Battling the Scourge of Cerebrospinal Meningitis in Nigeria

Fri, Apr 7, 2017 | By publisher


BREAKING NEWS, Cover, Featured


The yearly ritual of treating cerebrospinal meningitis during dry season in Nigeria takes a new turn as health officials discover a rare species of meningitis, which is more expensive to treat, has crept into the country

| By Olu Ojewale | Apr 17, 2017 @ 01:00 GMT |

IT sneaked in on Nigerians like a thief in the dead of the night and at the last count it has killed no fewer than 336 persons. Most of the dead were children aged five to 14. The current outbreak of Cerebrospinal Spinal Meningitis, CSM, appears to have caught the nation unaware, thereby sending health officials into a wild and urgent search for enough vaccines to prevent escalation of the disease. “As at April 3, 2017, a total of 2,997 suspected cases of CSM have been reported in 16 states in Nigeria, of which 146 have been laboratory-confirmed,” Lawal Bakare, a spokesperson of the Nigeria Centre for Disease Control, NCDC, said in a statement on Tuesday, April 4.

According to the ministry of health, 90 local government areas across 16 states of the country have been affected so far. The states are: Zamfara, Katsina, Sokoto, Kebbi, Niger, Nassarawa and Jigawa. The rest are Gombe, Taraba, Yobe, Kano, Osun, Cross Rivers, Lagos, Plateau and the federal capital territory.

Apparently irked by the development, health workers in Nigeria began a mass vaccination programme on Wednesday, April 5, to try to halt a mass outbreak of the deadly CSM. “Right now, vaccinators are in the field in Zamfara State administering doses of vaccine to contain the spread of the disease,” Bakare told AFP.

Zamfara, a state in North-West Nigeria, and the neighbouring states of Sokoto, Katsina, Kebbi and Niger have been reportedly hit hardest by the disease which broke out since last November. Perhaps, the most painful aspect of the outbreak is that Nigeria did not expect type C meningitis. Osagie Ehanire, minister of State for Health, on Wednesday, April 5, harped on this while speaking to journalists at the State House, shortly after the federal executive council, FEC, meeting where he listed the main challenges facing the government in tackling the problem to into include “extremely expensive” drugs, new strain of bacteria and short shelf life of the drugs usable to treat the strange strain of the microorganism causing the disease.

“This country before suffers meningitis around this time of year when dry season is turning to rainy season in the area called the ‎meningitis belt that ranges all the way from Senegal down to Ethiopia, Eritrea. And the prevailing germ was the Meningococcus A,” he explained. The minister said mass vaccination over the years against the Type A virus had led to almost total elimination of the disease and that the Type C has been very rare. “Unfortunately, there is no cross immunisation. If you are immune to Type A it doesn’t make you immune to Type C. And because Type C was very rare, the availability of vaccines has been very meagre relatively,” he said.

Besides, the minister said the vaccines for Type C meningitis are “extremely expensive” to make ‎and if acquired and stored without using, they may expire. “So, companies make the vaccines on request and on demand and they store just as much as they calculate will be used. So, the Type C was not very much in demand; but right now, this present epidemic has led to a big demand,” he said.

Osagie Ehanire
Ehanire

The minister said so far, the country had “mobilised vaccines to come in from all corners; 500,000 units doses of vaccines are being distributed ‎and they have started vaccination campaign already.” He said Nigeria would also get additional 826,000 units free from donors which would be shipped‎ from Europe within the next few days. In addition, he said the ministry had placed order for two million doses.

“As the situation goes on we will be able to determine if we need to increase the order or if this one will be sufficient. You don’t want to order more than you need because they all have limited life span, but on the other hand you need to have more of these vaccines to be able to take care of the epidemic.

“Right now, it seems there is control going on, it is beginning to decrease in Sokoto State and Zamfara is still trying to even out and we hope that with the reactive vaccinations going on we shall be able to bring the epidemic to a gradual halt,” he said.

Nevertheless, the minister said there had been a robust response by his ministry and the governments of the states concerned along with the Nigerian Centre for Disease Control, NCDC; Nigeria Primary Health Care Development Agency; World Health Organisation; UNICEF; and other partners since the outbreak.

To curb a possible widespread of the disease, he said: “There are two treatment centres being set up in every local government and lumber puncture kits have been distributed so that doctors can take samples to laboratory for testing. There are field epidemiologists who are doing findings and contact tracing in other to interrupt the spread of this epidemic.”

In addition, Bakare said the NCDC had, in collaboration with other stakeholders, activated an Emergency Operations Centre, EOC, to manage the CSM outbreak. This would bring the national response into an Incidence Management System, IMS, to ensure that all activities across the country would be managed using a clear command and control structure. With the new coordinating structure, the country will have a tight, multi-partner team of experts pulled from the most competent agencies focusing on outbreak control in Nigeria.

