Niger - Meningitis outbreak ongoing in the Zinder region

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 2: 2 to 8 January 2023
Data as reported by: 17:00; 8 January 2023
...

Meningitis Niger

376 cases
12 Deaths
3.0% CFR

EVENT DESCRIPTION

A meningitis outbreak has been ongoing in the Zinder region
of Niger, since early November 2022. From 1 November to 31
December 2022, a total of 376 suspected meningitis cases,
including 111 confirmed cases with 12 deaths, case fatality
ratio (CFR=3%), have been reported from (55%) six out of 11
health districts of Zinder region. Notably, in week 52 of 2022,
30 suspected meningitis cases with one death were reported
nationally from Zinder Region. The affected health districts are
Dungass, Magaria, Matameye, Mirriah, Zinder, and Goure health
districts.

Only Dungass health district has crossed the epidemic threshold,
while Mirriah and Matameye (Kantché) health districts have
reached the alert threshold. The outbreak is spreading from
the Dungass health district to the neighbouring health districts,
namely Magaria, ZindhaveVille, Kantché, Gouré and Mirriah.
Since the beginning of this outbreak, Dungass health districts
have reported 70% of all cases (271 cases and five deaths),
followed by Magaria (19 cases and three deaths), Matameye (46
cases and two deaths), Mirriah (37 cases and one death), Zinder
(two cases, and one death), and Gouré (one case and zero death).
As of 31 December 2022, 197 cerebrospinal fluid (CSF) samples
have been collected for laboratory analysis. Of the 154 CSF
samples analysed, 111 (72%) were positive, including two for
Hemophilus Influenzae (2%), 104 for Neisseria Meningitidis
(94%), and five for Streptococcus pneumoniae (4%).

The age group between 2 to 14 years old (64%) is the most
affected, followed by the age group of 15 to 29 years (27%). Males
and females have been equally affected, with males contributing
slightly more cases, 53%.

SITUATION INTERPRETATION

A coordination team for outbreak response, including all
partners, is in place. Coordination activities, including the
one health technical committee meeting at the national and
departmental level are organised regularly.

A Surge team was deployed in the affected region to support
the investigation and response activities.

The Meningitis response plan has been finalized.

Surveillance system activities have been reinforced in the
Zinder region especially in Dungass health district, including
cases investigations in the integrated health centres affected.

Laboratory activities are ongoing, including samples
collection and laboratory transmission for analysis and
confirmation

Case management activities, including procurement of
ceftriaxone, cases isolation, deployment of health workers
for case management, distribution of case management
guidelines and provision of free treatment to cases are
ongoing

Risks communication and community engagement activities,
including meeting with administrators and community
leaders in districts, advocacy meetings, delivering messages
through community radios, and sensitisation on the use of
health services continue.

Logistic and immunization activities, including the reception
of 295 200 doses of vaccines, provision of tents for
vaccination sites, and logistics management are underway.

SITUATION INTERPRETATION

Bacterial meningitis remains a significant public health problem
in Africa, especially in countries that lie along the meningitis belt,
which include Niger. In addition to this outbreak, the government
of Niger is facing a humanitarian crisis linked to insecurity in
the Sahel region and other disease outbreaks, namely measles,
yellow fever and the COVID-19 pandemic. The high recorded
case fatality rate for this meningitis outbreak is concerning and
highlights the need to strengthen the early identification of cases
and case management. Furthermore, there is an urgent need for
a reactive meningitis vaccination campaign to stop the chain of
transmission in the affected districts and districts at high risk.

https://apps.who.int/iris/bitstream/handle/10665/365578/OEW02-0208012023.pdf?sequence=1&isAllowed=y

 

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 4: 16 to 22 January 2023
Data as reported by: 17:00; 22 January 2023
...

All events currently being monitored by WHO AFRO

Niger Meningitis Ungraded

Date notified to WCO 7-Dec-22
Start of reporting period 31-Oct-22
End of reporting period 15-Jan-23

Total cases 490
Cases Confirmed 111
Deaths 16
CFR 3.3%

The first case of meningitis was reported on 31 October 2022 and confirmed on 23 November 2022 with Neisseria meningitidis identified as the causative agent. As of 15 January 2023, Zinder has reported 490 cases of meningitis including 111 laboratory confirmed cases and 16 deaths (CFR 3.3%). These cases were reported from six health districts (HD): Dungass (331 cases, 6 deaths), Gouré (1 case, 0 deaths), Magaria (28 cases, 4 deaths), Matamèye (83 cases, 3 deaths), Mirriah (46 cases, 2 deaths), and Zinder ville (2 cases, 1 death). A reactive vaccination campaign is underway in the region.


