Battling meningitis: Killer disease on the prowl, 438 dead

When the first outbreak of the deadly Cerebro Spinal Meningitis (CSM) in February, many thought nothing to it as such reports had been usual and that the disease would run its circle. The number of deaths in the past week, however, is so scary and more deaths are still being reported. TADE MAKINDE, BIOLA AZEEZ, ISAAC SHOBAYO and NEWTON-RAY UKWUOMA chronicle the devastation so far, experts’ opinions and their proferred solutions.

HAJIYA Salamatu Isa, a school teacher in Zamfara State, lost her four year-old daughter to Meningitis sometime in February. It was the dry season, which was usually accompanied by low humidity and dusty conditions, and which usually ends with the onset of the rainy season. Cerebro Spinal Meningitis (CSM) outbreaks were caused mostly by Neisseria meningitidis serogroup A (NmA). Because the disease was rampant in February, Salamatu tried to immunise all her family members, but due to non-availability of vaccine, she could not. The vaccine shortage killed her daughter and several others. Among them was Mallam Bello Aliyu, a civil servant, in Zamfara State, also lost his 35-year-old neighbor to meningitis, while some of his family members were also affected.

Since its outbreak, meningitis has claimed 336 lives in 16 states as of Monday, even as the Federal Government and its partners, both local and especially international donors, had intensified response to check the outbreak.

Meningitis bacteria, which affects the lining surrounding the brain and spinal cord, are transmitted from person to person through droplets of respiratory or throat secretions. It is a swelling of the protective membranes covering the brain and spinal cord known as the meninges, usually caused by an infection of the fluid surrounding the brain and spinal cord, said Dr Victor Adeyefa, Belgium-trained medical practitioner based in Ibadan.

After many years with no major reports of the outbreak of the disease, it was assumed that Nigeria had conquered the epidemic, until February this year when deaths began to occur again from Meningitis outbreaks. The first of this recent outbreak, which took 18 lives in Niger State, created a little panic. By last week, however, over 300 lives had been lost, creating a panic as the FCT Primary Health Care Development Board, Abuja, confirmed the death of five people in the Federal Capital Territory (FCT). According to the Executive Secretary of the FCI board, Dr Rilwanu Mohammed, four deaths were recorded in Durumi and one in Dakwa in Abuja.

By the time the Nigeria Centre for Disease Control (NCDC) confirmed outbreak of CSM, at least 282 deaths had occurred in five states. Chief Executive Officer of the centre, Chikwe Ihekweazu, in Abuja, confirmed that 1,966 suspected cases had been recorded, while 109 were being treated since the outbreak of the disease two months ago. But the centre quickly deployed a response team to the affected states; Zamfara 44 cases; Katsina 32; Sokoto 19; Kebbi 10, and Niger, 4 cases.

During the week, Kano State, which was not among the first five states that the epidemic broke out from, also confirmed the outbreak of Meningitis in 9 Local Government Areas. The state Commissioner of Health, Dr. Kabiru Ibrahim Getso, said that 20 cases were recorded in nine Local Government areas of the state, and that 4 of them were confirmed.

The state government, however, immediately approved the sum of N19 million to curtail the outbreak of the diseases and also intensified surveillance at all levels of health care delivery team that would quickly respond to reported cases of meningitis, just as drugs had been procured and distributed to major health facilities.

In Plateau State, a source close to the General Hospital in Shendam local government revealed that 14 cases were recorded in the council area while the remaining 15 were discovered in Tunkus in Mikang local government adding that majority of those in admission had been treated and discharged accordingly.

The State Commissioner of Health, Dr Kunden Deyin, who said only three people are presently in Plateau State Specialist Hospital, added that few cases recorded in the month of march had been treated and discharged.

A national policy on meningitis in the state now stipulates that before any case is confirmed as being that of meningitis, a blood sample or cerebrospinal fluid must have been diagnosed at a government approved medical laboratory.

For now, Kwara State also appears to be safe as no case of the disease has been reported in the state since its outbreak in other parts of the country. However, they did not rule out possibility of the disease in the area, considering self medication said to be prevalent among some residents. The health experts thus, advised people to report cases of the disease to hospitals when noticed.