As such, John Oladejo, head of emergency preparedness and response at the NCDC, has been given the responsibility to act as the incident manager of the response team. By his position, Oladejo would be reporting through the chief executive officer of the NCDC to the minister of health. This measure will ensure response activities are coordinated in one place. “We are confident that we have turned the tide, and with increasing vaccination activities, expect a reduction in number of cases. Importantly, lessons learned from this outbreak will help the country prepare for the future,” he said.

Apparently disturbed by the outbreak of the CSM, Sa’ad Abubakar, the Sultan of Sokoto, urged Nigerians to avoid self-medication as part of measures to tame the epidemic in many parts of Nigeria. The Sultan, who gave the warning in a statement signed by Samaila Mera, Emir of Argungu in Kebbi State, on Tuesday, April 4, called on parents and caregivers to ensure that their wards sleep in clean, well ventilated abodes and avoid overcrowding, adding that they should also report all suspected cases immediately to the nearest health facility.

Also, he called on all traditional and religious leaders to support all measures taken or recommended to be taken by the government and health officials. While commending the efforts of governments at all levels and international partner organisations to stop the outbreak, Abubakar urged residents to support government officials working in any capacity, to bring an end to the outbreak.

Additionally, the Sultan has called for a meeting of the Northern traditional leaders on primary healthcare and relevant agencies of government for April 11, to brainstorm on the unfortunate development in order to establish modalities for collaboration at all levels, to fast track the efforts of government to control the epidemic. Interestingly, the minister of health has accepted the Sultan’s suggestion, according to the statement which quoted the monarch as urging the general public to pray to God for the speedy interruption and eradication of the disease from the country.

The Sultan’s religious advice is understandable unlike Governor Abdulaziz Yari of Zamfara State who thinks the disease is a punishment from God for the sin victims have committed. On Tuesday, April 4, at the Presidential Villa after meeting with President Muhammadu Buhari, the governor was quoted as saying: “What we used to know as far as meningitis is concerned is the Type A virus. The World Health Organisation, WHO, has carried out vaccinations against this Type A virus not just in Zamfara, but many other states. However, because people refused to stop their nefarious activities, God now decided to send Type C virus, which has no vaccination. People have turned away from God and he has promised that ‘if you do anyhow, you sin anyhow’ that is just the cause of this outbreak as far as I am concerned. There is no way fornication will be so rampant and God will not send a disease that cannot be cured.”

Yari’s statement infuriated so many persons who seemed to have abandoned the main topic and descended on him for daring to attribute the meningitis scourge to punishment for sin or lifestyles of Nigerians. Reacting, Ehanire said: “the federal government does not have views of that nature‎ and I am not sure the state government can really continue to make that statement. When things happen, yes you can begin to look this way and that way for the cause of it; but like I said nature played us an unfortunate stroke but that is not to say we committed sin or anything. It does happen that things occur out of the blues.”

A faction of the Peoples Democratic Party led by Ahmed Makarfi said it was wrong to blame God for the outbreak of meningitis in the country. It said that rather than blame God, Yari should blame his political party, the governing All Progressives Congress, APC, for its inability to curtail the scourge.

In a statement issued by Dayo Adeyeye, spokesman of faction, the party said on Wednesday that the primary responsibility of any government was to protect the lives and property of its citizens, adding that the APC government had remained insensitive to the plight of Nigerians.

Sa'ad Abubakar III
Abubakar III

It said that the government had wasted so much funds on the State House Clinic with no tangible result but neglected other health centres and clinics across the country that he said had the capacity to manage the health challenges of other Nigerians, adding that the federal ministry of health has not taken any concrete step to contend with the spread.

Ben Murray-Bruce, a Nigerian senator, simply mocked the governor for his alleged statement. Murray-Bruce, who represents Bayelsa East Senatorial District, Bayelsa State, disagreed with the governor, saying in his tweet on Wednesday, April 5, “Meningitis is caused by bacteria, not sin. If sin caused meningitis, most of us politicians will get it, but it’s the poor who suffer it most.”

Apparently feeling uncomfortable with the reactions created by his statement, Yari said his comments on meningitis outbreak was twisted by some elements with a view to ridicule him because of his rising political reputation. He said he only lamented the paucity of appropriate vaccines to confront the outbreak of meningitis in his state and not that the outbreak was a divine punishment from God for sins of fornication committed by the people.

The governor, who spoke through Ibrahim Magaji Dosara, his special adviser on media and public enlightenment, Wednesday, April 5, in Abuja, said he merely asked Nigerians to move closer to God and plead for his mercy to avert further infectious diseases in the state and Nigeria since God has answers to challenges. He added: “Let it be known too that the governor still insists that all diseases come from God and that at no point in his interaction with the reporters did he insinuate that God was punishing Nigerians but instead drew from the teachings of great Islamic traditions to buttress the point he was trying to convey,” the spokesperson said.

