Meningitis: The Killer Disease Ravaging Nigerians 

With 16 states and the FCT said to be affected by the recent outbreak of meningitis in Nigeria, and about 340 persons reported to have lost their lives, Martins Ifijeh writes on role of the government, stakeholders and the citizens in eradicating the killer disease 

Nigerians should take precautions against meningitis

When two weeks ago the report of cerebrospinal meningitis outbreak hit Nigerians, not many believed it will linger on and take the lives of hundreds of people the way it did. But as the day went by, the deadly and viral nature of the killer disease became obvious, claiming almost 350 persons, which were majorly children.

 The disease has also spread to 16 states, the Federal Capital Territory and 90 local government areas in the country. States affected so far are Zamfara, Katsina, Sokoto, Kebbi, Niger, Nassarawa, Jigawa, Gombe, Taraba , Yobe, Kano, Osun, Cross Rivers, Lagos, Plateau and FCT.

 The Federal Ministry of Health (FMOH) and the Nigerian Centre for Disease Control (NCDC) say the disease has reached an epidemic status in five of such states, and that five neighbouring countries within the Meningitis belt – Niger, Chad, Cameroon, Togo, and Burkina Faso – were facing similar outbreaks at the moment.

While about 350 people have lost their lives already in one of the most devastating meningitis outbreak in Nigeria, over 2524 persons, according to the FMOH and NCDC were currently being affected, with majority of the 131 samples collected already confirmed in the laboratory to be Neisseria Meningitides type C.

 The Director, Media and Public Relations, FMOH, Mrs. Boade Akinola says although this was not the first time or the worst epidemic ever faced by Nigeria, this round of the epidemic has come with a difference, as all previous epidemics were caused by Neisseria Meningitides type ‘A’ but this year’s own was recording Neisseria Meningitides type C in epidemic proportion for the first time.

 “Historically, the worst CSM epidemics experienced in Nigeria occurred in 1996 when about 109,580 cases and 11,717 deaths were recorded, followed by the one in 2003 (4,130 cases and 401 deaths) then in 2008 (9,086 cases and 562 deaths) and in 2009, when 9086 cases and 562 deaths were recorded.

 “These historical records and past experiences influenced health authorities in Africa (especially countries within the African Meningitis Belt), the World health Organisation (WHO) and many development partners to roll out a strategic intervention for the effective prevention of such epidemics. This gave birth to the mass vaccination campaign using a new conjugate vaccine the MenAfriVac-A in about 16 out of the 26 vulnerable countries (including Nigeria). It resulted in a reduction of over 94 per cent incidence of the disease in most countries, thus significantly reducing the risk of type A,” she said.

Akinola noted that some key lessons learnt from the MenAfriVac-A mass vaccination campaign and the recent happenings across the sub-region, were that, although type A was successfully displaced, other strains which were hitherto less significant can actually assume epidemic proportions. “Thus efforts must continue towards preventing a rebound of the type-A and also prevent a potential replacement by all other strains.

 But with the viral spread of the disease in several states, with high number of casualty, what is the likely cause and what can the public do to prevent themselves? The Ministry of Health provides a guide.

 It says the disease spreads from person to person through contact with discharges or droplets from nose and throat of an infected person, adding that it can also be transmitted through kissing, sneezing and coughing especially amongst people living in close quarters, hotels, refugee camps, barracks, public transportation and areas with poor ventilation or overcrowded places.

 According to Akinola, Nigerians should avoid overcrowded places, sleep in well ventilated places, avoid close and prolonged contact with a case/s, properly dispose off respiratory and throat secretions, strictly observe hand hygiene and sneezing into elbow joint/sleeves.

 The members of the public were also advised to reduce handshake, kissing, sharing utensils or medical interventions such as mouth resuscitation, and vaccination with relevant sero-type of the meningococcal vaccine should be used and self-medication should be avoided.

 While noting that self-medication should be avoided, she said Nigerians should acquaint themselves with at least the basic knowledge and understanding of CSM and how it was transmitted and prevented. “Nigerians should strictly adhere to the advice of health workers on how to protect themselves. There should be prompt seeking of medical care as soon as CSM or CSM-like Illness is suspected,” Akinola noted.

 She said the ministry has directed all hospitals to ensure appropriate diagnoses were made including laboratory confirmation and immediate reporting through the surveillance system.

