Tag: WHO in Nigeria

Meningitis Outbreak In Nigeria

Statistics: The outbreak began in March 2016, approximately 15 States have been affected, almost 2000 Suspected Cases. Approximately 300 deaths so far. The states with the largest number of cases include: Kebbi, Katsina, Niger, Sokoto, Zamfara State.

Who Is In Charge of Managing The Outbreak? 

  • Nigeria’s Centre for Disease Control  is leading outbreak control in coordination with the World Health Organization (WHO), UNICEF, US Centers for Disease Control (CDC), Medecins Sans Frontieres, and Ehealth Africa
  • NPHCDA is leading vaccination in Zamfara state, similar efforts are being coordinated in other affected states
  • WHO is working to ensure the availability of vaccines.

What Are The Risk Factors?

  • Outbreak tends to occur in dry season because of low humidity and dusty conditions
  • The northern part of Nigeria seems to have a higher perdisposition because of their environment
  • Overcrowding and poor sanitation can contribute to outbreaks
  • Living in Dormitories, military bases, child facilities
  • Lack of Vaccination
  • Compromised immune system
  • Pregnancy increases risk of Listeria meningitis.

What Is Meningitis? 

  • It is an Infection of the brain and spinal cord. Organisms can enter the blood stream and travel to the brain and spinal cord, or invade the meninges directly through an ear or sinus infection, skull fracture, or after surgeries in the brain or spinal area
  • Can be caused by bacteria, virus, or fungus
  • Bacterial meningitis most common in teenagers and young adults, it is very severe and can lead to death
  • Viral meningitis are most common in children <5 years, but often mild, can clear on its own
  • Fungal meningitis is rare, usually chronic, it is not contagious, and may be seen in people with immunodeficiency such as AIDS.

Bacterial Meningitis

  • Could be caused by multiple organisms including Streptococus Pneumonia, Haemophilus Influenzae, Listeria Monocytogenes, and most commonly Neisseria Meningitidis (N. meningitidis).
  • Nigeria’s current outbreak is of N. meningitidis (C serogroup), affects mostly teenagers and young adults.
  • Bacterial Meningitis is highly contagious, can lead to death with 24 to 48 hours if untreated.

How Bacterial Meningitis Spreads

  • It spreads through the respiratory system via droplets. Exposure to kissing, coughs, sneezes, shared cutlery, or sharing items that were in contact with an affected person’s saliva such as toothbrush, cigarettes etc.
  • Can contact meningitis by staying in an enclosed environment or room with an affected person.
  • Spreads very quickly in a crowded environment.

Symptoms Of Meningitis

  • Severe Headache that’s different from your usual
  • Difficulty concentrating or Confusion
  • Sudden high fever
  • Stiff neck
  • Sensitivity to light
  • Sleepiness or difficulty waking up
  • seizures
  • Poor appetite
  • Skin rash
  • Muscle and joint aches

Symptoms Of Meningitis In Infants

  • High fever
  • Irritability or Constant Crying
  • Poor feeding
  • Excessive sleepiness
  • Inactivity or sluggishness
  • Stiff neck or body
  • A bulge in the soft spot on the baby’s head

What To Do If You Suspect Meningitis

  • Prompt response and treatment can save lives and prevent complications
  • Avoid exposing others, wear mask and isolate yourself if possible
  • Go to the nearest hospital immediately
  • Tell the Doctor all your symptoms

Evaluation And Management Of Bacterial Meningitis

  • Bacterial meningitis is a medical emergency. Treatment must be initiated immediately to reduce the risk of death
  • Evaluate Patient for:
    • Recent exposure to persons with meningitis
    • Otorrhea (leaking ears) or rhinorrhea (runny nose)
    • Recent travel to areas with endemic meningitis
    • Recent or remote head injury
    • Recent infection (especially ear infection)
    • Immunocompromised conditions
    • Intravenous drug use
  • Obtain blood cultures and Cerobrospinal (CSF) fluid through lumbar puncture if no contraindications
  • Initiate empiric intravenous antibiotics immediately, can use third-generation cephalosporin like cefotaxime (2grams every 4 to 6 hours) and ceftriaxone (2grams every 12 hours), or fourth-generation cephalosporin such as cefepime (2 grams every 8 hours). These drugs can consistently penetrate the cerebrospinal fluid to kill the causative organism
  • Chloramphenicol is preferred for N. meningitides during epidemics. Ceftriaxone can be used as an alternative if Chloramphenicol is not available or contraindicated. The World Health Organization recommends the use of chloramphenicol as the empiric antibiotic of choice in treatment of patients with N. Meningitidis in Sub-Saharan Africa. 1 or 2 injections of the long-acting formula is acceptable.
  • Add vancomycin (15 to 20 mg/kg every 8 to 12 hours) for empiric gram positive coverage until culture results indicate the absence of other infections
  • Can use dexamethasone as an adjunct to decrease brain inflammation, risk of hearing loss, and other complications
  • Antibiotic dosing should be adjusted for patients with poor renal function.

Complications Of Meningitis

  • Complications usually occurs if a person is left untreated for a long time, and includes:
  • Brain damage
  • Hearing loss
  • Seizures
  • Gait problems
  • Shock
  • Death
  • Memory problems and learning disabilities

Prevention of Meningitis

  • Vaccination of high risk populations is the best option for prevention
  • Vaccination against meningitis should be provided as part of the routine childhood vaccination
    • Haemophilus Influenzae type B (Hib) vaccine prevents infections that cause meningitis and pneumonia
    • MMR (measles-mumps-rubella) vaccine prevents meningitis caused by measles and mumps
    • Pneumococcal vaccines also prevent bacterial meningitis especially in those older than 65, immunodeficient persons, or those with some chronic diseases
    • Varicella (chickenpox) vaccine and shingles vaccine prevent viral meningitis
  • Vaccination with the Haemophilus Influenzae type B (Hib) is recommended for boarding school students or new college students
  • Avoid traveling to areas with meningitis outbreaks or epidemics

Written by Dr. Idongesit Udoh

 

References
BellaNaija (March 30, 2017). Meningtis: 1966 suspected cases reported in five states. Article obtained from http://www.bellanaija.com.
Mayo Clinic Staff. Meningitis symptoms and causes. Article obtained from http://www.mayoclinic.org/diseases-conditions/meningitis
Stephanie Busari (March 31, 2017). Meningitis outbreak in Nigeria kills nearly 300. Article obtained from http://www.cnn.com.
Tunkel, A. R., Calderwood, S. B., Thorner, A. R. (2017). Initial therapy and prognosis of bacterial meningitis in adults. Article obtained from http://www.uptodate.com
Waure, C. D., Miglietta, A., Nedovic, D., Mereu, G., & Ricciardu, W. (2016). Reduction in Neisseria meningitides infection in Italy after meningococcal C. conjugate vaccine introduction: a time trend analysis of 1994-2012 series. Human Vaccines & Immunotherapeutics, 12(2), 467-473.
World Health Organization (March 13, 2015). Meningococcal disease – Nigeria. Article obtained from http://www.who.inte/csr.