Be that as it may, it is common knowledge that Nigeria lies in the so-called “meningitis belt” of sub-Saharan Africa, stretching from Senegal in the west to Ethiopia in the east, where outbreaks of the disease are a regular occurrence. Nigeria has a long history of CSM epidemics. One of the worst occurred in 1996 when 109,580 cases and 11,717 deaths were recorded.

In 2003, there were 4,130 cases and 401 deaths; 9,086 cases and 562 deaths in 2008, and 9,086 cases and 562 deaths recorded in 2009. The historical records and past experiences influenced health authorities in Africa (especially countries within the African Meningitis Belt), the World Health Organisation and Development Partners to roll out a strategic intervention for the effective prevention of such epidemics.

According to the CDC bacterial meningitis is very serious and can be deadly. Death can occur in as little as a few hours, and even though most people recover from meningitis, however, permanent disabilities (such as brain damage, hearing loss, and learning disabilities) can result from the infection.

The types of bacteria that can cause meningitis include, Streptococcus pneumoniae, Group B Streptococcus, Neisseria meningitidis, Haemophilus influenzae and Listeria monocytogenes. According to medical information, causes and risk factors common causes of bacterial meningitis vary by age group. People at increased risk for bacterial meningitis include babies compared to people in other age groups.

However, people of any age can develop bacterial meningitis. People working with meningitis-causing pathogens, such as microbiologists who are routinely exposed to meningitis-causing bacteria are at increased risk of meningitis. Generally, the meningitis bacteria spread from one person to another although how people spread the germs often depends on the type of bacteria. There are also people that carry these bacteria in or on their bodies without being sick. They are “carriers.” Most carriers never become sick, but can still spread the bacteria to others.

People spread germs by coughing or sneezing while in close contact with others, who breathe in the bacteria. People spread Neisseria meningitidis by sharing respiratory or throat secretions (saliva or spit). This typically occurs during close (coughing or kissing) or lengthy (living in the same household) contact.

Signs and symptoms of meningitis include sudden onset of fever, headache, and stiff neck. There are often other symptoms, such as nausea, vomiting, photophobia (increased sensitivity to light) and altered mental status (confusion). In newborns and babies, the meningitis symptoms of fever, headache, and neck stiffness may be absent or difficult to notice. The baby may be irritable, vomit, feed poorly, or appear to be slow or inactive. In young babies, doctors may also look for a bulging fontanelle (soft spot on infant’s head) or abnormal reflexes. It is advised that when these signs are noticed in children they should be taken to the doctor immediately.

Symptoms of bacterial meningitis can appear quickly or over several days. Typically they develop within three to seven days after exposure. Later symptoms of bacterial meningitis can be very serious (e.g., seizures, coma).

As information unfolds about where CSM ravaging areas, there appears to be little enlightenment on how to prevent the disease apart from vaccination.

Yari
Yari

Nevertheless, the Wellbeing Foundation Africa, WBFA, in its advisory note said that government would need to do more in terms of community mobilisation and awareness at the grassroots to succeed in eradicating or minimise effects of CMS. It said: “Cerebrospinal meningitis can only be successfully prevented or curbed at the ward level, a microcosm of the local government area, LGA. Case detection, verification, and treatment are best started here, for maximum effectiveness.” While commending efforts of government so far, the WBFA would want pregnant women and newborns to be provided with personal health records to enable health workers and mothers to track and monitor their immunisation and vaccinations.

WBFA urgently calls on national policymakers to provide appropriate antibiotic therapy and strengthen immunisation and to include Meningovax vaccine, which protects against meningitis A and meningitis C, into the immunisation schedules of Nigerian citizens, as a recognised preventive step, which is widely administered internationally. Similarly, the foundation calls on policymakers and health workers in Nigeria to disseminate and distribute accurate information to patients and citizens about the disease to increase understanding and prevent the disease from further spreading.

Besides, the WBFA said it would continue to advocate for increased strengthening of primary healthcare, PHC, systems, as the one true solution to Nigeria’s health crisis. “Nationally, as Nigeria strengthens its disease surveillance systems, so must it strengthen its detection and treatment referral systems so infected patients can be better detected and treated. There is an urgent need to harness public service announcement advocacy with a strong disease surveillance system, where a control and command reporting system is central. The Wellbeing Foundation Africa understands that it is only with a strong national reporting structure between hospitals, health workers and policymakers that a resilient health system can be built against national disease outbreaks,” the WBFA said in its statement.

That notwithstanding, all efforts seem to have been geared towards making sure that the disease does not do more havoc to the populace. But how effective those efforts will be in curbing the spread of the disease will manifest in due course. Nigerians are watching.

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