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The highest burden of this disease occurs in sub-Saharan Africa in an area that is referred to as the "Meningitis Belt". This is the area between Senegal and Ethiopia and includes all or part of at least 15 countries, with an estimated total population of approximately 300 million, according to the World Health Organisation (WHO). Epidemics occur in seasonal cycles between the end of November and the end of June, with the arrival of rains, depending on the location and climate of the country and decline rapidly with the arrival of the rainy season. This year's most heavily affected countries have been Burkina Faso and Togo. According to the latest numbers published by Burkinabe Ministry of Health, one has registered a total of 10,210 cases, including 1,208 deaths, in the country this dry season so far. Measures taken by the Ministry of Health, WHO and humanitarian organisations include epidemiological surveillance and treatment. The latest numbers reported from the Togolese Ministry of Health include 589 persons infected with the Meningococcal disease; 95 of them have already died. In neighbouring Benin, the Ministry of Health has reported 502 cases and 50 deaths. Other affected West African countries are Côte d'Ivoire (244 cases; 43 deaths), Ghana (1,407 cases; 190 deaths), Guinea (123 cases; 23 deaths), Mali (382 cases; 33 deaths), Mauritania (26 cases; 2 deaths), Niger (2,508 cases; 210 deaths), Senegal (121 cases; 7 deaths) and The Gambia (50 cases; 3 deaths). The Red Cross and WHO report that there is insufficient meningococcal vaccine to protect the populations at risk, appealing to donors financing their campaigns in this geographically wide-spread outbreak area. Also the Burkinabe Ministry of Health has launched an appeal to the international community for assistance of the costly campaign. In Burkina Faso only, the epidemic has spread to 30 of the country's 53 districts, affecting a population of approximately 7.5 million. In several countries, where health infrastructure is better developed, mass vaccination has however started. In Ghana, where 21 districts have been affected, mass vaccination campaign is ongoing, WHO reports. Vaccination on a smaller scale is also ongoing in Chad (to hinder the epidemic from reaching the country), The Gambia, Guinea and Mali. While local Meningococcal meningitis outbreaks occur every dry season in the "Meningitis Belt," it usually reaches the epidemic threshold for two to three consecutive years in epidemic cycles every eight to 12 years. Last year, at the same time, the epidemic had caused an estimated 700 deaths, meaning that this year's death toll already is significantly higher There exist various forms of meningitis, but meningococcal meningitis is the only form of bacterial meningitis, which causes epidemics. Transmission is by direct contact, including respiratory droplets from nose and throat of infected persons. Most infections are subclinical and many infected people become symptomless carriers. Waning immunity among the population against a particular strain favours epidemics, as do overcrowding and climatic conditions such as dry season or prolonged drought and dust storms. Meningococcal meningitis is characterized by sudden onset of intense headache, fever, nausea, vomiting, photophobia, and stiff neck. Neurological signs include lethargy, delirium, coma and/or convulsions. Infants may have illness without sudden onset and stiff neck. The incubation period is between two and ten days, mostly three to four days. Even when the disease is diagnosed early and adequate therapy instituted, the case fatality rate is between 5% and 10% and may exceed 50% in the absence of treatment, according to the WHO. In addition to the mortality associated with meningococcal meningitis 15% and 20% of those who survive will suffer with neurological sequelae (e.g. deafness, mental retardation) as a result of their illness. Source:
WHO, Red Cross and Red Crescent and afrol archives
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