Health 
Meningitis on return in Africa

Meningococcal meningitis occurs globally, but the disease follows a pattern of epidemics flaring for two to three consecutive years in countries in sub-Saharan Africa. This area has experienced epidemic cycles every eight to 12 years in the past, according to the World Health Organisation (WHO). The last recorded epidemic was however recorded only three years ago, in 1996-98, resulting in over reported 300,000 cases and most affecting Nigeria, Burkina Faso, Mali and Niger. 

The new, alarming reports of a new meningitis epidemic developing in Africa were therefore somewhat unexpected. On 7 March, the International Federation of Red Cross and Red Crescent (IFRC) informed that the meningitis epidemic was threatening 8.4 million people in Ethiopia, some 16% of the population. "There is serious cause for alarm about the spread of this epidemic," said Dr. Bradley Hersh, a senior medical epidemiologist with the IFRC. "While to-date there have been 1,348 cases reported and 108 deaths confirmed, this is probably a serious under-estimate of the reality on the ground."

The Ethiopian Ministry of Health's plan of action to control the epidemic includes strengthening surveillance activities, carrying out mass vaccinations in districts that have exceeded the epidemic threshold and health education activities. The Ministry is also coordinating activities with international aid agencies. International support to the Ethiopian authorities has included the implementation of mass vaccinations, strengthening case management and support to surveillance activities, according to the WHO.

Some 4,500 kilometres to the west, a similar situation is developing in Burkina Faso. A total of 3,356 people are reported to have contracted the disease, according to Burkinabe health officials. The epidemic has already claimed 600 lives this year. Senior health ministry official Mathias Some told the BBC his ministry had appealed to international partners and "every one has said they are ready to ensure Burkina Faso has the resources to carry out a mass vaccination campaign." 

A mass vaccination campaign in the most affected Burkinabe regions is already being carried out, according to the WHO. The campaign at first seemed to curb the development of the epidemic, but in recent weeks the numbers contracted and dead suddenly started to rise again, provoking the government's call for increased international aid. 

Both Burkina Faso and Ethiopia are in the so-called "African Meningitis Belt", including most Sahelian countries. Rising numbers of meningitis have so far been registered in several countries within the "Belt", most significantly in Benin, Burkina Faso, Cameroon, Chad, Ethiopia and Niger. 

In Niger, the government yesterday informed that at least 108 people had died of the disease in the country. So far, no mass vaccination campaign has started in Niger, the world's second poorest country (after Sierra Leone). 

In Chad, the WHO had received reports of 2317 cases and 267 deaths since the outbreak began in the last months of 2000, as of 4 March. The Ministry of Health has responded by strengthening surveillance, providing public information and carrying out mass vaccinations in the affected areas. In support of the local health authorities, Médecins sans Frontières (MSF) is implementing mass vaccinations and strengthening case management in the préfectures of Moyen Chari and Mayo Kebbi, districts on the Cameroonian border.

Just across the border, in Northern Cameroon, MSF so far has registered around 300 cases and 20 deaths in two districts, Wum and Mbenwi, in the Northwestern province. The Ministry of Health of Cameroon, with the assistance of MSF, already has started a mass vaccination campaign. 

In Benin, bordering with Burkina Faso and Niger in the north, some 2,500 cases of meningitis have so far been reported, including some 150 deaths. Atacora and Borgou in northern Benin are the most affected départements and the Ministry of Health in these départements is launching a mass vaccination campaign. 

The African meningitis belt is the area between Senegal and Ethiopia and includes all or part of at least 15 countries, with an estimated total population of approximately 300 million. Minor epidemics normally occur in seasonal cycles between the end of November and the end of June, depending on the location and climate of the country and declines rapidly with the arrival of the rainy season, according to the WHO. The current epidemic is however of a larger extent, threatening to affect wide ranges of the population if mass vaccination campaigns are not carried out.

There exist various forms of meningitis, but meningococcal meningitis is the only form of bacterial meningitis, which causes epidemics. Transmission is by direct contact, including respiratory droplets from nose and throat of infected persons. Most infections are subclinical and many infected people become symptomless carriers. Waning immunity among the population against a particular strain favours epidemics, as do overcrowding and climatic conditions such as dry season or prolonged drought and dust storms. 

Meningococcal meningitis is characterized by sudden onset of intense headache, fever, nausea, vomiting, photophobia, and stiff neck. Neurological signs include lethargy, delirium, coma and/or convulsions. Infants may have illness without sudden onset and stiff neck. The incubation period is between two and ten days, mostly three to four days.

Even when the disease is diagnosed early and adequate therapy instituted, the case fatality rate is between 5% and 10% and may exceed 50% in the absence of treatment, according to the WHO. In addition to the mortality associated with meningococcal meningitis 15% and 20% of those who survive will suffer with neurological sequelae (e.g. deafness, mental retardation) as a result of their illness.

Source: WHO, Red Cross and Red Crescent and afrol archives

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