Cerebrospinal Meningitis Outbreak Research Articles

Epidemic forecast and preparedness for explosive-cerebrospinal meningitis outbreak in Nigeria using the preventive vaccination strategy.

Within the African meningitis belt, yearly outbreaks of cerebrospinal meningitis (CSM), with incidence rates of 10-100 cases per 100 000 population, are typically punctuated by explosive epidemics occurring every 8-12 years, with incidence rates that can exceed 1000 cases per 100 000 population. From 1928 to 2018, Nigeria recorded the highest number (21%) of cases in the region. The reactive vaccination strategy, a protocol with major drawbacks, has been the vaccination method utilised in Nigeria. This review highlights the need for governments within the African meningitis belt to start preparations against the next explosive CSM epidemic expected to occur between 2024 and 2028 using the preventive vaccination strategy. We performed a literature search on the Google Scholar search engine using relevant search strings and included studies and reports between 1905 and 2022 that met set criteria. Neisseria meningitidis serogroups A, B, C, W135, X, and Y; Haemophilus influenzae serotypes a, b, c, e, and f; and Streptococcus pneumoniae serotypes 1, 4, 5, 6, 9, 19, 19F, and 20 were implicated as aetiologies. However, the reactive vaccination strategy was only used against N. meningitidis A or C, H. influenzae b, and pneumococcal conjugate vaccine. Between 2011 and 2017, a polysaccharide vaccine (ACW or ACYW) active against serogroups A, C, W and Y was used within the African meningitis belt for the first time. Varying genotypes of N. meningitidis, H. influenzae and S. pneumoniae were identified. Our results revealed a very high success rate for the preventive vaccination strategy. In order to ensure reductions in the morbidity and mortality associated with invasive CSM, the Federal Ministry of Health, Nigeria, should leverage existing knowledge of the circulating serogroups, serotypes, and genotypes of the primary bacterial aetiologies and commence the implementation of the preventive vaccination strategy.

Descriptive characterization of the cerebrospinal meningitis outbreak in Zamfara State, 2017-18

Introduction: Cerebro-spinal meningitis (CSM) is an epidemic-prone disease characterized by inflammation of the meninges. From epidemiological week 36, 2017 through epidemiological week 21, 2018, Zamfara State reported an outbreak of CSM that affected all the 14 Local Government Areas (LGAs). Therefore, we conducted a descriptive analysis of the outbreak to determine its epidemiology.

Characteristics of Cerebrospinal Meningitis Cases in 2017 Outbreak, Sokoto State, Nigeria: A Secondary Data Analysis

Introduction: Cerebro-Spinal Meningitis (CSM) is an acute illness affecting surrounding layers of the brain and spinal cord, mostly caused by bacterial infection. The disease is responsible for the occurrence of epidemic meningitis in the African Meningitic belt. For many years, this region has experienced a large serogroup A epidemic every 7-10 years. A sharp decrease in the number of reported cases was demonstrated in countries where Men Afrivac has been introduced. However, serogroup replacement with serotype C was noted in the region, which has posed a serious threat to eliminating CSM epidemics. We describe the characteristics of cerebrospinal meningitis cases in the 2017 outbreak in Sokoto state, Nigeria.
 Methodology: We obtained CSM data from the state epidemiology unit from 7th February to 24th May 2017. We extracted data on demographic characteristics, clinical features, case management and outcome of cases. We used Microsoft Excel and SPSS to analyze the data for proportions, cross-tabulations and chi-square test to find associations between variables.
 Results: A total of 4969 CSM cases were recorded, with 283 deaths (case fatality rate: 5.7%). The cumulative attack rate was 96.4/ 100,000 populations. The highest proportion of cases was among ≥ the 15-year age group 2063(41.5%), and males were more affected, 2843(57.2%). Of the total 4969 suspected CSM cases, specimens were collected for only 225 (4.4%) cases, of which 58 (25.8%) were positive. Most 48 (82.8%) of the positive specimen were of NmC serotype. Only age was found to predict outcome (aOR: 1.52; 95% CI= 1.18 – 1.97).
 Conclusion: Sokoto State outbreak of Cerebro-spinal meningitis in 2017 was huge and largely caused by NmC. Those aged less than 15 years might be at higher risk of dying from CSM and we therefore recommend that specific preventive interventions such as vaccination and awareness creation should target this age group.