 “Hospitals should commence early treatment as soon as the diagnoses of CSM is made, and there should be restriction of interaction with other people once one is diagnosed as a case of CSM.” Adding, she said all secondary and tertiary public health facilities should provide free treatment to all CSM patients.

 On the actions taken so far by the Health Ministry since the recent outbreak, Akinola said a CSM outbreak control team has been constituted to coordinate all responses aimed at controlling the outbreak (although a recent information from the NCDC twitter handle says the control team has now been transitioned into an Incident Management System). Adding that membership include FMOH, NCDC, National Primary health Care Development Agency (NPHCDA), the World Health Organisation (WHO) and other partners (MSF, UNICEF, CDC and EHealth Africa).

 She said all initial five states have commenced Emergency Operation Centre EOC/EPR meetings and mapping of resources at state level to identify ongoing activities.

 “Functional Isolation Centres/Units have been identified in all states and efforts are on to strengthen them. Antibiotics and management supplies are available and being used as per protocol in all states for treatment. Number of cases currently on admission or treated since the onset of the outbreak are being collated across LGAs and states, and micro plan concluded in Zamfara for possible vaccination in week 14,” she added.

 On surveillance, the Ministry of Health Director said active case searches in the affected LGAs and register review were ongoing ongoing. “Also, clinician sensitisation and training have been proposed in selected areas, while CSM guidelines, including laboratory protocol were under review.”

 Akinola said that the ministry has embarked on communication and social mobilisation through community health education as part of state team responses with support from UNICEF, while most states (especially Katsina and Zamfara) are doing radio jingles with support from UNICEF, while IEC materials were being developed by NCDC, NPHCDA and UNICEF.

 As a prevention mechanism, Akinola urged members of the public to avoid overcrowding, sleep in well ventilated places, avoid close and prolonged contact with a case, proper disposal of respiratory and throat secretions, strict observance of hand hygiene and sneezing into elbow joint/sleeves.

 “We are equally reassured that more doses are expected and all necessary documentation for the new vaccines arrivals have been concluded,” she stated. She also assured that the Federal Ministry of Health would continue to provide regular feedback to the general public on the necessary steps to take, urging people to “remain calm and continue to abide by the health advisory being issued periodically,” she said.

 Meanwhile, Lagos State Commissioner for Health, Dr. Jide Idris, in a statement made available to THISDAY said though, seasonal meningitis outbreak usually affects the mainly Northern states that fall within the meningitis belt of the country, it was not impossible that outbreaks can occur in any part of the country, Lagos inclusive, in view of the phenomenal climatic change as well as the high human migration.

 He added that no case of CSM has been recorded in Lagos State contrary to what has been published. “However as a responsive government, we deem it fit to alert the public.”

 Idris explained that the disease usually presents with high body temperature, pain and stiffness of the neck, headache, vomiting, fear of light, restlessness and confusion stressed that death may occur if not promptly and properly managed.

 He therefore emphasised the need for the observance of high standards of personal and environmental hygiene as a preventive measure against the disease. Adding that such measures should include washing of hands with soap and water frequently; avoiding direct contact with the discharges from an infected person and covering of the mouth and nose when coughing and sneezing.

 Idris noted that health workers in the state, especially those in the hospitals, the State Epidemiology Team and the Disease Surveillance and Notification Officers (DSNOs) in all the 57 Local Governments and Local Council Development Areas have been placed on high alert and therefore the disease surveillance and monitoring activities have since been intensified.

 “Health workers are also advised to avoid close contact with suspected and probable cases of CSM based on the case definition distributed, ensure proper disposal of respiratory and throat secretion of cases, report suspected or probable cases, observe universal safety precautionary measures and make use of personal protective equipment when in contact with such cases as highlighted in the Fact-Sheets earlier forwarded to them,” he noted.

While urging residents to take responsibility for their health and report persons with the above symptoms to the nearest public health facility or the Ministry of Health, Idris said the government had put in place all the above measures towards avoidance and prevention of outbreak of CSM in Lagos State.

 He advised the general public to remain calm and report suspected cases to the nearest public health facility or contact Disease Surveillance Officers of the Ministry of Heath on the following GSM numbers 08037170614, 09087106072, 08023169485, 08052817243, 08026441681.