[Critical review of control strategies for meningococcal meningitis epidemics in Sub-Saharan Africa].

Strategies for controlling meningitis epidemics in Sub-Saharan countries, although regularly re-examined, are based on epidemiological, immunological and logistical considerations dating from the 1970s. The strategy recommended by WHO consists in organising large-scale vaccinations in the event of declared epidemic. However, the obvious failure of this strategy has meant that a review and evaluation of the emergency vaccination criteria is necessary. In spite of the current controversy regarding the immunogenicity of the polysaccharide vaccine, its safety, effectiveness in the field and low cost should justify the renewal of a debate on its use in routine vaccination. Routine--or preventive--vaccination could significantly reduce the incidence of meningococcal meningitis as well as its severity. The conjugate vaccine, when available, will constitute an additional advantage in the prevention of meningococcal meningitis. The organisation of a strategy combining both polysaccharide and conjugate vaccines according to the population targets and possibilities of funding remains to be defined.