Emergence of Neisseria meningitidis serogroup X in the 2017/2018 Cerebrospinal Meningitis outbreak, Nigeria

Background: Outbreaks of meningitis occur periodically in Nigeria, with the northern parts mostly affected. Neisseria meningitidis is the commonest cause of meningitis outbreaks; Streptococcus pneumoniae and Haemophilus influenzae causes. Following a large outbreak in 2016/2017, another outbreak occurred in 2017/2018, with Neisseria meningitis C being the cause. This study is aimed at characterizing Neisseria meningitidis strains using genotypic technique (PCR) and bringing to limelight the need for continued surveillance, especially with the emergence of Neisseria meningitidis serogroup X, which like serogroup C, is also capable of causing epidemics. Methods and materials: We conducted active surveillance of suspected meningitis cases that met the WHO case definition in states that reported cases of meningitis between November 2017 and June 2018. CSF was collected from suspected meningitis cases and aliquots sent to the National Reference Laboratory, Abuja from States that reported cases and analysed by culture, Rapid Diagnostic Test (Pastorex®) and Polymerase Chain Reaction for detection of N. meningitidis, S. pneumoniae and H. influenzae. Results: 548 samples were analysed by PCR to detect sodC, lytA and hpd genes. Neisseria meningitidis (n = 236, 43.1.0%; NmC = 182, 33.2%, NmX = 43, 8.0%. others = 11, 2.0%) was the predominant cause of meningitis followed by S. pneumoniae (n = 22, 4.0%) and Haemophilus influenzae (n = 26, 4.7%). Conclusion: This study detected an unusual serogroup of Nm, although outbreaks of meningitis in Nigeria have previously been caused by NmA and NmC. Our data underscores the urgent need for ongoing bio surveillance. The increasing incidence of Neisseria meningitidis X is worrisome, because the reactive and preventive vaccination for meningitis does not cover this serogroup, countries in the African meningitis belt must prepare to face this potential new challenge. Information has been shared with the Nigeria Centre for Disease Control and WHO for further action.

A twin disaster: Addressing the COVID-19 pandemic and a cerebrospinal meningitis outbreak simultaneously in a low-resource country

ABSTRACT Managing a deadly pandemic in low- and middle-income countries (LMIC) is challenging. The task becomes tougher when there is an outbreak of an equally deadly disease. This is the present situation of Ghana, a low-resource country, that is confronted with the coronavirus disease 2019 (COVID-19) pandemic and cerebrospinal meningitis (CSM) outbreak. Apart from the resource constraint at both governmental and individual levels, such a situation affects the overall wellbeing of ordinary citizens as well as healthcare professionals, particularly those in high-risk areas. Perhaps, more than ever, we have to ensure equitable distribution of scarce healthcare resources in our effort to manage this ‘twin disaster’ of COVID-19 and CSM. We evaluated Ghana’s situation (outbreak response) and recommended measures to help us navigate this conundrum of a public health crisis.

A rapid assessment of the implementation of integrated disease surveillance and response system in Northeast Nigeria, 2017

BackgroundIntegrated disease surveillance and response (IDSR) is the strategy adopted for public health surveillance in Nigeria. IDSR has been operational in Nigeria since 2001 but the functionality varies from state to state. The outbreaks of cerebrospinal meningitis and cholera in 2017 indicated weakness in the functionality of the system. A rapid assessment of the IDSR was conducted in three northeastern states to identify and address gaps to strengthen the system.MethodThe survey was conducted at the state and local government areas using standard IDSR assessment tools which were adapted to the Nigerian context. Checklists were used to extract data from reports and records on resources and tools for implementation of IDSR. Questionnaires were used to interview respondents on their capacities to implement IDSR. Quantitative data were entered into an MS Excel spreadsheet, analysed and presented in proportions. Qualitative data were summarised and reported by thematic area.ResultsA total of 34 respondents participated in the rapid survey from six health facilities and six local government areas (LGAs). Of the 2598 health facilities in the three states, only 606 (23%) were involved in reporting IDSR. The standard case definitions were available in all state and LGA offices and health facilities visited. Only 41 (63%) and 31 (47.7%) of the LGAs in the three states had rapid response teams and epidemic preparedness and response committees respectively. The Disease Surveillance and Notification Officers (DSNOs) and clinicians’ knowledge were limited to only timeliness and completeness among over 10 core indicators for IDSR. Review of the facility registers revealed many missing variables; the commonly missed variables were patients’ age, sex, diagnosis and laboratory results.ConclusionsThe major gaps were poor documentation of patients’ data in the facility registers, inadequate reporting tools, limited participation of health facilities in IDSR and limited capacities of personnel to identify, report IDSR priority diseases, analyze and interpret IDSR data for decision making. Training of surveillance focal persons, provision of IDSR reporting tools and effective supportive supervisions will strengthen the system in the country.

