Nigeria: Meningitis Emergency Plan of Action (EPoA) DREF Operation no. MDRNG021

A. Situation analysis

Description of the disaster

Meningitis is a serious viral or bacterial disease in which an outside layer of the brain or spinal cord becomes affected and swollen, and can lead to death of the patient. Symptoms of the disease include neck stiffness, high fever, rash, headache, vomiting and confusion. The bacterial or viral infection is transmitted through droplets, which include sneezing coughing and sharing of eating or drinking utensils. Meningococcal disease is spread from person to person. The bacteria spread by exchanging respiratory and throat secretions (saliva or spit) during close (for example, coughing or kissing) or lengthy contact, especially if living in the same household. The bacteria are not spread by casual contact or by simply breathing the air where a person with meningococcal disease has been. People in the same household, roommates, or anyone with direct contact with a patient’s oral secretions would be considered at increased risk of getting the infection.

As one of the countries within the Meningitis Belt, Nigeria has recorded outbreaks in the past. Until recently, these outbreaks were caused mostly by Neisseria meningitides serogroup A (NmA). These outbreaks occur in the dry season, due to low humidity and dusty conditions and usually ends with the onset of the rainy season.

The current outbreak of Cerebrospinal Meningitis (CSM) in Nigeria is a repetition of series of outbreaks mostly affecting States in the upper parts of the country, which fall within the African Meningitis Belt. Since the first case of Cerebrospinal Meningitis (CSM) was reported in the North-Western Region of Nigeria in week 50 of 2016, not less than 4,255 suspected cases have so far been reported with 455 deaths and CFR of 10.7% from 128 Local Government Areas (LGAs), with the outbreak reaching epidemic proportion in five states, including Zamfara, Sokoto, Kebbi, Katsina and Niger States. As at reporting week 13 of 2017, all 14 LGAs in Zamfara state as well as neighbouring LGAs have been affected some of the cases have crossed alert or epidemic thresholds as shown on the spot map below. The table below also shows the list of affected states and cases reported as at 9 th of April, 2017. Zamfara, Katsina and Sokoto states account for 93% of the cases reported (Nigeria CDC sitrep on 11th April 2017).

Although Nigeria has witnessed outbreaks of meningitis in the past, since the large-scale vaccination against meningitis A there is a “serotype replacement” – and increase in the cases and outbreaks caused by other Nm serogroups such as W, X, and C. The current outbreak is caused by - N. meningitis serogroup C (NmC). Therefore, vaccines containing Men C are required in its prevention as a matter of urgency be put in place to combat the spread. As at Monday 9th of April, 128 (LGAs) in 21 States have been affected by - Neisseria Meningitides type C.

Summary of the current response

Overview of Host National Society

The Nigerian Red Cross Society (NRCS), as an auxiliary to the Government of Nigeria has continued to support the Government in the fight to contain the outbreak since its inception. The NRCS has a pool of trained and well equipped volunteers comprising of health action teams (HATs), mothers’ Club, NDRT and CBHFA trainers/volunteers with a wealth of knowledge and practical experience in responding to disasters and health epidemics. Through the National Society (NS)’s grassroots presence and wide range of community-based volunteers, the NRCS is carrying out social mobilization, disease surveillance as well as supporting the case management teams in Sokoto and Zamfara States.

At the National and State level, the NRCS is an active member of the Emergency Operations Centre (EOC) led by the Nigerian Centre for Disease Control (NCDC). At the EOC, the NRCS has been saddled with the responsibility to support the Social mobilization and Surveillance Working groups.
Following the continued spread of cases, the NRCS intends to scale-up these activities through a DREF operation, targeting those communities in the affected LGAs, surrounding LGAs identified to be at high risk on the outbreak spreading. These will include social mobilization activities for preventive and reactive campaigns, disease surveillance and risk mapping as well as Psychosocial Support (PSS) services.