The Kwara state commissioner for Health, Mr. Sulaiman Alege, said that the state is prepared in case there is an outbreak of meningitis. “We have also started sensitisation to alert our poeple to create avenues in the homes to get fresh air and caution them on need for prompt response by contacting the ministry if they notice any sign of the disease,” Alege said.

Even Lagos, Osun and Oyo states

Believed to be a Northern disease, that impression has permanently changed as recent report had it that it had spread to the South West with outbreaks recorded in Lagos, Oyo and Osun states. The CSM ravaging people this time around is a different strain from the one the government had been preparing hard to prevent from breaking this time of the year as it regularly did. But that the epidemic has broken out in the South West has not surprised Dr Adeyefa. He said the erroneous belief that meningitis only occurs in the North was because many believe that the region is the hottest part of Nigeria.

“Meningitis breaks out anywhere the weather is hot. These days, most states, even in the West have been experiencing a very hot weather, so we should expect this to be a regular outbreak from now unless urgent attention is paid to healthy living in hot weathers. The escalating drought and influx of refugees from endemic and insurgence areas has not helped.

“Meningitis is from menococi bacteria and can be transferred through breathing airs. It causes febrile illness and neck stiffness. However, it is not true that one can be infected through handshakes. Now that we have seen a huge shift in the movement of people from the North to the West, especially to Lagos, the outbreak should now be expected because any of those travelling from North to South could be latent carriers of the bacteria.

“Check the houses where the epidemic was reported in Lagos and Osun states. It is not ideal that 8 to 12 persons should cramp themselves in a room, especially where there is no ventilation. It is true that we never heard of meningitis in this area in the past, but we never had more people sleep in a room than now. Close and prolonged contact such as coughing, sharing eating or drinking utensils, kissing, sneezing also facilitates the spread.

The Lagos State Commissioner for Health, Dr Jide Idris, recently warned residents and heath workers that the state was not immune to CSM, hence his advise that they should avoid close contact with suspected and probable cases. He dismissed reports of the disease’s outbreak in the state, saying no case of Cerebrospinal Meningitis had been recorded in the state.

According to him, “seasonal meningitis outbreak occurs mainly in the Northern states that fall within the meningitis belt of the country. It is not impossible that outbreaks can occur in any part of the country, Lagos inclusive, in view of the phenomenal climatic change as well as the high human migration.”

Dr Bamidele Iwalokun, a Molecular Biologist in Lagos State, also called for effective preventive and response strategies against meningitis epidemic to curb the spread and fatality rate in the country. Iwalokun, who heads the Immunology and Vaccinology Research Department, Nigeria Institute of Medical Research (NIMR), Yaba, Lagos State, made the call against the backdrop of the outbreak.

However, by the middle of the week, the number of deaths had increased from 344 to 438 as of Friday, according to statistics released by NCDC. According to the statistics, as at 5 April, 2017, three cases of Meningitis were recorded in Lagos out of which two people died.

There are fears that it may further increase due to the high cost of vaccines and the rising heat in most parts of the country, but some concerned state governments beyond the South West have begun to take pre emptive measures at minimizing the outbreak so that they won’t be caught unawares.

In Enugu also, the state’s Chief Disease Surveillance Officer, Dr Okechukwu Ossai, said the state had scaled up surveillance and public outreach by adopting a more proactive measure through increased surveillance and widespread public outreach on CSM in the state.

With the death toll rising dangerously, the government has also waded in through its many agencies. During its investigation into the outbreak, it was discovered that the CSM ravaging the North East this time around, and which had spread to Lagos and Osun states, was a different strain from the one the government had been preparing to prevent from breaking this time of the year as it regularly did. The new strand of meningitis, called “stereo- type C”, had emerged in place of the previous known type “stereotype 1”, which has disappeared.

