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Meningococcal Meningitis outbreak in Togo

10 March 2017

Background

The bacterium Neisseria meningitides, 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. 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.

The current outbreak in Togo began in January 2017. In 2016, the country recorded a meningitis epidemic in the northern region caused by Neisseria meningitides serogroup W with 1,975 cases involved and 127 deaths.

Important data and facts about the outbreak

·    201 suspected cases of meningitis with 17 deaths have been reported by 19 health districts in Togo since 1 January 2017.

·    In Week 2 of the outbreak, the district of Akebou (Plateau Region) issued a health alert after 4 cases of meningitis were reported in the district.

·    In Week 4 of the outbreak, the epidemic threshold was reached in Akebou with nine cases and an attack rate of 12.4 per 100,000 people.

·    From 02/01/17 – 12/02/17, 48 suspected meningitis cases including three deaths were reported in Akebou. Tests later confirmed that 14 of these specimens were cases of Neisseria meningitides serogroup W.

Government response to the outbreak

∙    A vaccination campaign will be going ahead shortly. 56,000 doses of meningitis vaccines have been requested for this purpose.

∙    A World Health Organization Field Mission team has been deployed to support and strengthen the response to the outbreak.

∙    Meetings are taking place with government authorities and health partners in neighbouring Ghana and Benin to enhance meningitis awareness and supervision in those countries.

∙    Extra training is being provided to district levels clinicians.

∙    Meningitis surveillance is being strengthened in Togo.

Meningococcal meningitis – a brief outline

Meningococcal infection is caused by the bacterium Neisseria meningitidis (the meningococcus) which is spread from person to person via respiratory droplets such as sneezes, coughs and other close contact. Most infections with Neisseria 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. Neisseria meningitides 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.

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, Disease Distribution Map, 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 utensil 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

·    Meningococcal disease – Togo, Disease Outbreak News 23 February 2017

·    Meningococcal disease, Emergencies preparedness, response, World Health Organization, accessed 10 March 2017

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