COVID-19 effects on national health system response to a local epidemic: the case of cerebrospinal meningitis outbreak in Ghana

The present novel coronavirus disease (COVID-19) has reached unprecedented levels globally, overwhelming many health care systems. In the midst of this, Ghana is saddled with the outbreak of a disease of public health importance-cerebrospinal meningitis (CSM). With over 1000 cases of COVID-19 confirmed and still counting, a total of 409 CSM cases of CSM has been reported in the country, with the gravity of the latter apparently condoned. While the end to COVID-19 is uncertain, a coordinated set of public health interventions that prioritize local epidemics are important to ensure a continuum of health care for the population. Health policy actors must race against time to ensure decisions on containing the current CSM outbreak is based on scientific evidence of the epidemiology of the disease in the settings while building local capacity (human and infrastructure) for current and future local epidemics.

Historical review of the epidemic situation, prevention and control of epidemic cerebrospinal meningitis during 1966 to 1967

During the winter and spring of 1966 to 1967, the nationwide revolution networking not only exerted great pressure on food, housing and transportation, but also triggered the most serious nationwide epidemic cerebrospinal meningitis outbreak in history. The students of the revolution networking were the disseminators of the disease and the first group of patients. The unprecedented scale and scope of the epidemic, the destroyed medical and health order and other factors exacerbated the epidemic situation. Zhou Enlai restarted the " prevention and treatment by masses " mode to gradually control the epidemic. Fifty years later, looking back on the history of the epidemic situation and prevention and control of epidemic cerebrospinal meningitis, many problems are worth pondering deeply.

Cerebrospinal Meningitis Outbreak in Zamfara State, North–West Nigeria, December, 2016–June, 2017

Background: Meningitis is an acute severe infection of central nervous system associated with significant morbidity and mortality. Neisseria meningitides is the main cause of meningitis epidemics in the African region. An outbreak of meningitis was confirmed in Zamfara State and five other states in the Northern part of Nigeria. We were deployed to Zamfara State to support the state health officials to control the outbreak. We described the outbreak, strengthened surveillance, improved laboratory testing and managed data which informed decision making. Methods & Materials: We conducted active case search in health facilities and communities, obtained daily line–list of suspected cases (any person with fever and one of the following: neck stiffness, altered consciousness, bulging fontanelle in toddlers) from all 14 Local Government Areas (LGAs) surveillance officers. Line–lists were cleaned, merged and updated daily. We performed univariate analysis to determine rates, frequencies and proportion. Cerebrospinal fluids (CSF) were collected from suspected cases and were tested using Pastorex kits and culture. Results: A total of 7,035 suspected cases and 536 deaths (case fatality rate: 7.6%) were reported. 3522 (50.1%) were females and modal age group was 1–10 years old 2975 (42.3%). Shinkafi LGA was the worst hit with an attack rate of 663/100,000. Epidemic threshold for the state was reached in epidemiological week 12–17 and peaked at week 14. Out of 233 CSF samples sent for laboratory testing, 109 (46.8%) tested positive for Neisseria meningitides, 103 (94%) of which is serogroup C. Conclusion: The outbreak affected mostly the younger age group and was predominantly caused by Neiserria meningitides serogroup C

Cerebrospinal Meningitis outbreak in Kaura-Namoda Local Government Area, Zamfara State, 2017

Cerebrospinal Meningitis outbreak in Kaura-Namoda Local Government Area, Zamfara State, 2017

Outbreak of cerebrospinal meningitis due to Neisseria meningitidis serogroup C, Sokoto State, Nigeria - May 2017

