Nigeria may be in for another epidemic of meningitis. As at the last count, no fewer than 269 people have been reported killed and 1,966 affected since the outbreak of the disease in February.
Zamfara has the highest number of confirmed cases with 44, followed by Katsina with 32, Sokoto 19, Kebbi 10, Niger 4 and Abuja 5. The Nigeria Centres for Disease Control (NCDC), said the outbreak has reached epidemic proportions in Zamfara, Sokoto, Kebbi, Katsina and Niger. Reports say the outbreak has spread to 15 states.
There are fears that the outbreak has taken to a new strain of Cerebrospinal Meningitis (CSM) in some parts of the country. The new strain, identified as “stereotype C”, emerged in place of the previous known type “stereotype A”, which has disappeared. The new strain is said to be responsible for the increasing cases of meningitis in adjacent Sokoto and Kebbi between 2013 and 2016.
The new strain may have been imported from Niger Republic, sources say. The Minister of Health, Prof Isaac Adewole, who confirmed the development, said the new strain was not common to Nigeria. Unfortunately, the vaccines that provide protection to stereotype “C” meningitis (Neisseria meningitidis serogroup C) are not commercially available. The only available source is through a special process managed by the World Health Organisation (WHO). However, WHO has provided some limited quantities and vaccination campaign has started in Zamfara to be extended to Sokoto and Kebbi states. Sadly, with over 269 people killed and 1,966 casualties recorded so far, there are fears that more lives may be lost if the situation is not properly managed.
Adequate preparation on the part of the government is critical to stemming the meningitis outbreak. A professor of virology, Prof. Oyewale Tomori has acknowledged the efforts of the Federal Government and partners so far but said the high fatalities arising from the outbreak were largely due to lack of preparedness on the part of the authorities. He said for some years now, the country had put the disease in check with availability of vaccines. According to him, the C strain is not new to Nigeria.
“In times past it was the type A that was raging, but successful MenA vaccination campaigns over the years have taken care of that. However from 2013, according to published research studies, we began to see large number of cases caused by type C. There are publications showing that CSM outbreaks due to type C were reported in 2013: Sokoto – 856 cases and 58 deaths, in 2014: Kebbi – 333 cases and 35 deaths, in 2015: Kebbi: – 5714 cases and 292 deaths and Sokoto: 680 cases and 29 deaths”, Tomori stated.
“The 2015 outbreak was the third consecutive year of CSM outbreaks due to type C. The Federal Government official records – Weekly Epidemiological Report has the following data : 2013: 871 cases and 47 deaths, 2014: 1176 cases and 81 deaths, 2015: 2709 cases and 130 deaths; 2016: 831 cases and 43 deaths. In 2015 Federal Government through the NPHCDA mobilised 355,000 doses of ACYW vaccines for reactive vaccination of 2-30 years old in Aleiro, Kebbi State. I think the MSF also assisted.
“However, note that reports from the Federal Government did not indicate the type responsible for the outbreak, hence ACYW vaccines were used. You will see that if the Epid Division of the Federal Ministry of Health and our lab facilities had been up to par, we would have known that we were dealing with type C and responded accordingly. This is now the 4th consecutive year of CSM outbreaks due to type C and we are still unprepared”.
Tomori advised that there should be improvement on field surveillance, need to equip our labs to be able to rapidly and correctly identify the serotype responsible for the cause of the epidemic, and stockpile appropriate vaccines for control.
“Indeed the meningitis vaccine can be used proactively (that is, vaccinate our people prior to the seasonal CSM outbreaks) to protect our people from the incessant outbreaks of CSM. We did that with MenA vaccine, so why not now? To be able to do that, field and laboratory teams must work together to alert the government who must purchase and deploy vaccine IN ADVANCE of possible outbreaks”, the professor said.
“We know what to do, but we will not do it. The cost of buying a bullet proof car is enough to upgrade existing laboratory facilities to provide needed support to disease surveillance and ensure “meningitis-proof” environment for millions of our people. Enough of bullet proof cars for one/two individuals, time to spend our money to provide “disease-proof” environment for the millions of our people”.
Tomori pointed out that if Nigeria had gotten its response preparedness right, it would have made provision for other strains of the disease since it is common sense that strains of these diseases change from time to time.
“I can say it is a success in one part but failure due to lack of preparedness on the other hand, because we should have known that these diseases change their strains from time to time. It is unfortunately, the vaccines available cannot cover for all the strains.”
Meningitis is an infection of the meninges, a thin layer of the connective tissue that covers the brain and the spinal cord. It can be caused by bacteria, virus, parasite or fungus. It is of great public health importance because it has high morbidity and fatality rate, epidemic prone but treatable.
The Director of Surveillance, NCDC, Mrs. Olubunmi Ojo, who confirmed the 269 deaths in about 15 states, said immunisation is key to the prevention of meningitis. According to Ojo, while reactive vaccination helps to curtail outbreaks, a vaccination campaign against NmC with a long-lasting conjugate vaccine is sorely needed. Expressing concern that NCDC and its partner agencies and institutions at the Federal Ministry of Health will continue to work closely with states to bring the outbreak under control, she stressed the need for preventing outbreaks of this scale in the future. She said the Federal Capital Territory is one of the most hit as the outbreak crossed the threshold for an epidemic. Currently, Nigeria may have been placed on red alert, apparently because of the scale of the current outbreak.
According to Sokoto Health Commissioner, Dr Balarabe Kakale, whose state has seen 10 killed in the latest meningities outbreak, the authorities had been on red alert since March 20, 2017. He said the deaths were recorded in the seven local governments of Kebbe, Bodinga, Rabah, Wamakko, Gada, Dange/Shuni and Tureta, mostly affected by the meningitis outbreak. Kakale noted that Emergency Response Teams had treated more than 330 mixed cases of severe malaria and meningitis across the seven LGAs, adding that the last time there was an outbreak of such nature was in 2015. In Zamfara, 44 cases were recorded out of which 29 people died.
In a report, the Director of Disease Control, Federal Ministry of Health, Abuja, said the six states mostly hit accounted for the 1,090 infected people and 154 deaths.
Efforts by the Federal Government
Meanwhile, the Minister of Health, Adewole, says a team of epidemiologists had been deployed to address the challenge. The minister, who described the outbreak of meningitis in the country as unfortunate, said the ministry was working hard to contain the situation as it had deployed epidemiologists and vaccines to arrest the outbreak of the new strain of CSM. On his part, Director General, NCDC, Dr. Chikwe Ihekweazu, said meningitis could be treated if detected early.
Credit: Chioma Obinna (Vanguard)