Streptococcus pneumoniae infection accounts for nearly one-fifth of all meningitis deaths globally, half of which occur in Sub-Saharan Africa. Pneumococcal conjugate vaccines (PCVs) prevent vaccine-serotype disease and have been rolled out as part of infant immunization programs worldwide¹. Despite widespread PCV usage, the burden of pneumococcal meningitis remains highest within the so called ‘African meningitis belt’ where, in addition to endemic disease, periodic pneumococcal meningitis outbreaks occur at a scale not seen elsewhere². Between 2000 and 2018, there were at least two confirmed large pneumococcal meningitis outbreaks and seven possible outbreaks across several meningitis-belt countries³. In 2023, Togo reported a pneumococcal meningitis outbreak with an attack rate of 112 per 100,000 population and a case fatality rate of 8.5% cases despite having introduced the 13-valent PCV (PCV13) in 2014, highlighting the need for more effective control of pneumococcal disease.

There is an overlap between the geographies of the meningitis belt and forced displacement in Sub-Saharan Africa, which accounts for 44% of all displaced persons globally. Conflict and climate-related emergencies drive forced displacement across the meningitis belt⁴. This is exemplified by the recent Sudanese conflict, which has displaced millions of people in a country that already had 3.7 million internally displaced people⁵. Humanitarian crises negatively impact the delivery of infant immunization programs, including PCV immunization, which may increase the risk of pneumococcal disease and outbreaks in populations with reduced access to healthcare. The risk of pneumococcal outbreaks during humanitarian crises is exacerbated by overcrowding and poor hygiene and sanitation⁶. If the goals of the WHO Defeat Meningitis 2030 Roadmap are to be realized, displaced populations within the meningitis belt should be prioritized in pneumococcal disease control strategies.

肺炎链球菌感染占全球脑膜炎死亡人数的近五分之一，其中一半发生在撒哈拉以南非洲地区。肺炎球菌结合疫苗 (PCV) 可预防疫苗血清型疾病，并已作为全球婴儿免疫计划的一部分推广¹。尽管 PCV 使用广泛，但肺炎球菌脑膜炎的负担在所谓的“非洲脑膜炎带”内仍然是最高的，该地区除了地方病外，还定期爆发肺炎球菌脑膜炎，其规模在其他地方是前所未见的²。 2000 年至 2018 年间，多个脑膜炎带国家至少发生了两次确诊的大规模肺炎球菌脑膜炎疫情，并可能爆发了七次肺炎球菌脑膜炎疫情³。尽管多哥在 2014 年引入了 13 价 PCV (PCV13)，但 2023 年报告爆发了肺炎球菌脑膜炎，发病率为每 10 万人口 112 例，病死率为 8.5%，这凸显了更有效控制肺炎球菌的必要性疾病。

脑膜炎带与撒哈拉以南非洲被迫流离失所的地区存在重叠，该地区占全球流离失所者总数的 44%。冲突和与气候相关的紧急情况导致整个脑膜炎带被迫流离失所⁴。最近的苏丹冲突就是一个例子，该国已有 370 万境内流离失所者⁵ ，这场冲突导致数百万人流离失所。人道主义危机对婴儿免疫计划（包括 PCV 免疫）的实施产生负面影响，这可能会增加获得医疗保健机会减少的人群患肺炎球菌疾病和爆发的风险。人道主义危机期间，过度拥挤和卫生条件差，加剧了肺炎球菌爆发的风险⁶。如果要实现世卫组织《2030 年战胜脑膜炎路线图》的目标，肺炎球菌疾病控制战略应优先考虑脑膜炎带内的流离失所人口。