By Sola Ogundipe
Bacterial meningitis is serious business. Symptoms can come on quickly and escalate rapidly, often in 24 hours. It’s important to know the warning signs and to get medical treatment fast. A person diagnosed with bacterial meningitis will be lucky to live. Testing the spinal fluid is the only way to confirm a meningitis diagnosis, and if it goes untreated, the worst-case scenario is death. Because it’s so contagious, other people are infected suddenly, and it goes so rapidly. The good news is that there is treatment and it is preventable with an effective vaccine.
Children undergoing vaccination against meningitis in Nigeria.
About two years ago, the World Health Organisation and partner organisations including the International Federation of Red Cross and Red Crescent Societies (IFRC), Médecins sans Frontières (MSF), and the United Nations Children’s Fund (UNICEF), had warned of imminent outbreak of a meningitis epidemic as a result of an acute global shortage of meningitis C-containing vaccines.
The four organisations, that constitute the International Coordinating Group for Vaccine Provision for Epidemic Meningitis Control – ICG, urged vaccine manufacturers to step up meningitis C-containing vaccine production by five million doses before the 2016 meningitis season began.
Cyclical cases of meningitis C have been rising since 2013, first in Nigeria in 2013 and 2014, and then in Niger in 2015, but the sub region was ill prepared for the larger number of cases during the 2016 meningitis season.
There were no plans to stockpile doses of vaccine in readiness for flare-ups of the disease the following year and beyond, neither was there revised production plans to meet demand. Unlike substantial progress made in introduction of the MenAfrVac vaccine against meningitis A, the African meningitis belt remains susceptible to menace of meningitis C outbreaks. In the first six months of 2015, there were 12,000 cases of meningitis C in Niger and Nigeria, and 800 deaths. A critical shortage of vaccine hampered prevention efforts.
According to WHO, meningococcal meningitis is a bacterial form of meningitis, a serious infection of the thin lining that surrounds the brain and spinal cord. It can cause severe brain damage and is fatal in 50 percent of cases if untreated. Several different bacteria can cause meningitis. Neisseria meningitidis is the one with the potential to cause large epidemics. There are 12 serogroups of N. meningitidis that have been identified, six of which (A, B, C, W, X and Y) can cause epidemics.
Invasive meningococcal infection a.k.a Cerebro Spinal Meningitis (CSM) is not a relatively new disease. Bacterial meningitis is an inflammation of the protective membranes covering the brain and spinal cord. Bacteria enter the body and reproduces. It goes into spinal fluid and around the brain.
Meningitis has been described in ancient texts. Even Hippocrates described meningitis in his work. The first recorded outbreak occurred in the early 19th Century but it was not until around 1840 that the first outbreak in Africa was reported among French troops based in Algiers. The first major meningitis epidemic in West Africa was reported in 1905.
According to records, that year, an outbreak of 32 cases of epidemic meningitis in Zungeru, in northern Nigeria was reported in the Journal of Tropical Medicine. The outbreak was widespread, with further cases reported from Yola, nearly 500 miles (800 km) east of Zungeru.
Estimates showed there were at least 20,000 cases and many thousands of deaths. The epidemic spread rapidly westwards and the following year, reached northern Ghana. The main epidemiological features of epidemic meningococcal disease as it is seen in West Africa today were present.
The pattern remains the same – a high attack rate, seasonality and spread from area to area over a period.
Currently, there is another deadly meningitis outbreak which spread and rapidly has killed almost 400 people. It is the worst to hit Nigeria since 2009 when it 156 died. Almost 3,000 cases have been reported nationwide. The predominant type of meningitis causing this outbreak is meningitis type C for which there is shortage of vaccines. Nigeria, which lies on the meningitis belt, stretching from the Sahel region to the Horn of Africa, is used to meningitis type A outbreaks.
The Federal government has already procured 500,000 doses of vaccines from WHO and expecting 0ver 800,000 additional doses from the UK.
What to look out for
Many people don’t know the warning signs or that meningitis is vaccine-preventable. Symptoms can vary depending on the illness. The main symptoms to look out for are fever, rash, vomiting, headache, stiff neck, sensitivity to light, drowsiness, seizures, extreme sleepiness, sensitivity to light, confusion, nausea and fever. The signs and symptoms do not appear in a definite order, may not occur all together, or may not appear at all. This symptoms list does not include every possible sign and symptom of meningitis or septicaemia.
It is often misdiagnosed because early symptoms can be similar to common viral infections. Even those who have been vaccinated against meningococcal disease should be aware of the symptoms so they can watch for it in themselves or in others. In order to diagnose meningitis, doctors may do a blood test and take a sample of cerebrospinal fluid, the watery fluid that flows in and around the brain and spinal cord. The fluid is collected through a lumbar puncture and examined for the presence of white blood cells and bacteria. Blood and CSF samples will be cultured for the presence of bacteria. Treatment should not be delayed for more than 1-2 hours while diagnostic tests are taking place.
Treatment for meningitis must begin immediately following diagnosis and requires hospitalization for IV antibiotics. Meningitis requires injectable antibiotics and fluid replacement. Transfer to a hospital with an intensive care department may be necessary. The choice of antibiotic will be based on the susceptibilities of the meningitis bacteria in each patient’s area. Treatment with injectable antibiotics should be started until a bacterial cause can be excluded.
Survivors of bacterial meningitis may require ongoing treatment or therapy after their recovery. Almost all patients with viral meningitis recover without any permanent damage, although full recovery may take weeks to months.
Prevention is clearly the best option
The best way to prevent bacterial meningitis is through vaccination. Get vaccinated, practice good hygiene through regular hand washing. If it’s been a few years since the vaccine was administered, get a booster shot. Vaccines prepare the immune system by exposing the body to a germ so that it is better able to fight an infection when it occurs. Vaccines contain either parts of a germ, live but weakened germs, or inactivated (dead) germs. The vaccines available protect against major causes of bacterial meningitis. Best protection is to get the meningitis vaccine or booster. Even people who survive can have mental impairment or deafness following it. So people should get vaccinated.
Sleep in well ventilated places
Avoid close and prolonged contact with a case/s
Proper disposal of respiratory and throat secretions
Strict observance of hand hygiene and sneezing into elbow joint/sleeves
Reduce hand shaking, kissing, sharing utensils or medical interventions such as mouth resuscitation
Vaccination with relevant sero-type of the meningococcal vaccine
Anyone can be infected anywhere, any time
Bacterial meningitis, which is the most severe and common form of meningitis, causes around 170,000 deaths globally every year.
Even with prompt diagnosis and treatment, approximately 10- 20 per cent of patients with bacterial meningitis will die within 24 to 48 hours after the onset of symptoms, and around 10-30 per cent will sustain permanent damage and disability.
Infants and children under five years old and adolescents between 15 and 19 years of age are most at risk. But anyone in the world can get meningitis at any time.
Those surviving meningitis can have their lives devastated as a result of long-term effects, such as deafness, brain damage, learning difficulties, seizures, difficulties with physical activities and loss of limbs (due to septicaemia).
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By Sola Ogundipe