Meningococcus serogroup C clonal complex ST-10217 outbreak in Zamfara State, Northern Nigeria

Brenda Kwambana-Adams ,Garba Abdullahi,Rahab C Amaza,Yahaya Buhari,Rabi Usman,Sulaiman A Gummi,Ibrahim Mamadu ,Abdul Karim Sesay ,Jason Busuttil,Ebenezer Foster-Nyarko,Adebola Olayinka,Olivier Ronveaux,Alliyu I Yarima,Chikwe Ihekweazu,Madikay Senghore,Mohammed Abdulaziz,Abdullahi Shehu Umar ,Umberto D’alessandro ,André Bita ,Badaru Sikiru ,Sani Rabiu ,Bashir Abdullahi,Linda Haj Omar ,Aderinola Olaolu Moses,Mary Stephen,Ifeanyi Okudo,Husaini U Bako,Archibald Worwui,Adamu Kankia,Eme Ekeng,Michael Oladotun Popoola ,Bernard E Ebruke ,Catherine Okoi,Adebayo Adedeji,Murtala Rabiu,Adamu Atiku,Mamoudou Harouna Djingarey,Jason M Mwenda,Nwando ,Wondimagegnehu Alemu,Martín Antonio

doi:10.1038/s41598-018-32475-2

Abstract

After the successful roll out of MenAfriVac, Nigeria has experienced sequential meningitis outbreaks attributed to meningococcus serogroup C (NmC). Zamfara State in North-western Nigeria recently was at the epicentre of the largest NmC outbreak in the 21st Century with 7,140 suspected meningitis cases and 553 deaths reported between December 2016 and May 2017. The overall attack rate was 155 per 100,000 population and children 5–14 years accounted for 47% (3,369/7,140) of suspected cases. The case fatality rate (CFR) among children 5–9 years was 10%, double that reported among adults ≥ 30 years (5%). NmC and pneumococcus accounted for 94% (172/184) and 5% (9/184) of the laboratory-confirmed cases, respectively. The sequenced NmC belonged to the ST-10217 clonal complex (CC). All serotyped pneumococci were PCV10 serotypes. The emergence of NmC ST-10217 CC outbreaks threatens the public health gains made by MenAfriVac, which calls for an urgent strategic action against meningitis outbreaks.

Highlights

The “meningitis belt” spans twenty-six contiguous countries across Africa and is characterized by large recurrent meningitis epidemics and frequent seasonal outbreaks[1]
PCR detected an additional 19 Nm meningitis cases in addition to the 22 cases detected by both methods and 3 cases detected by Rapid Test only
We report the largest NmC meningitis outbreak to hit a single state in Nigeria to date

Summary

Introduction

The “meningitis belt” spans twenty-six contiguous countries across Africa and is characterized by large recurrent meningitis epidemics and frequent seasonal outbreaks[1]. The bulk of epidemic meningococcal disease outbreaks in Nigeria and across the “meningitis belt” were previously attributed to meningococcus serogroup A (NmA)[5]. Sequential outbreaks of meningococcus serogroup C (NmC) occurred in Nigeria in 2013 and 2014 in Nigeria[11,12] despite the roll out of MenAfriVac campaigns. These outbreaks were followed by a larger outbreak in Niger in 201513. Reactive vaccination campaigns are further hampered by low lumbar puncture rates among suspected cases and inadequate laboratory characterisation of causative pathogens that should guide response[19]

Methods

Results

Conclusion