https://apps.who.int/iris/bitstream/...1622012023.pdf

 

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WHO: Meningitis - Niger (8 February 2023)

Source: https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON439

Meningitis - Niger

8 February 2023


Situation at a glance
From 1 November 2022 to 27 January 2023, a total of 559 cases of meningitis (of which 111 are laboratory confirmed), including 18 deaths (overall CFR 3.2%), have been reported from Zinder Region, southeast of Niger, compared to the 231 cases reported during 1 November 2021 to 31 January 2022. The majority of laboratory-confirmed cases (104/111; 93.7%) are due to Neisseria meningitidis serogroup C (NmC). Reactive vaccination campaigns with the trivalent ACW meningococcal polysaccharide vaccine have been implemented.
Niger is located largely in the African meningitis belt with seasonal outbreaks recurring every year. However, the ongoing outbreak shows both an increased number of cases and an increased growth rate compared to the previous seasons.
Zinder region shares an international border with Jigawa State in Nigeria where a NmC outbreak is also ongoing, confirming the risk of international spread. Moreover, the simultaneous occurrence of other epidemics, insecurity and population displacement, all in the context of a protracted humanitarian crisis, are likely to contribute to the spread of the outbreak in other countries of the West African subregion.
WHO assesses the risk posed by the current meningitis outbreak in Niger as high at the national level, moderate at the regional level, and low at the global level.
Description of the situation
Being located in the African meningitis belt, Niger has been affected by several meningitis epidemics resulting in 20 789 cases and 1369 deaths (CFR 6.6%) reported since 2015.
From 1 November 2022 to 27 January 2023, a total of 559 cases of meningitis (of which 111 are laboratory confirmed), including 18 deaths (overall CFR 3.2%) have been reported from Zinder region, southeast of Niger, compared to the 231 cases reported during 1 November 2021 to 31 January 2022.
The last meningitis outbreak in the Zinder region, occurred in the 2021/2022 season, with a total of 372 cases, including 12 deaths (CFR 3%).
Figure 1. Epicurve of cases of meningitis reported in Niger by month, 1 October 2021 - 27 January 2023.
Of the 228 samples collected from suspected cases, 154 (67.5%) have been analyzed by Niamey's Center for Medical and Health Research (CERMES). Neisseria meningitidis serogroup C was identified in the majority of confirmed cases (n=104; 93.7%), followed by Streptococcus pneumoniae (n=5; 4.5%) and Haemophilus influenzae (n=2; 1.8%). The remaining 43 samples tested negative.
Males represent 53% of all cases. Among the total of 559 cases of meningitis, people under 20 years of age are the most affected by the outbreak (n=538; 96.3%), with 202 cases (36.2%) reported in the 10-14 years age group, followed by the 5-9 years age group with 153 cases (27.4%), the 15-19 years age group with 107 cases (19.1%), and the 0-4 years age group with 76 cases (13.6%).
The most affected health district of Zinder region is Dungass (342 cases, 6 deaths), followed by Matamèye (98 cases, 3 deaths), Mirriah (72 cases, 3 deaths), Magaria (38 cases, 5 deaths), Zinder ville (7 cases, 1 death) and Gouré (2 cases, 0 deaths).
Figure 1. Distribution of reported meningitis cases by health district, Zinder region, Niger, 1 November 2022 – 27 January 2023.
Epidemiology of meningitis
Meningitis is a serious infection of the meninges, the membranes covering the brain and spinal cord. Several different bacteria can cause meningitis, however, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis (N. meningitis) are the most frequent ones, and are transmitted from person to person through droplets of respiratory or throat secretions from infected people.
A total of 12 serogroups of N. meningitidis have been identified, six of which (A, B, C, W, X and Y) can cause meningococcal meningitis epidemics.
The average incubation period is 4 days but can range between 2 and 10 days. The most common symptoms of meningitis are a stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. Even with early diagnosis and adequate treatment, 5% to 10% of patients die, typically within 24 to 48 hours after the onset of symptoms. Bacterial meningitis may result in brain damage, hearing loss or a learning disability in 10% to 20% of survivors. A less common, but even more severe (and often fatal), form of meningococcal disease is meningococcal septicaemia, which is characterized by a haemorrhagic rash and rapid circulatory collapse.
The highest burden of disease is seen in a region of sub-Saharan Africa, known as the African Meningitis Belt, which is especially recognised to be at high risk of meningococcal but also pneumococcal meningitis epidemics.
Niger is located largely in the African meningitis belt, where meningitis epidemics typically follow a seasonal pattern (usually from January to June), with a size that varies from year to year. In 2015, a large meningitis outbreak attributed to NmC occurred, affecting nearly 10 000 people. In 2009 and 2006, meningitis outbreaks caused by N. meningitidis serogroups A (NmA) and X (NmX), respectively, were also reported. Haemophilus influenzae and Streptococcus pneumoniae are two other important pathogens that contribute significantly to the bacterial meningitis burden within Niger.
Licensed vaccines against meningococcal, pneumococcal and haemophilus influenzae diseases have been available for many years. These bacteria have several different strains (known as serotypes or serogroups) and vaccines are designed to protect against the most harmful strains. Over time, there have been major improvements in strain coverage and vaccine availability, but no universal vaccine against these infections exists.
In the African meningitis belt, meningococcus serogroup A accounted for 80–85% of meningitis epidemics before the introduction of a meningococcal A conjugate vaccine through mass preventive campaigns (since 2010) and into routine immunization programmes (since 2016). Among vaccinated populations, incidence of serogroup A meningitis has declined by more than 99%, and no serogroup A case has been confirmed since 2017.
However, cases of meningitis and outbreaks due to other meningococcal serogroups, apart from serogroup B, continue to strike.