Introduction : between 2013 and 2016, consecutive outbreaks of cerebrospinal meningitis (CSM) caused by a new strain of Neisseria meningitidis serogroup C (NmC) led to a reported 7,583 cases and 434 deaths in Northwest Nigeria with 1536 cases and 87 deaths from Sokoto state. In March, 2017 a suspected outbreak of CSM was reported in Sokoto State. We investigated the outbreak to describe the epidemiology, identify risk factors, and recommend preventive measures. Methods : we conducted a 1:1 unmatched case-control study using a structured questionnaire to identify risk factors. We defined a suspected case as any resident of Sokoto, with sudden onset of fever (>38.5°C rectal or 38.0°C axillary) and one of the following signs; neck stiffness, altered consciousness, vomiting, diarrhea and/or other meningeal signs including bulging fontanelle in toddlers between February 27 and May 3, 2017. We identified cases at treatment camps and through active case search. Cerebrospinal fluid (CSF) samples were collected for laboratory investigations. Results : we recorded 133 cases with attack rate 89.7 per 100,000. 73 (56%) were female. Mean age (standard deviation) 16 (±10.1) years. Bivariate analysis revealed socio-economic status (OR = 3.5 [95% CI = 2.1 - 5.8]) and previous vaccination against CSM (OR = 2.5 [95% CI = 1.4 - 4.5]) were associated with the outbreak. On multivariate analysis, socio-economic status (aOR = 2.80 [95% CI = 1.61 - 4.87]) and previous vaccination against CSM (aOR = 2.05; [95% CI = 1.05 - 3.99] ) emerged as independent risk factors of CSM in the outbreak. Of the 84 CSF samples collected, 11 (13%) had NmC isolated. Conclusion : this was an outbreak of CSM due to NmC associated with low socio-economic status and previous vaccination against CSM. We supported enhanced case-based surveillance, standard case management, and reactive vaccination with meningococcal C conjugate vaccines. We recommend targeted health promotion campaigns in poor communities and regional vaccination campaigns with a long lasting meningococcal C conjugate vaccine to curtail the current outbreak and to prevent future outbreaks.

Descriptive epidemiology of cerebrospinal meningitis Type C in Bodinga LGA, Sokoto State, Nigeria, April 2017

Introduction : outbreaks of cerebrospinal meningitis (CSM) have recurred in a cyclical fashion for the past 100 years in Africa. Surveillance data showed evidence of serogroup replacement of Neisseria meningitides A by serogroup C with series of outbreaks in 2013 through 2017. In Nigeria outbreaks of CSM occur annually and 13,420 cases with 1,069 deaths were reported by the end of week 18, 2017. We investigated to describe CSM type C epidemic in Bodinga LGA.

Outbreak of cerebrospinal meningitis in Kebbi State, Nigeria, April 2017

Introduction: community-acquired bacterial meningitis continues to exact a heavy toll, even in developed countries, despite the implementation of childhood vaccination programs and effective antimicrobial agents. Nigeria experienced an outbreak of cerebrospinal meningitis (CSM), majorly affecting five states (Zamfara, Sokoto, Kebbi, Niger, and Katsina). We investigated the outbreak in Kebbi State to determine the magnitude, characterize the outbreak in person, place and time, and strengthen case management.

Outbreak investigation of Neisseria meningitides serogroup C Meningitis in Kano State, March - May 2017

Introduction: Nigeria experienced a multi-state outbreak of Cerebrospinal Meningitis (CSM) from Neisseria meningitides serogroup C (Nmc) in March 2017. Kano State, one of the affected 22 states reported its first two confirmed CSM cases on March 22nd 2017. NFELTP residents were deployed to the state to determine the magnitude of the outbreak and characterize it in time, place, and person, and to carry out response activities to control the outbreak.

Managing an outbreak of cerebrospinal meningitis in Zamfara State, 6th to 25th May, 2017

Introduction: the 2016/2017 Cerebrospinal meningitis (CSM) outbreak in Nigeria was first reported on 13th December 2016 in Zamfara State. This outbreak was caused predominantly by Neisseria meningitis sero group C (NmC). As at the 3rd of May 2017, Zamfara State reported 6,400 suspected cases with 503 deaths and a case fatality rate (CFR) of 7.9%. There was a limited amount of NmC vaccine globally to conduct reactive vaccination. The state also has inadequate health-care workers (HCWs) especially doctors to conduct a lumbar puncture (LP) for diagnosis and treatment. The CSF collection rate was about 5.0% (343 samples were collected). Based on this, the National Cerebrospinal Meningitis Emergency Operations Centre (CSM EOC) deployed 28 health workers consisting of doctors, nurses and data managers to improve case management and active case search from 6th to 25th May, 2017.

OUTBREAK OF CEREBROSPINAL MENINGITIS IN KEBBI STATE, NIGERIA.

