Disease outbreaks reported: Meningococcal disease in the African meningitis belt

Report
from World Health Organization
Published on 10 Apr 2002
The highest burden of this disease occurs in sub-Saharan Africa in an area that is referred to as the meningitis belt. This is the area between Senegal and Ethiopia and includes all or part of at least 15 countries, with an estimated total population of approximately 300 million. Epidemics occur in seasonal cycles between the end of November and the end of June, depending on the location and climate of the country and decline rapidly with the arrival of the rainy season. WHO has received reports from ministries of health in the following countries:
Benin: From 1 January to 31 March 490 cases including 50 deaths (case-fatality ratio, 10.2%) have been reported to WHO. Thirteen districts have been affected of which Materi, Toucountoun, Bembéréké, and N'dali have reached the epidemic threshold. (For more information about the epidemic threshold principle, see the article in the Weekly Epidemiological Record.) Surveillance has been reinforced in the affected districts.

Burkina Faso: As of 3 April, the Burkina Faso Ministry of Health has reported a total of 6 145 cases including 813 deaths (case-fatality ratio, 13%) in the country since 1 January. The epidemic started in the district of Pama and has spread to 26 districts, affecting a population of c. 6 million.

On 5 April the Ministry of Health has launched an appeal to the international community for assistance in combating the epidemic. The appeal is for help in the provision of drugs and vaccine, laboratory equipment, reagents and operational costs to ensure surveillance and full epidemic investigation and response. WHO has provided 47 000 vials of oily chloramphenicol through the International Coordinating Group of Vaccine Provision for Epidemic Meningitis Control (ICG).

Chad: Cases were reported to WHO in the districts of Koumra, Goré and Pala. Neisseria meningitidis serogroup A was laboratory confirmed. A mass vaccination campaign has been implemented in Goré and Pala.

Cote d'Ivoire: From 1 January to 31 March 189 cases including 32 deaths (case-fatality ratio, 17%) have been reported to WHO.

Ethiopia: As of 3 April 3 540 cases including 166 deaths (case-fatality ratio, 4.7%) have been reported to WHO since the outbreak began in September 2001 (see previous report). The regions affected by the outbreak are: Sidama, Davro, Keffa, South Omo, Amhara and Tigray.

The Task Force on Epidemic Meningococcal Disease, set up by the Ministry of Health is working to coordinate control activities including surveillance, case management, vaccination campaigns and logistics. WHO and its partners are providing vaccine and 10 000 vials of oily chloramphenicol through the International Coordination Group on Vaccine Provision for Epidemic Meningitidis Control (ICG) . The Ministry of Health, on behalf of the Task Force, has launched an urgent appeal for US$ 2.5 million to carry out a mass vaccination campaign in 5 priority zones in the Southern Nations, Nationalities and Peoples Region. The campaign is ongoing in 4 districts with the support of Médecins sans Frontières (MSF-Holland) Holland, the International Federation of the Red Cross and Red Crescent Societies and UNICEF; 14 districts have yet to be vaccinated.

Gambia: From 1 January to 31 March 50 cases including 3 deaths (case-fatality ratio, 6%) have been reported to WHO. The Department of State for Health is planning a mass vaccination campaign from the 15 to 29 April. WHO has provided 275 000 doses of vaccine.

Ghana: From 1 January to 31 March 1 407 cases including 190 deaths (case-fatality ratio, 14%) have been reported to WHO. Twenty-one districts have been affected of which Bongo, Kessena, West Gonja, Na, Jirapu-Lambus, Gushiegu-Karaga, Techiman, Krachi, East Maprusi, Builsa and Lawra have reached the epidemic threshold. Neisseria meningitidis serogroup A has been identified and a mass vaccination campaign is ongoing.

Guinea: From 14 January to 3 February 22 cases including 6 deaths (case-fatality ratio, 27%) have been reported to WHO in Youmou district. Neisseria meningitidis serogroups A and C were laboratory confirmed. Case management and vaccination were implemented.

Mali: From 1 January to 31 March 336 cases including 29 deaths (case-fatality ratio, 8.6%) have been reported to WHO. Six districts have been affected of which Ansonga, Niafunké have reached the epidemic threshold. Neisseria meningitidis serogroup A was isolated and cases have been under investigation. Stocks of vaccine and chloramphenicol have been reinforced.

Mauritania: From 7 January to 31 March 26 cases including 2 deaths (case-fatality ratio, 8%) have been reported to WHO.

Niger: From 1 January to 31 March 2 508 cases including 210 deaths (case-fatality ratio 8.4%) have been reported to WHO. The outbreak has occurred in the entire country except in the Diffa area (east Niger). Six health districts: Bilma, Loga, Guidan-Roumdji, Madaoua, Dakoro(Maradi), and Matameye(Zinder) have been particularly affected. The first four districts have reached the epidemic threshold. Neisseria meningitidis serogroup A has been identified in most laboratory confirmed cases, and some W135 have been identified as well. Surveillance activities have been reinforced.

Somalia: As of 1 March 237 cases including 15 deaths (case-fatality ratio, 6.3%) have been reported to WHO since the outbreak began in October 2001 (see previous report). The outbreak has affected the cross border zone with Ethiopia in the vicinity of the towns of Hargeisa and Harti Sheikh. A National Epidemic Task Force including the Ministry of Health, Somalia, WHO, UNICEF, the Somali Red Crescent Society (SRCS) and Médecins sans Frontières (MSF-Holland) has coordinated the response and conducted a mass vaccination campaign. The teams carrying out the campaign assisted in epidemiological surveillance, collection and testing of samples. Neisseria meningitidis serogroup A has been laboratory confirmed by the WHO Collaborating Centre for Reference and Research on Meningococci, Oslo, Norway. The epidemic trend has been declining.

Sudan: As of 11 February 330 cases including 49 deaths (case-fatality ratio, 14.8%) have been reported in the south of the country. As of 3 April, 30 000 people have been vaccinated in Torit county. Neisseria meningitidis serogroup A has been laboratory confirmed. Health education, active case surveillance and case management have been reinforced in the affected areas. WHO, UNICEF, African Medical and Research Foundation, NGOs and a network of counterparts have provided technical assistance, laboratory support, vaccine, drugs, supplies and transport.

Senegal: From 7 January to 10 March 71 cases including 6 deaths (case-fatality ratio, 8.5%) have been reported to WHO.

Tanzania: From November 2001 to February 2002 84 cases including 6 deaths (case-fatality ratio, 7.8%) have been reported in refugee camps in Kibondo district, western Tanzania . The outbreak occurred during an unusually heavy rainy season in the country. Neisseria meningitidis serogroup A has been isolated.

Togo: From 1 January to 24 March 559 cases including 91 deaths (case-fatality ratio, 16%) have been reported to WHO. Thirteen districts have been affected of which Assoli, Tchamba, Sotouboua, Blitta, and Wawa have reached the epidemic threshold. Neisseria meningitidis serogroup A has been isolated.