Meningitis-an acute inflammation of the meninges of the brain and spinal cord- may be suspected when there’s a sudden onset of fever (>38.5 oC rectal or >38.0 oC axillary) and any of the following signs: stiff neck, bulging fontanelle, convulsion or other meningeal signs. However, isolation of the causal pathogen: Neisseria meningitidis, Streptococcus pneumoniae or Haemphilus influenzae type B from the cerebrospinal fluid of an individual gives you a confirmed case of meningitis.
Although cases occur worldwide, an extensive region of Sub-Saharan Africa- The Meningitis Belt– has had recurring epidemics over the years. This region comprising of 26 countries from Senegal in the west to Ethiopia in the east has the reason for its susceptibility in part related to its climatic features with outbreaks occurring mainly in the hot, dry and windy months of the year. Studies have shown that epidemic meningitis has been dwelling in Africa for the past 100 years with waves featuring every 8-12 years and lasting for two to three years.
On vaccines and bacterial serogroups, over a million cases have been reported in Africa since 1988 with most caused by Neisseria meningitidis Serogroup A. However, there has been a massive reduction of the A trend due to the successful roll-out of MenAfriVac- a conjugate vaccine developed to curb this particular sub-type A serogroup by making it affordable and tailor-made. In fact, since its introduction in 2010, it has reduced the occurrence of meningitis in Chad alone by 94% and the whole continent by 57%, vaccinating more than 260 million individuals across 19 countries. Thanks to the Bill and Melinda Gates foundation for the US $70 million grant of 10 years that kick-started the Meningitis Vaccination Project, a partnership between PATH and the World Health Organization (WHO). The foundation charged the project with the development, testing, licensure and mass introduction of a meningococcal conjugate vaccine. However, outbreaks in Togo and Nigeria recently have had serogroups W and C respectively as the dominant cause of the epidemics. This calls for a close monitoring of the changing epidemiology of meningococcal disease as well as a review of the current strategy by the WHO in tackling it.
Finally, these epidemics usually strain the delivery of routine healthcare services as emergency treatment centres are set up as well as catastrophically increase the healthcare expenditure of people. A study carried out in Burkina Faso discovered that households spent US $90 per meningitis case and up to US $154 more when meningitis sequelae occurred (Colombini A, et al). You can imagine the depletion of household resources in these developing or worse still, impoverished countries.
My heart goes out to the families of those who lost their lives to meningitis.
ALUKO OLUWABUSAYO DANIEL
COLLEGE OF MEDICINE, UNIVERSITY OF LAGOS, NIGERIA