Public health response

• A technical committee has been established in the Zinder region to coordinate the response to the epidemic. The meningitis response plan has been finalized and implemented. An international team from WHO and other partners including MSF and UNICEF has been deployed to support the response.
• Surveillance system activities have been reinforced in the Zinder region especially in Dungass health district, including case investigations. Laboratory activities are ongoing, including sample collection and confirmation from suspected meningitis cases.
• Case management activities have been strengthened, including procurement of the antibiotic ceftriaxone, cases isolation, deployment of health workers for case management, distribution of case management guidelines and provision of free treatment to cases.
• A request for 608 960 doses of trivalent ACW polysaccharide vaccine was approved and delivered by the International Coordinating Group (ICG) on Vaccine Provision in two batches of approximately 300 000 doses each on 31 December 2022 and 9 January 2023.
• Reactive vaccination campaigns with the trivalent ACW meningococcal polysaccharide vaccine have been implemented by the MoH with the support of WHO and The Global Alliance for Vaccines and Immunization (GAVI) in the Health Districts of Dungass, Gouré, Mirriah and Matamèye, targeting the age group 2 to 29 years. The overall vaccination coverage reached is 99.8%.
• Risks communication and community engagement activities are ongoing in close cooperation with administrators and community leaders in affected districts, delivering health advice and infection, prevention and control recommendations through community radios and other channels, including door-to-door sensitisation on the need to immediately seek medical assistance if symptoms occur to promptly start treatment.

WHO risk assessment

The ongoing outbreak shows both an increased number of cases and an increased growth rate compared to the previous seasons.
Moreover, the meningitis epidemic season (usually from January to June, marked by high temperatures and dry winds combined with heavy dust, a period known as the harmattan), the mixing of populations, the simultaneous occurrence of other epidemics in the same region (measles, diphtheria and COVID-19), insecurity and population displacement, all in the context of a protracted humanitarian crisis, are likely to contribute to the spread of the outbreak.
The Zinder region borders Jigawa State in Nigeria, where a NmC outbreak is also ongoing, confirming the risk of international spread to other countries of the West African subregion.
WHO assesses the risk posed by the current meningitis outbreak in Niger as high at the national level, moderate at the regional level, and low at the global level.

