Location at a look
Between October 1, 2022 and April 16, 2023, Nigeria reported a complete of 1,686 suspected instances of meningitis, together with 124 deaths, for a case fatality price (fatality) of seven%.
Meningitis is a severe an infection of the meninges, the membranes protecting the mind and spinal twine. It’s a devastating illness and a significant public well being problem. Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae And Streptococcus agalactiae (group B streptococci) are the primary causative brokers of meningitis. Vaccines can assist stop meningococcal illness.
Description of the scenario
From October 1, 2022 to April 16, 2023, a complete of 1,686 suspected instances, 532 confirmed instances and 124 deaths (case fatality: 7%) have been reported in 81 native authorities areas (LGAs) in 22 of the 36 administrative states, together with the federal authorities. Capital Territory (FCT), Nigeria.
Males symbolize 57% (n = 961) of the overall suspected instances. The very best proportion of reported instances are kids aged 1 to fifteen years. Jigawa State accounts for 74% (n=1,252) of all suspected instances and borders the Zinder area of Niger, the place a meningitis outbreak has been reported since October 2022.
A complete of 481 cerebrospinal fluid samples have been collected from sufferers in 18 states. Of those samples, 247 examined constructive for bacterial an infection by PCR testing. Of the constructive instances, 226 (91%) have been as a consequence of Neisseria meningitidis serogroup C (NmC), whereas 13 instances (5.4%) have been attributable to Streptococcus pneumoniaeand just one case (0.4%) per Haemophilus influenzae. For 232 samples the outcome was unfavorable and for 2 the result’s pending. Within the final 5 weeks alone (epidemiological weeks 11 to fifteen), 41 of 140 samples examined (29%) have been constructive for NmC. The confirmed instances have been reported from eight states, together with Jigawa (231), Zamfara (six), Yobe (5), Benue (one), Gombe (one), Katsina (one), Oyo (one) and Sokoto (one). .
Fig. 1. Map exhibiting meningitis instances (n=1686 suspected instances) between October 1, 2022 and April 16, 2023
Supply: Nigeria Middle for Illness Management and Prevention (NCDC)
Jigawa State includes 27 LGAs, of which 25 have reported not less than one suspected case. There have been 66 deaths in Jigawa State. In the course of the present outbreak, Maigatari and Sule-tankarkar LGAs have each crossed the epidemic threshold of 10 suspected instances per 100,000 inhabitants and account for 60% of the overall reported instances, with 505 and 247 instances respectively.
The lethality of this epidemic is 7% and 5% respectively nationally and in Jigawa State.
Determine 2. Weekly distribution of meningitis instances (n = 1686 suspected instances) between October 1, 2022 and April 16, 2023
Epidemiology of the illness
Meningitis is a severe an infection of the meninges, the membranes protecting the mind and spinal twine. It’s a devastating illness that is still a significant public well being problem. The illness might be attributable to many various pathogens, together with micro organism, fungi or viruses, however bacterial meningitis constitutes the best international burden.
A number of totally different micro organism could cause meningitis. Streptococcus pneumoniae, Haemophilus influenzaeAnd Neisseria meningitidis are the most typical. N. meningitidischargeable for meningococcal meningitis, is the one which dangers inflicting giant epidemics.
Meningococcal meningitis is unfold from individual to individual by way of droplets of respiratory and pharyngeal secretions, normally by asymptomatic carriers. Extended shut contact with an contaminated individual or dwelling with a service makes it simpler to unfold the illness. The common incubation interval is 4 days however can range between two and ten days.
The huge meningitis belt of sub-Saharan Africa, stretching from Senegal within the west to Ethiopia within the east (26 nations) and together with the northern a part of Nigeria, has the very best charges of illness college students. In these nations, meningitis follows a seasonal sample, being commonest in the course of the dry season (December to June), peaking between March and April, when air humidity is low and protracted and mud hundreds are excessive, prone to harm the pharyngeal mucosa and facilitate an infection. colonization of the nasopharyngeal epithelium by meningococci. The size of seasonal epidemics varies from 12 months to 12 months.
Response measures carried out throughout an outbreak, together with improved case detection and administration in addition to mass vaccination campaigns, contribute to epidemic management.
Meningococcal meningitis stays a public well being drawback in Nigeria, with outbreaks reported in recent times. With assist from WHO, the Nigeria Middle for Illness Management and Prevention (NCDC) is implementing response measures on the nationwide degree. These embrace vaccination, surveillance, lively case discovering, pattern testing and case administration.
With assist from WHO, the Nigeria Middle for Illness Management and Prevention (NCDC) is implementing response measures on the nationwide degree. These embrace:
- Each day coordination conferences have been held on the state and LGA ranges since December 2022;
- Surveillance actions with speedy response groups persevering with to conduct lively case discovering;
- Case administration actions in public well being facilities in affected LGAs;
- Vaccination actions in 17 excessive precedence wards within the precedence LGAs of Maigatari, Sule-tankarkar, Gumel and Gagarawa – all in Jigawa State.
Nigeria has carried out interventions to fight meningitis, together with introducing the Meningococcal A (MenA) conjugate vaccine in opposition to NmA from 2011 to 2022. By preventive campaigns, Nigeria has vaccinated over 100 million individuals. individuals aged 1 to 29 years and the vaccine has been included within the nation’s routine immunization schedule since 2019. Amongst populations vaccinated in opposition to MenA in meningitis belt nations, the incidence of serogroup A meningitis has been enhance. has decreased by greater than 99% and no instances of serogroup A have been confirmed since 2017. Nevertheless, there are nonetheless annual reviews of meningitis instances within the nation that are primarily related to meningococcus serogroup C (NmC).
Insecurity, notably in northeastern Nigeria, is affecting vaccination protection, notably in areas managed by non-state armed teams. On the nationwide degree, vaccination protection stays suboptimal at 50% in 2021.
Permitted vaccines in opposition to meningococcus, pneumococcus and Haemophilus influenzae the illnesses have existed for a few years. These micro organism have a number of totally different strains (referred to as serotypes or serogroups) and vaccines are designed to guard in opposition to probably the most dangerous strains. Over time, there have been main enhancements in pressure protection and vaccine availability, however there is no such thing as a common vaccine in opposition to these infections.
Moreover, in November 2022, a meningitis outbreak was confirmed within the Zinder area of Niger. This area borders Jigawa, which is the worst affected state in Nigeria. The chance of cross-border transmission is excessive as a consequence of inhabitants actions throughout the border.
Primarily based on the above info, the general threat of meningitis in Nigeria is assessed as excessive nationally, reasonable regionally and low globally.
Stopping meningitis by way of vaccination is the best approach to cut back the burden and affect of the illness by offering long-lasting safety. The deliberate deployment of multivalent meningococcal conjugate vaccines is a public well being precedence to get rid of outbreaks of bacterial meningitis within the African meningitis belt.
Early analysis and remedy are important to the administration of all forms of meningococcal illness. Applicable case administration, lively group case discovering, and mass and responsive vaccination of affected populations are crucial in response to outbreaks. At the moment, a reactive vaccination marketing campaign is underway. To information subsequent response actions, it’s essential to watch the unfold of the illness to new areas, together with contemplating new requests for vaccines as applicable. The velocity of the reactive marketing campaign is crucial, the goal being to launch it inside 4 weeks of crossing the epidemic threshold.
WHO doesn’t advocate any restrictions on journey and commerce with Nigeria based mostly on presently obtainable info.