of meningococcal disease.
This policy brief explores how tertiary students can be informed of their risk of meningococcal disease and offered vaccination to prevent meningococcal colonisation, disease, death, or lifelong disability.
Problem statement
Young adults aged 15–24 years have the second highest burden of meningococcal disease in South Africa (SA), similar to other middle- and high-income countries.
First-year university students have an increased risk of meningococcal disease in comparison to the general population, probably reflecting higher carriage acquisition and prevalence driven by behavioural factors and exposure to new strains from varied geographic origins. Sporadic cases and small clusters of invasive meningococcal disease often occur among students living in shared accommodation.
Local situation
Currently, SA is amongst the top 15 African countries with a high burden of meningitis, even though it does not experience meningococcal epidemics as do other countries in the African meningitis belt. As in many other high- and middle-income countries, meningococcal disease incidence in SA has been steadily climbing since 2022 following a dip during the COVID-19 pandemic years.
In the Western Cape province, the young adult population (15–24 years of age) had the second highest meningococcal disease incidence at one episode per 100 000 persons in 2023.
Primary cause and main modifiable root causes
Neisseria meningitidis, the bacterial organism responsible for causing meningococcal disease, asymptomatically colonises the back of the human nasopharynx and is spread from person to person through respiratory droplets.
Meningococcal vaccination against the meningococcal serogroups causing invasive disease is effective in preventing disease.
In SA, meningococcal vaccination is not part of the national immunisation programme and even though vaccines are available in the private sector, less than 1% of the population has received a dose of the meningococcal vaccine.
Policy options
To minimise meningococcal disease-related deaths and complications among tertiary students, it is crucial to focus on both meningococcal carriage and disease. This can be done through increasing awareness of the risk of meningococcal disease amongst the students and by providing meningococcal vaccination for the students.
Option 1
Implement an on-campus education campaign to improve awareness of meningococcal disease and prevention and promote meningococcal vaccine uptake.
Option 2
Vaccinate ALL first-year tertiary students against meningococcal disease during the first month of registration.
Option 3
Vaccinate only first-year students staying in institutional residences within the first month following registration.
Recommendations
Meningococcal disease, although relatively uncommon, is a devastating illness that strikes healthy young adults and can result in sudden death or lifelong disability within hours of onset.
In SA, tertiary students are at particularly high risk due to behavioural and environmental factors that increase meningococcal carriage and transmission, especially within institutional residences and other shared-living arrangements.
Preventing meningococcal disease is, therefore, a public health imperative and a moral responsibility, given the significant human, social, and economic costs associated with every episode. Vaccination is the only reliable means of primary prevention, and global experience has demonstrated its effectiveness in reducing both carriage and disease.
For a more in-depth look into this policy brief, download the full PDF below.
