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Meningococcal Meningitis outbreak in Nigeria

20 April 2017

Background

The number of suspected cases of meningococcal meningitis in the current outbreak in Nigeria has now reached 5,695 including 611 deaths, according to the Nigeria Centre for Disease Control. The outbreak began in Zamfara state in December 2016.

The bacterium Neisseria meningitides (N. meningitidis), which causes meningococcal disease is present in the semi-arid areas of sub-Saharan Africa. This area has been named by the World Health Organization (WHO) as the ‘African Meningitis Belt’ due to its horizontal spread across countries in the region, including Nigeria. Every year, epidemics of meningococcal meningitis occur in seasonal cycles in the African Belt during the hot, dry season between the months of late November and the end of June.

Nigeria experienced a large N. meningitidis serotype C outbreak in 2015 which caused over 55,000 cases including almost 2,500 deaths, in the same areas currently affected. Since the implementation of a mass immunisation campaign with meningitis A vaccine in Nigeria which began in 2011, subsequent outbreaks of meningitis have mainly been caused by new serotypes including N. meningitidis sero-groups C and W135. The recurrence of a meningitis outbreak in Nigeria is probably due to the low immunity of the population against the emerging serotypes.

Important data and facts about the outbreak

·    221 cases (4%) of the 5,695 cases are laboratory confirmed.

·    Neisseria meningitidis serotype C was the commonest cause of meningitis amongst those who tested positive: 151 out of 221 confirmed cases (71%).

·    The outbreak currently affects 25 Local Government Areas (LGAs) across six states including Zamfara, Sokoto, Katsina, Kebbi, Niger and Yobe.

·    The most affected age group is that made up of 5-14 year olds who have not experienced previous infections due to meningitis group C, making them particularly susceptible to this strain of the disease.

·    The current outbreak has the potential to spread to neighbouring countries as Zamfara, Sokoto and Katsina states share their border with Niger and there is high population movement between the two countries.

·    WHO has urged Nigeria, Togo, Benin, Burkina Faso, Niger and Ghana to strengthen their surveillance.

Official response to the outbreak

∙    The Nigeria Ministry of Health activated the Emergency Operation Centre and has appointed an incident manager.

∙    The Nigeria Centre for Disease Control (NCDC) has organised Rapid Response Teams (RRTs) to provide onsite assistance.

∙    The World Health Organization (WHO) has deployed four international experts to Nigeria to provide high level technical support.

∙    A mass vaccination campaign has taken place in Zamfara and Katsina states.

∙    Medicines are being distributed to affected states.

∙    Communication and social mobilisation activities are being conducted to raise population awareness in affected states.

Meningococcal meningitis – a brief outline

Meningococcal infection is caused by the bacterium Neisseria meningitidis (N. meningitidis, the meningococcus) which is spread from person to person via respiratory droplets such as sneezes, coughs and other close contact. Most infections with N. meningitidis do not lead to any illness, as the bacterium lives harmlessly in the nose and throat. However, occasionally, the bacterium invades the blood stream causing septicaemia (blood poisoning) and meningitis (inflammation of the fluid surrounding the brain and spinal cord) which can cause death or disabilities, including deafness, paralysis and limb infection which may require amputation.

Different types of bacteria can cause meningitis. N. meningitidis can trigger large epidemics and has 12 serogroups which have been identified to date. Six of these serogroups (A, B, C, W, X and Y) can cause epidemics.

Meningococcal disease is a major threat to the health of 430 million people in areas of sub-Saharan Africa. Meningococcal epidemics can occur in the Meningitis Belt causing tens of thousands of cases. The African Meningitis Belt extends from Senegal in the west to Ethiopia in the east and includes the countries of Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d’Ivoire (Ivory Coast), Democratic Republic of Congo, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, South Sudan, Sudan, Tanzania, Togo and Uganda. Other neighbouring countries, which are outside the Meningitis Belt are also at high risk of meningitis epidemics.

Medical experts believe that dust, which is common during the dry season, leads to an increase in respiratory infections and helps spread the disease because the bacterium attaches itself to dust particles. The hot, dry Harmattan wind which blows from late November to mid-March in the western Sahara region of Africa, including Nigeria, can lead to an increase in meningitis cases.

Cases of Meningococcal meningitis disease caused by serogroups A, C, W and Y can be reduced with the use of vaccines which target these particular strains of the bacteria. The use of antibiotics can be very effective in curing the disease as long as treatment is started promptly.

Worldwide distribution of Meningococcal Meningitis

Meningococcal Meningitis Map 2015

Map source: World Health Organization, Meningococcal Meningitis

Advice for those travelling to or working in the areas affected

·    Ensure you are vaccinated against meningitis. Meningitis vaccine which protects against the strains A, C, W135 and Y is recommended for all travellers going into areas where there is a current outbreak and for people working within the Meningitis belt and neighbouring countries where they have close contact with the local population.

·    The risk of contracting meningococcal meningitis is highest in those who spend prolonged periods of contact with local populations during an epidemic.

·    Be aware of how meningitis is spread e.g. through cough droplets and sneezes. Individuals can be meningitis carriers but may not display any symptoms (asymptomatic carriers).

·    Keep away from people who are coughing and sneezing. Cover your mouth and nose with a tissue if you are sneezing and coughing and then dispose of the tissue.

·    Avoid being in overcrowded situations where possible.

·    Practice good hand hygiene, including regular handwashing, avoiding sharing cutlery and utensils with others.

·    Seek medical attention promptly if you suspect you or a family member/friend has meningococcal meningitis.

For further advice please click on the related information topics on the right hand panel of this screen.

Sources

·    Nigeria meningitis outbreak tops 600 deaths, Outbreak News Today, 17 April 2017

·    Weekly bulletin on Outbreaks & other Emergencies Week 14: 1-7 April 2017, World Health Organization Africa Region, accessed 18 April 2017.

·    WHO and partners provide vaccines to control meningitis C in Nigeria, World Health Organization, 13 April 2017

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