Guinea: Meeting on the Risk of a Meningococcal Meningitis Outbreak (UNHCR)

UNHCR KISSIDOUGOU, Guinea, 26/03/01
Meeting on the Risk of a Meningococcal Meningitis Outbreak

The first case of meningitis in Kountaya camp presented at the beginning of March 20001. During the week of 19th to 25th March 2001 we exceeded the limit of 15 cases per 100,000 population per day at Kountaya. Please note that an epidemic of meningitis is declared once this rate is exceeded for two consecutive weeks. Also note that the last epidemic of meningitis occurred in the Prefecture of Kissidougou in 1993.

As a result of the above, a meeting was called by HCR (attended by the DPS of Kissidougou, the Director of Kissidougou hospital, and the focal points of each of the health agencies, ARC, MSF, MDM, ACF, HCR) on Sunday 25th of March 2001, at 10.30 Am. The purpose of the meeting was to discuss the current situation and determine the lines of action for each implementing partner.

Below follows a summary of the discussion and the decisions taken, as well as a review of the key elements needed to deal with this situation.

1. Surveillance Focal Point: Dr. Doumbia

Partners concerned: ARC, MSF, MDM, FICR/CRG, Director Kissidougou Hospital, DPS, and HCR

In the Field: Partners are requested to increase surveillance for new cases on a daily basis in every site for which they are responsible. The following data are requested for each case:

Partners are also asked to map the location of each case and visit the home of all patients (old and new) to search for additional cases. This may also help to determine focal points of infection.

Daily: Each partner/agency will give daily reports to HCR by 18.00 hours at the latest for the previous day - (the day begins at 8 am each morning).

Data Communication by Radio (ARC, MSF, MDM, FICR/CRG, Kissidougou Hospital:
Date needed. For radio communication, only: place, age, sex, suspect or probable case.
N.B.- Please note that even if there has been no case, «zero cases » must be reported.

Weekly: Each partner/agency will present a resume of cases (see attached form annex I)

Feedback: The HCR focal point will provide a report to agencies and partners during the weekly health meeting (every Wednesday)

The system will commence on Monday 26th March.

2. Case definition

Agencies are asked to review the case definitions below with their personnel:

Standard case definition:

Non-outbreak situation: Neck stiffness, fever (39 - 40), intense headache, photophobia
Nausea and projectile vomiting.

Outbreak definition: (less specific)

Suspect case (peripheral level):

• Sudden onset of fever (‘» 38,5 rectal, » 38,0 axillary)
• With stiff neck
• And/or petechial or puerperal rash

For infants under one year of age:

• fever
• with bulging fontanel

Probable case (intermediate level - where an L.P. can be performed)

• Suspect case
• with turbid CSF (with or without a negative gram stain)
• OR an ongoing epidemic

Confirmed case (central level - well functioning laboratory):

• Suspect or probable case
• And: either CSF antigen positive
• OR positive culture

Regarding suspect cases, agencies are asked:

• To perform a lumbar puncture if feasible under the conditions (please send the CSF sample in a clean container at ambient temperature with the patient).
• to refer the patient to Kissidougou hospital as quickly as possible
• to follow the treatment schedule below

Laboratory Investigation: (Focal Point Dr. Bruno)

• if the lumbar puncture has not been done at the peripheral level, it should be done as soon as the patient arrives in the hospital. The following should also be done:

Methylene Blue gram stain (for gram negative diplococci)

• Review the availability of reagents at the hospital: Action: Dr. Bruno

Culture on special media (Mueller-Hinton or Chocolate - Agar)

• Examine the availability of other culture media: Action: Dr. Bruno / Dr. Ablo

Responsibility for transfer of specimens: Dr. Bruno

3. Treatment

Antibiotic Therapy

Immediately following the L.P. If the L.P. is delayed, treat immediately:

Action:

Dr. Bruno will follow up on the stock of oily chloramphenicol available
Agencies are asked to review the treatment protocol with their health personnel

Other measures

- Isolation: if possible at the level of Kissidougou hospital, we may eventually envisage an isolation tent (Dr. Bruno: please follow up with logistics to bring the tents from Conakry). Depending on conditions once treatment commences, the following may be needed:

- rehydration if necessary

- anti convulsive treatment if necessary (diazepam - (route NG in infants)

- anti-emetics if necessary.

4. Prevention

- transmission is commonly person to person by respiratory droplets of oral secretions; therefore: reduction of overcrowding in the transit camps as soon as possible is imperative to avoid the spread of the disease

- The organism is sensitive to heat and desiccation therefore it is not necessary to disinfect clothes, sheets.

Vaccination

Last week OMS was asked to look into the availability of vaccine at the country level. There is no vaccine in Kissidougou at present: Drs. Bruno / Brennan please follow the request for vaccine.

Chemoprophylaxis

This is not recommended by WHO during an epidemic for the following reasons: large numbers of contacts are possible, there is a risk of adverse events, this would encourage resistance. Prophylaxis may be eventually considered for small groups of persons living in very closed conditions.

5. Information, Education and Communication

Agencies are asked to inform their community health workers concerning this issue, in order to answer any community concerns. Above all we need to avoid panic, false rumors, and social isolation of patients families.

In conjunction with the mass information section (HCR), we can envisage posters to communicate simple clear messages (focal point Dr Doumbia). We are convinced that it is better not to make a formal announcement before being certain that an epidemic exists, and/or to confront rumors on this subject.

6. Other Points.

A mixed team will visit Kountaya on Monday the 26th of March to investigate thee situation in the field.