Household transmission of Neisseria meningitidis in the meningitis belt

The epidemiology of Neisseria meningitidis is dynamic, with risk of meningococcal disease varying widely by region and depending on a confluence of host, organism, and environmental factors. Because transmission of N meningitidis results mainly in asymptomatic carriage, evaluation of oropharyngeal carriage can be helpful to understand the epidemiology and transmission of N meningitidis and, in turn, develop strategies for the prevention and control of meningococcal disease. The bacterium is transmitted through respiratory droplets and close contact, with transmission increasing in crowded settings such as military camps, universities, and schools.1 Household contacts of patients with meningococcal disease have been shown to be at increased risk of meningococcal carriage and disease in developed countries, where incidence of meningococcal disease is low and outbreaks infrequent. However, less is known about household transmission dynamics of N meningitidis in the unique epidemiological context of the meningitis belt of sub-Saharan Africa, which is characterised by high rates of endemic disease, annual outbreaks, and periodic large-scale epidemics, historically due to serogroup A meningococci.2