WHO advice

Meningococcal meningitis remains a public health concern with a high case fatality rate and leading to serious long-term complications.
Preventing meningitis through vaccination is the most effective way to reduce the burden and impact of the disease by delivering long-lasting protection. The rollout of multivalent meningococcal conjugate vaccines is a public health priority to eliminate bacterial meningitis epidemics in the African meningitis belt. Introduction into routine immunization programmes and maintaining high coverage will be critical to avoid the resurgence of epidemics.
Antibiotics for close contacts of meningococcal cases, when given promptly, decrease the risk of transmission. Outside the African meningitis belt, chemoprophylaxis is recommended for close contacts within the household. Within the meningitis belt, chemoprophylaxis for close contacts is recommended in non-epidemic situations. Ciprofloxacin is the antibiotic of choice, and ceftriaxone an alternative.
Admission to a hospital or health centre is necessary. Isolation of the patient is not usually advised after 24 hours of treatment.
Appropriate antibiotic treatment must be started as soon as possible. Ideally, lumbar puncture should be done first as antibiotics can make it more difficult to grow bacteria from the spinal fluid. However, blood sampling can also help to identify the cause and the priority is to start treatment without delay. A range of antibiotics is used to treat meningitis, including penicillin, ampicillin, and ceftriaxone. During epidemics of meningococcal and pneumococcal meningitis, ceftriaxone is the drug of choice.
The response to epidemics consists of appropriate case management, active community-based case-finding and reactive mass vaccination of affected populations. Surveillance, from case detection to investigation and laboratory confirmation is essential to the control of meningitis.
Reactive vaccination campaigns have been implemented in Zinder region, and monitoring the spread to new areas is crucial to guide further response activities, including considering further vaccine requests if appropriate. Timeliness of the reactive campaign is critical, ideally within four weeks of crossing the epidemic threshold.
WHO does not recommend any restriction on travel and trade to Niger on the basis of the information available on the current event.

Further information

• WHO. Health topics, Meningitis
• WHO. Meningitis fact sheets
• Defeating meningitis 2030: baseline situation analysis
• Defeating meningitis 2030: global roadmap
• WHO. Immunization, Vaccines and Biologicals. Meningococcal meningitis
• WHO AFRO. Meningococcal Meningitis.
• WHO AFRO: Outbreaks and Emergencies Bulletin

Citable reference: World Health Organization (8 February 2023). Disease Outbreak News; Meningitis - Niger. Available at https://www.who.int/emergencies/dise...em/2023-DON439

 

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 15: 3-9 April 2023
Data as reported by: 17:00; 9 April 2023
...

Niger Meningitis

831 Cases
41 Deaths
4.9% CFR

EVENT DESCRIPTION

Niger health authorities continue to respond to the
meningitis outbreak that began in November 2022 in
Dungass health district (HD) in the Zinder region. Cases
continue to be reported and the outbreak has spread to
additional HDs in the Zinder region.

In week 13 alone, 67 new cases were reported including
seven deaths. During this week, four surveillance areas of
100 000 inhabitants exceeded the epidemic threshold. In
the early stages (late 2022 to early 2023) of this outbreak,
Neisseria meningitidis serogroup C (NmC) was identified
in most confirmed cases.

From week 1-13 of 2023, a total of 831 suspected cases
were reported including 41 deaths yielding a case fatality
rate (CFR) of 4.9%.

Cases were reported in eight of the 11 health districts in the
Zinder region (which shares an international border with
Jigawa State in Nigeria): Mirriah (309 cases, 13 deaths),
Zinder ville (195 cases, 6 deaths), Magaria (134 cases,
13 deaths), Matamèye (109 cases, 8 deaths), Dungass
(71 cases, 0 deaths), Takéita (10 cases, 0 deaths), Gouré
(2 cases, 0 deaths) and Tanout (1 case, 1 death).

Males accounted for 58% of cases. The most affected
age group is 5-14 years with 400 cases (48.1%), followed
by 15 years and older with 245 cases (29.5%), 1-4 years
with 151 cases (18.2%), and 0-11 months with 35 cases
(4.2%).

PUBLIC HEALTH ACTIONS

The technical committee established in the Zinder
region continues to coordinate the response to the
outbreak.

Active case finding at the community level and in
health facilities for early detection of new cases
continues.

Household sensitization through community relays
and volunteers continues in affected districts.
Case management activities have been intensified,
including procurement of ceftriaxone, case isolation,
deployment of health workers for case management,
distribution of case management guidelines, and
provision of free treatment to cases.

Reactive vaccination campaigns with ACW trivalent
meningococcal polysaccharide vaccine have been
implemented in the initially affected HDs.

Risk communication and community engagement
activities continue in close collaboration with
administrators and community leaders in the affected
districts.

SITUATION INTERPRETATION

Niger is largely within the African meningitis belt and
experiences seasonal outbreaks every year. The current
outbreak shows an increase in the number of cases and
in the number of health districts exceeding the epidemic
threshold. The meningitis epidemic season generally
runs from January to June and the spread of the outbreak
is likely to be exacerbated by mixing of populations, other
ongoing epidemics in the same region like measles,
diphtheria, and COVID-19, insecurity, and population
displacement occurring in the context of a humanitarian
crisis.
...
https://apps.who.int/iris/bitstream/handle/10665/366975/OEW15-0309042023.pdf?sequence=1&isAllowed=y