In February, the Nigerian Centre for Disease Control, NCDC, raised an alarm over the outbreak of Cerebro Spinal Meningitis across north-western Nigeria.
The first case of the disease was reported in Zamfara State in November, 2016, but did not become a national concern until February when the NCDC said it got alerted. By then, the disease had become an epidemic affecting six states in the northern part of the country.
Since the outbreak, about 489 people are believed to have died of the disease with about 4,637 suspected cases reported across the country.
Meningitis is a condition in which the protective membrane (meninges) covering the brain and spinal cord becomes inflamed. This inflammation is usually caused by an infection of the fluid surrounding the brain and spinal cord.
Meningitis has occurred in different parts of the world but the highest incidence of the disease is found in the ‘meningitis belt’ of sub-Saharan Africa including Senegal, Gambia, Guinea Bissau, Nigeria, Niger, Chad.
Though the epidemiology of meningitis is not fully understood, it is more commonly seen during the dry season, from December to June.
In this meningitis belt, until recently, the Type A strain of the bacteria was most common with attack rates sometimes reaching 1,000 cases per 100,000 population.
However, it is the unusual Type C strain of the bacteria that Nigeria is currently battling with.
According to Nasir Sani-Gwarzo, a chief epidemiologist at the Federal Ministry of Health, the recent outbreak of the strain C bacteria does not mean that the type A has been eliminated totally, but only displaced.
Mr. Sani-Gwarzo, who spoke at a meeting of traditional and political leaders on meningitis in Kaduna, said if care not taken, the Type A can return in a full epidemic outbreak in 10 years.
CONTAINING THE DISEASE
On getting information about the outbreak, procuring vaccinations and drugs to contain the spread of the deadly disease became a major concern for international health agencies, the federal government, state governments, local governments and concerned individuals across the globe.
Unfortunately, there was no vaccine readily available for the Type C.
The Health Minister, Isaac Adewole, said Nigeria usually had an outbreak of the Type A meningitis and that its vaccine, MenAfriVac®, was readily available in the country.
Mr. Adewole, a professor, in a statement by his ministry, said there have been mass vaccination campaigns since 2010 when the vaccine was introduced.
“What we have in the country now is the serotype C, which we didn’t have the vaccine available in the country. We needed to solicit to the World Health Organisation and other international partners to supply us with the vaccine needed to combat the disease as the vaccines are not readily accessible,” he said.
Mr. Adewole said of the 489 deaths, 171 were confirmed to be from the Type C meningitis with Zamfara, Sokoto, Katsina, Niger and Kebbi states most affected. Many of the other deaths could not be clinically confirmed as the victims were buried before any autopsy could be carried out.
The Minister of State for Health, Osagie Ehanire, while explaining some of the challenges the country is facing in combating the disease said the drugs are ‘extremely expensive’ and have a short shelf life.
Mr. Enahire added that the vaccines are expensive to make and if acquired and stored without use, they could expire.
“There is just a limited stock of the Type C as it is not much in demand, this outbreak has led to a greater demand,” he explained.
Mr. Ehanire said the Type C vaccine has been very rare and immunisation for one type does not work for the other.
“Unfortunately, there is no cross immunisation. If you are immune to Type A doesn’t make you immune to Type C. And because Type C was very rare, the availability of vaccines has been very meagre relatively,” he said.
Mr. Adewole said 500,000 doses of the Type C vaccines have been acquired and distributed, with about 420,000 used in Zamfara to vaccinate residents between the age of zero and 30.
He also said 823,000 doses of conjugated Type C had been delivered to the Federal Government by the UK government, while UNICEF had provided over one million Type A vaccines to Nigeria free, and the ministry has placed an order for additional two million doses.
Mr. Adewole said the Federal Government would spend over $1 billion to procure vaccines and administer on some 21 million persons against the meningitis in the affected states.
After the Federal Executive Council meeting last week, Mr. Ehanire shed more light on the new vaccine used to contain the meningitis outbreak. He explained that the new vaccine is called the conjugate A+C vaccine which can serve as a cover for the strain A and C meningitis.
He said it protects the recipient for 12 years compared to the previously used vaccine, MenAfriVac® which protects for about 10 years from only the Type A meningitis.
The minister said the outbreak has been managed and is no more expanding.
“We hope it will come down soon,” he added.
TRANSMISSION AND PREVENTION
Meningitis infects only humans. The bacteria can be carried in the throat and spread through close and prolonged contact such as kissing, sneezing or coughing on someone, or living in close quarters such as a dormitory. Sharing eating or drinking utensils with an infected person also facilitates the spread of the disease.
Common symptoms to look out for in a person suspected with the disease includes stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting.
The symptoms often present similar symptoms with other infectious diseases such as cerebral malaria, experts said. It is, thus, very important to seek medical care at health centres when someone is experiencing any or all of these symptoms – especially sudden neck stiffness.
Wondimagegnehu Alemu, the WHO Country Representative to Nigeria said that the NCDC with support from WHO, the US Centre for Disease Control (CDC), UNICEF and other partners were leading the response to the on-going outbreak and also carrying out intensified surveillance, capacity building for case management and risk communication.
The Nigerian Medical Association in its press statement, however, condemned the ‘late’ immunisation Nigerians against the disease.
The president of the association, Mike Ogirima, said the reactive measures were ineffective based on the epidemiology of the disease.
“For immunisation to be effective, it must be administered around three months before the clinical manifestation due to latent period. We want the National Centre for Disease Control (NCDC) and other government agencies to be proactive in the approach to our emergencies”.
“Various epidemiological studies in the country in the past has shown that meningitis strain C was involved in the epidemic past in Nigeria and we should have emergency medical preparedness plans that should be activated routinely to avert disaster,” he added
Mr. Ogirima also demanded the immediate resuscitation of local vaccine production (LVP) at Yaba, Lagos State which has been moribund since 1991; and the expansion of the scope of LVP at the national veterinary research institute, Vom, Plateau State.
“Our pharmaceutical industries should be challenged and supported to produce our consumable. This should be the new order instead of budgeting huge sums of money for importation of vaccines and other consumables,” he said.
Mr. Alemu had also said that an accelerated development of affordable and effective conjugate vaccines to cover all epidemic types of meningitis is a high priority for WHO and partners to prevent future outbreak.