The National Human Rights Commission (NHRC) immediately expressed concern about rising cases of deaths and ill-health following the outbreak of meningitis in the country. The Acting Executive Secretary of the commission, Mrs Oti Ovrawah, urged relevant stakeholders to act fast to avoid further loss of lives. She emphasised that the Federal Ministry of Health and its counterparts in the states should, as a matter of urgency, take immediate and proactive steps urgently to contain the outbreak.

Though a new strain, the NCDC boss allayed fears that though vaccine for this new strain of CSM was not commercially available, “There is a vaccine available, but we had to make application to the World Health Organisation for the vaccines, which have arrived and we have started vaccination campaign in most of the states.

Eradication

In Northern Nigeria, efforts to control the epidemic in Katsina in the past included the use of sulphadimidine snuffs, which was very effective at that time. They achieved this success by carefully coordinated plans involving the Emirs, district heads and the people in carrying out the intervention in the districts where they worked at a time public health efforts in Nigeria was still in the infancy stages. But the Sultan of Sokoto, Alhaji Muhammad Sa’ad, has warned Nigerians against such self-medications as part of measures, saying, in a statement signed by the Emir of Argungu, in Kebbi State, Alhaji Samaila Mera, that; in the interim, because of the dynamic nature of the outbreak, the Sultan is calling on parents and caregivers to ensure that their children sleep in clean, well ventilated abodes and avoid overcrowding.

Also, the Sokoto State government has treated no fewer than 100 meningitis and malaria patients since March. The state Commissioner for Health, Dr. Balarabe Kakale, said that the patients were mostly treated in the worst hit areas such as Rabah, Kebbe, Tureta, Gada, Dange/Shuni, Wamakko and Bodinga. The state government has purchased assorted drugs, consumables to curb the meningitis epidemic in the state.

“Meningitis outbreak usually coincides with drought, hence the need for authorities to take proactive measures like mass vaccination, hygiene education and intensive surveillance at border crossings,” said Adeyefa.

“In modern times, the Hajj is still a place where international transmission of meningitis still occurs, even though in recent years mandatory vaccinations have greatly reduced this risk. During some journeys from West Africa by horses or camels, usually in a few months, which is well within the period in which the causative bacteria, it can persist in the upper airway tract,” added Dr Richard Ajayi of St Richards Hospital, Ile Ile, Ketu, Lagos.

The two cases of meningitis recorded in Ibadan, another city believed to be safe from the outbreak, confirms that migration also assists in spreading the epidemic.

Dr Oyewole Lawal, Director of Public Health, Oyo State Ministry of Health, on Thursday, confirmed the cases in Ojoo, Akinyele Local Government Area of the state.

“Our surveillance committee has reported that the two suspects arrived Ibadan from the Northern part of the country and they manifested some symptoms of CSM. We have beefed up tracking and increased surveillance efforts in all primary healthcare centres at the local government levels, secondary healthcare level and all the private hospitals around Ojoo.

Though no case of any outbreak has been reported, a worried Akwa Ibom State government has alerted the people on the dangers associated with meningitis ailment, warning against being caught off-guard.

The Commissioner for Health, Dr Dominic Ukpong, urged residents to imbibe a high sense of personal hygiene. Washing of hands and restricted handshakes should be imbibed. The Chairman of the state chapter of the Nigerian Medical Association (NMA), Dr Aniekeme Uwah, said surveillance has been stepped up to monitor developments in any part of the state, even as an emergency centre for the ailment has been opened at Ikot Ekpene.

A total of 500,000 doses of Meningitis C vaccines have, however, been distributed to some of the affected states for immediate outbreak response vaccination. The Technical Assistant, Communications, NCDC, Dr Lawal Bakare, also said that an additional 823,970 doses of the vaccine were expected from the United Kingdom to support vaccination activities in other affected states.

“Vaccination is a critical intervention in healthcare, just like the consumption of clean water. The meningitis vaccine will offer long-term immunity against the disease to high risk populations. Vaccinating people suppresses the meningitis bacteria to ensure it does not develop to fatal stages.

“We continue to advocate for scientists and for the global community to really try and push to develop a vaccine for meningitis ‘C’. All we can do is prevention,” he told journalists.