Time delays in the response to the Neisseria meningitidis serogroup C outbreak in Nigeria - 2017.

Assad Hassan,Raji Ismail,Mahmood M Dalhat,Jeremiah Agenyi,Chikwe Ihekweazu,G U Mustapha,Chima Thomas,Patrick Nguku,Oyeronke Oyebanji,Aliyu M Na’Uzo,Muhammad Shakir Balogun,Eteng Womi-Eteng Oboma,Bola B Lawal,Caroline L Trotter

doi:10.1371/journal.pone.0199257

Abstract

BackgroundNigeria reports high rates of mortality linked with recurring meningococcal meningitis outbreaks within the African meningitis belt. Few studies have thoroughly described the response to these outbreaks to provide strong and actionable public health messages. We describe how time delays affected the response to the 2016/2017 meningococcal meningitis outbreak in Nigeria.MethodsUsing data from Nigeria Centre for Disease Control (NCDC), National Primary Health Care Development Agency (NPHCDA), World Health Organisation (WHO), and situation reports of rapid response teams, we calculated attack and death rates of reported suspected meningococcal meningitis cases per week in Zamfara, Sokoto and Yobe states respectively, between epidemiological week 49 in 2016 and epidemiological week 25 in 2017. We identified when alert and epidemic thresholds were crossed and determined when the outbreak was detected and notified in each state. We examined response activities to the outbreak.ResultsThere were 12,535 suspected meningococcal meningitis cases and 877 deaths (CFR: 7.0%) in the three states. It took an average time of three weeks before the outbreaks were detected and notified to NCDC. Four weeks after receiving notification, an integrated response coordinating centre was set up by NCDC and requests for vaccines were sent to International Coordinating Group (ICG) on vaccine provision. While it took ICG one week to approve the requests, it took an average of two weeks for approximately 41% of requested vaccines to arrive. On the average, it took nine weeks from the date the epidemic threshold was crossed to commencement of reactive vaccination in the three states.ConclusionThere were delays in detection and notification of the outbreak, in coordinating response activities, in requesting for vaccines and their arrival from ICG, and in initiating reactive vaccination. Reducing these delays in future outbreaks could help decrease the morbidity and mortality linked with meningococcal meningitis outbreaks.

Highlights

Meningococcal meningitis outbreaks in Africa are frequently detected too late to enable appropriate control and preventive actions to limit their impact [1]
Four weeks after receiving notification, an integrated response coordinating centre was set up by Nigeria Centre for Disease Control (NCDC) and requests for vaccines were sent to International Coordinating Group (ICG) on vaccine provision
Health workers in these local government area (LGA) had been managing the cases for severe malaria unsuccessfully, many of whom tested negative for malaria

Summary

Introduction

Meningococcal meningitis outbreaks in Africa are frequently detected too late to enable appropriate control and preventive actions to limit their impact [1]. The age group mostly affected by outbreaks of meningococcal meningitis are the 5–15 year olds [4], and about 10–20% of patients develop neurological sequalae such as deafness, learning disabilities and epilepsy [5]. These figures are likely to be higher due to the sub-optimal reporting system to record cases [3, 6]. Between January and June 1996, the largest ever epidemic of meningococcal meningitis in Nigeria affected a reported 109,580 cases leading to 11,717 deaths (CFR 10.7%) [8]. We describe how time delays affected the response to the 2016/2017 meningococcal meningitis outbreak in Nigeria

Methods

Results

Conclusion