44 Nigerians die of Cerebrospinal Meningitis

Karishi General hospital
Karishi General hospital

As the Cerebrospinal Meningitis (CSM) season reaches its peak in Nigeria, no fewer than 44 people have died from the disease, the Nigeria Centre for Disease Control (NCDC) has disclosed.

The NCDC declared that the 2018/2019 meningitis season began on October 1. The agency said in preparation for this year’s outbreak, all states in the meningitis belt were formally placed on alert on November 8, 2018.

The meningitis outbreak is usually synonymous with the dry season. This begins around November and peaks around March and April, when the temperature is hottest before subsiding in June/July every year.

Since the onset of this year’s season, NCDC in its situation report (October 1 to March 17) said a total of 395 suspected cases have been reported from 14 states. Out of these, 43 samples were positive for bacterial meningitis. Most of the cases tested positive for the meningitis strain C. There are several different types of meningococcal meningitis (A, C, W) that can cause epidemics.

However, the C strain of the disease is quite new to the country and caused a major meningitis outbreak in Nigeria two years ago.

So far, 44 deaths have been reported in the latest outbreak taking case fatality ratio to 11.1 per cent.

In the reporting Week 12, 14 states – Anambra, Bauchi, Bayelsa, Borno, Ebonyi, Gombe, Jigawa, Katsina, Kebbi, Kwara, Niger, Sokoto, Yobe, and Zamfara – have recorded at least one confirmed case across 40 local government areas.

PREMIUM TIMES reported how the Executive Director, Niger State Primary Health Care Development Agency, Usman Ndanusa, said that CSM has claimed eight lives in Borgu Local Government Area of the state.

Mr Ndanusa, who is a Pharmacist, disclosed this in an interview with the News Agency of Nigeria (NAN) on Wednesday in Minna.

Cerebrospinal Meningitis

CSM remains a major public health challenge affecting countries in the African meningitis belt. In Nigeria, 25 states and the Federal Capital Territory (FCT) are often most affected.

CSM is an acute inflammation of the membrane covering the brain and the spinal cord. It can lead to death if left untreated. The disease is contagious and can be transmitted through tiny droplets of respiratory secretions from an infected person during close contact such as coughing or sneezing.

CSM is more common among children and people less than 15 years and deaths are higher among untreated cases. As the season gets drier, more cases are expected to be reported.

Lesser Deaths Reported

However this year, the country has not witnessed a large outbreak of the disease as compared to 2018 and 2017 respectively.

Between Week 1 and 11 (2019), 588 suspected meningitis cases with 36 confirmed laboratory cases and 40 deaths were reported from 141 LGA in 25 states. However, during the same period in 2018, 1872 suspected cases with 208 confirmed laboratory samples and 175 deaths from 191 LGAs in 25 states were reported.

Also when compared to 2016/2017 season, there is a decline. Between December 2016 and June 23, 2017, Nigeria recorded severe cases of the disease with a total of 1,166 people dead. Unfortunately, children between five and 14 were most affected accounting for 6,791 cases out of a total 14,513 cases recorded in 24 states.
Zamfara was the most affected state in terms of casualties, followed by Sokoto and Katsina. Together, they accounted for about 89 per cent of the cases in 2017.

The 2017 outbreak, which reached an epidemic alert threshold, was declared over six months after the first case in 2017. Fortunately, in 2018, the casualties from the diseases were not as high as that of the previous year.

However, a report from NCDC for the last four weeks shows that no local government has reached an alert threshold. Also, the casualties reported from the disease are also lower than in 2018.

Vaccination Helps

The mass vaccination embarked upon by the government in 2017 and 2018 to contain the meningitis outbreak seems to be paying off.

In March 2017, the World health organisation supported Nigeria to request and receive 500,000-polysaccharide meningitis A+C vaccines from the International Coordinating Group (ICG) on Vaccine Provision

The vaccines, funded by Gavi, the Vaccine Alliance, were used for reactive campaigns in Zamfara (420,000), Sokoto (20,000), and Katsina (50,000) states.

“With the outbreak, almost 2.5 million doses of vaccines were provided for reactive vaccination campaigns. At the end of the exercise, 2,118,035 people (coverage of 86.7%) were vaccinated in 50 LGAs across 4 states to curtail the spread of the disease,” WHO had said.

According to WHO, substantial progress has been made in recent years in protecting Africa from the disease due to one of the main epidemic types, through the successful introduction of the Men A conjugate vaccine (MACV) against meningitis A.

“Since MACV was introduced in 2010, more than 260 million people have been vaccinated across 19 countries. This has resulted in a reduction of the number of meningitis cases by more than 57 per cent. Much work, however, remains to be done to protect the region from meningitis C outbreaks and other types of the disease,” the global health agency said.

Early Preparation

NCDC in its latest weekly report on the disease indicated that an early preparation has also paid off as surveillance of the disease started since October last year.

NCDC and partners had commenced preparedness activities, through the national CSM Technical Working Group (TWG).

The Director-General, NCDC, Chikwe Ihekweazu, said the TWG had completed a risk assessment exercise for prioritisation and issued letters of alert to states to ensure adequate preparation for the season.

He said the national Cerebrospinal Meningitis Emergency Operations Centre has been monitoring cases and ensuring preparedness and coordination of response across the states.

“The multi-agency CSM Emergency Operation Centre has been activated,” he said.

Media messages have been developed and disseminated through conventional and social media. Monitoring of the situation continues across the high-risk states. Outbreak investigation and control measures have commenced, he said.

Signs and symptoms of CSM

Signs and symptoms of CSM include sudden high fever, severe headache, stiff neck, sensitivity to light, difficulty concentrating and convulsion in children.

The major risk factors include overcrowding and sleeping in poorly ventilated rooms. The disease is vaccine preventable and can be treated if presented to the health facility early.

Five important things to prevent CSM

1. Avoid overcrowding and ensure adequate ventilation in the home.

2. Cover your nose and mouth with disposable tissue or blow.

3. Wash your hands frequently especially after coughing or sneezing.

4. Visit the health facility when sick.

5. Health workers should practice Universal care precautions at all times.

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