Thought Leadership

Diagnosis: Meningococcal Meningitis

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I cannot forget one of ‘my’ patients during the first medical clinical rotation under Professor Nwabueze at the University of Nigeria Teaching Hospital. You could not imagine a death more painful. This young man of about 40 years had full blown meningism with a neck stiff, high unrelenting fever, confusion, coma and eventual death.

Nigeria belongs to a region of the world where meningitis is most prevalent occuring in often large epidemics; commonly referred to as the “meningitis belt“. These large epidemics which occur in a cyclic mode due to herd immunity (whereby transmission is blocked when a critical percentage of the population had been vaccinated, thus extending protection to the unvaccinated). This form of meningitis, caused by type a of the bacteria is generally referred to as Cerebro-Spinal Meningitis (CSM).

There have been several reports in the media about an ongoing Meningitis outbreak in Northern Nigeria. This cycle has been expected for some time.

On the 9th of February, WHO announced that there have been 1364 suspected cases of meningococcal disease in Nigeria including 108 deaths (case-fatality rate: 7.9%) in 19 out of 35 states and Abuja.…t

Now on the 3rd of March, the Minister of Health Professor Osotimehin goes public saying that 5,323 cerebrospinal meningitis (CSM) cases had been reported in various parts of the country with 333 deaths in 22 states. (case-fatality rate: 6.3%)

…it must have be considered quite serious that tonight, the 5th of March 2008…our beloved NTA International had as their lead story on Network News at 9pm! Believe it or not…this came before they went through their usual nightly routine on who had visited the President, Vice President, Senate President, Speaker and all their respective First Ladies….

…Professor Osotimehin faced the Nation telling us:

  • He had just returned from a tour of the affected states
  • The states are leading in the control of the outbreak
  • He stated that 6 million doses of the vaccine had been procure (WHO says 1 million to Nigeria on their website – date 04/03/09)
  • He expressed satisfaction at the response
  • The strategy of the FMoH was to “continue and sustain

We have come to accept these epidemics as inevitable. Despite repeated coverage of the ongoing legal battles with Pfizer and the Kano epidemic of 1996, (for which Pfizer has negotiated a N11.2bn settlementt)
,we as a country have not confronted confronted our reality when it comes to CSM and other infectious disease. They will not go away!

While we are HAPPY that the Minister is taking the lead on this…we need to start now preparing for the next cycle (large outbreaks occur apporximately every 3 years)

  • Antibiotics that can cure meningococcal meningitis…but patients need access to health care services rapidly. A case fatality ratio of 7% is way too high and an indictment on the health services provided.
  • Yes, a vaccines against the disease exists—they are “polysaccharide” vaccines—and they have limitations. They don’t work in children under two and thus leave the most vulnerable unprotected.
  • Because polysaccharide vaccines do not provide long-lasting immunity, the reactive mass vaccination campaigns must be repeated outbreak by outbreak, therefore requiring skilled expertise.
  • We therefore need a national centre for disease control as in most other countries in the world, to train and maintain the skills necessary to prepare and respond to outbreaks like this.
  • To support this we need a Field Epidemiology Training Programme as in many African countries...Ghana, Zimbabwe, Uganda, South Africa, and Kenya
  • In the future we can and should manage outbreaks like this without the help of European Commission Humanitarian Aid Department (ECHO), Médecins sans Frontières and UNICEF as is the case in this outbreak…

The good news is there is hope for a vaccine that will give long standing immunity against Meningitis A…which will hopefully be available soon. But having a vaccine is one thing…getting it to people that need it is another. With our vaccine coverage rates for childhood vaccines averaging at 30% (data from 2003) then we do have a lot of work to do….a lot!

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

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