Cerebrospinal meningitis (CSM), is a major public health problem still affecting tropical countries particularly in sub-Saharan Africa. Group A and occasionally group C account for large scale epidemics in many countries in the African meningitis belt. The study aimed to describe the pattern of cerebrospinal meningitis outbreak in Kebbi state in 2015. Information on cases and deaths was collected throughout the duration of the meningitis outbreak in all affected local government areas of Kebbi state. During this outbreak, we defined a suspected case as any person with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, altered consciousness or other meningeal signs and any toddler with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, or flaccid neck, bulging fontanel, convulsion or other meningeal signs. All the data was entered into SPSS statistical software and analyzed. A total of 1,992 suspected cases of CSM were seen within the 18 weeks that the outbreak lasted. 1127 (57.0%) were males and 865 (43.0%) were females with a case fatality rate of 4.0%. The highest proportion of cases was found among those above 15 years of age (31.0%), 1252 (62.9%) of cases were immunized against neisseria meningitides type A. Two-thirds (16) of the LGAs in the state were affected and Aliero LGA had about half (n=1106; 55.5%) of cases seen. Most (77.3%) of samples analysed were positive for Nm type C. Kebbi state experienced an outbreak of cerebro-spinal Meningitis in 2015 which was massive. Effective surveillance system and mass vaccination with polyvalent vaccines containing serogroup C will prevent future occurrence.

Lessons Learnt from Cerebrospinal Meningitis Outbreak Surveillance Data-A Case for Public Health Action

<p><strong>BACKGROUND:</strong> Outbreak of cerebrospinal meningitis (CSM) remains a major public health concern in Nigeria, particularly in northern Nigeria. The paper evaluates the effect of mass vaccination against cerebrospinal meningitis outbreak in 2013 on the incidence rate in 2014 and 2015, and to document lessons learnt from field experiences of the meningitis epidemic surveillance in Kebbi State, North-west, Nigeria.</p><p><strong>METHODS:</strong> The authors analysed cerebrospinal meningitis surveillance data generated from the routine integrated disease surveillance and response (IDSR) programme executed by the Ministry of Health with support from the World Health Organisation (WHO). Cerebrospinal fluid (CSF) samples via lumbar puncture procedures from a small proportion of all suspected cases that met the standard case definitions were collected, and then tested using the rapid agglutination test kits (Pastorex) at the state public health laboratory. The WHO supported the trained Local Government Areas Disease Surveillance and Notification Officers to ensure data quality.</p><p><strong>RESULTS: </strong>A total of 544 and 1,992 cases were analysed in 2014 and 2015 respectively. In 2014, 14% CSF samples were taken and 55.1% tested positive to <em>Neisseria meningitidis </em>type C. Of all the cases in 2014, 14% were reported dead. Further, in 2015, 4% CSF samples were tested and 83% were positive to <em>Neisseria meningitidis </em>type C. Of the total 1,992 cases in 2015, 4% were reported dead. Gender and CSF sample testing significantly predicts survival in 2014 (p<0.05).</p><p><strong>CONCLUSION: </strong>Desired political will and comprehensive epidemic prevention and control strategies are needed for effective control of seasonal outbreaks of CSM and other epidemic-prone diseases. Need for infrastructural and capacity development of hospital and state public health laboratories for adequate surveillance, testing of samples collected and effective case management cannot be over-emphasized.</p>

Climatic Variables and Disease Incidence in Ghana: A Study of Cerebrum Spinal Meningitis (CSM)

Aim: The study was undertaken to evaluate the effects of climatic factors on the outbreak of Cereb rospinal Meningitis (CSM) in the Obuasi Municipality of Ghana. Significance: The project provides a validated climatic pattern and serves as reference point to: 1. Health administrators on CSM emergency preparedness which could lead to the prevention of fa talities as measures would be put in place to address an occurrence. 2. Environmentalists on the environmental factors that cause CSM outbreak. 3. Health consultants for sensitization and creations of awareness of the causes of CSM. 4. Stakeholders for pla nning and implementation of outbreak preparedness methods and strategy. Methodology: Time series data on rainfall, temperature, and relative humidity was obtained from Ghana Meteorological Agency in Accra and AngloGold Ashanti, Obuasi. The rainfall and tem perature values were taken from 1980 to 20 11 while that of relative humidity was drawn from 1987 to 20 11 due to the unavailability of data. Data on the reported case of CSM was obtained

Role of Neisseria meningitidis W135 in the cerebrospinal meningitis outbreak in Senegal in 2012: Epidemiological and biological characteristics

Role of Neisseria meningitidis W135 in the cerebrospinal meningitis outbreak in Senegal in 2012: Epidemiological and biological characteristics

An outbreak of Cerebrospinal meningitis in Jigawa state Nigeria 2009

An outbreak of Cerebrospinal meningitis in Jigawa state Nigeria 2009