Again, here cometh the killer disease!

Dr. Baba Goni Sheriff, a consultant in infectious diseases and immunology with the Department of Medicine, University of Maiduguri is alarmed that bacterial meningitis and viral meningitis is here again and no one seem to pay much attention. According to him, the need for an early preventive measure is crucial and the media “is the first drug” for the disease.

 According to this scientist, the African meningitis belt was first discovered by Lappeysonnie in 1963; it lies between latitudes 4° and 16° North of the equator, it extends from Ethiopia in the East, passes through Sudan, Chad, Niger, Nigeria, Burkina Faso, Mali and Senegal, to the Gambia in West Africa. However, “recent epidemiologic evidence has shown that the belt extends beyond the original area earlier described i.e. northwards to Tunisia and southwards up to the republic of South Africa.”

 The outbreak often affects children, five and 15 years of age, although recent epidemic in Nigeria and Niger republic that occurred in 1996 had affected infants and older children. In the 1996 epidemic alone, there were more than 100,000 and 45,000 reported cases in Nigeria and Niger republic, respectively. Moreover, in an epidemic situation of such proportion, for each single case that was presented to a health facility, there were about five to eight unattended cases at home. The environment also plays a role in the advent of an epidemic with overcrowding and poor living conditions promoting spread of the disease, Dr. Sheriff implied.

The symptoms of this killer disease bear a resemblance to the flu, which includes severe headache, stiff neck, fever, rash, delirium or a vacant stare, nausea, vomiting and sometimes seizures. Not all of these symptoms need be present for a person to be ill with meningitis said experts. Children under the age of two may only appear to be sleepy, vomit and refuse food but when especially it affects infants within the age bracket of three months, it is a potential emergency.

Unfortunately for many Nigerians, especially rural dwellers, the symptoms of meningitis always come to them like other less serious illnesses, and due to the apparent total absence of qualified health workers’ unnecessary deaths occur each year. “These deaths are in thousands every year,” said Dr. Sheriff.

According to Dr. Sheriff, Cerebrospinal Meningitis (CSM), is simply an infection of the human brain and its coverings caused by a bacterium called Neisseria meningitides. It continues to cause a devastating cyclical epidemic in the meningitis belt of Africa over time with little awareness to the devastating effects of this insidious disease.

 He further explained that the epidemics in the past tend to occur in a cyclical pattern of five to 10 years, “but it has been observed recently that it is becoming often unpredictable and frequent for some unexplained reasons.” Although studies are going on about the disease, sporadic cases of cerebrospinal meningitis have been probably as old as man himself.

In Nigeria as it is the case in other African meningitis belt, outbreaks of CSM have become a regular occurrence at frequent and almost predictable intervals with one of the worst epidemic occuring in Northern Nigeria in 1921 “when the diseases was given the name ‘Dan Kanoma’ after the town of its origin and from then on regular epidemics resulting in severe morbidity and mortality have been reported in several West African countries.

 How it affects it victims

The mechanism that determine infectivity and severity of epidemics of CSM are complex, however, as a general guide, good nutrition and a competent immune system are amongst other factors that limit the severity of the epidemic and these is tantamount to wishing for the impossible in Nigeria and most of Africa where poverty, hunger and diseases have not only weaken the prople’s immune system but has apparently taken away their hope of survival.

 According to Dr. Sheriff, “The organism Neisseria meningitides resides inside the human white blood cells once it gets inside the body. The organism has nine different sero-groups (designated as: A,B,C,D,X,Y,Z,W135,29e). African epidemics of CSM are caused predominantly by sero-groups A and C, while European epidemic on the other hand are caused by mainly group B. Majority of infected persons do not develop illness but continue to harbour the organism in their throat, becoming a source of re-infection during epidemics. Recent advances in molecular biology make it possible to sub-divide the group further in to clonal groups. The recent African epidemics were due to sero-group A, clonal sub-group III.1,” he said.

 However, most recently, “clinical identification of the disease is often quite easy, that even locals are able to diagnose the disease when they see an infected person. The main clinical symptoms are severe headache, fever, neck stiffness, severe backache, intense dislike for sunshine or any source of strong light (i.e. photophobia). The onset is often abrupt, starting like ‘flu-like’ illness, sometimes associated with vomiting. A number of complications may occur, affecting the central nervous system, causing stroke, deafness, blindness and other related side effects. A skin rash and joint swelling and or pain suggest that immune abnormalities are caused by immune complex deposition,” said Dr Sheriff.

 Treatment and prevention of the disease

Said Dr Sheriff in further explanation: “Once accurately diagnosed, treatment that cures the great majority of patients is available. In sporadic cases, because the numbers are few, daily divided doses of antibiotics are best. However, during epidemics it is impossible to use such antibiotics because the number of affected patients is simply too overwhelming for health workers to contain. In such circumstances, the best regimen consists of long acting antibiotic that can produce cure in just one single dose. The drug can also be easily administered by little trained ancillary health workers in the field, a major advantage since the majority of cases during outbreaks occur in the rural areas.”

 “The most effective way of preventing an epidemic of CSM is mass vaccination of the population at risk, using the available polysaccharide vaccine. It is pertinent to note that two prominent Nigerian academics-cum-physicians of international repute were the first to suggest the use of single dose long acting antibiotic during epidemics of CSM as well as use of mass vaccination for epidemic containment. These two prominent Nigerians are Professor Idris Mohammed (former CMD UMTH, Maiduguri) and Professor SS Wali (former CMD AKTH, Kano).”

 However, he said, “it was almost after about three decades of their suggestion and initial submission to the world health organisation (WHO), that the WHO is now advocating for mass vaccination. We must doff our hats for these two great Nigerians. The problem with the polysaccharide vaccine is its low capacity to induce immune protection particularly in children. However, in order to circumvent this problem a more potent immunogenic vaccine in the form of conjugate vaccine is about to be produced by the WHO, which is now, being funded by the Bill and Melinda Gates foundation.”

 Failure to act

The number of the victims of meningitis often go without count. One Baba Iliya in Karu said, “I am 73-years-old and I have known this disease since when I was a little kid, I lost two kids to it and I have lost count as to how many people have died of meningitis throughout my travels in the north.”

 Yet not much is said of this disease that remained indelible in the mind of this old man. The infrastructure and outreach for medical workers to determine the victims especially at the rural areas are also absent. The scanty records available of victims are that of urban dwellers.

 Even with the wealth of evidence of the disease, the mass vaccination campaign against CSM is yet to start and “hardly starts in good time before the onset of the hot season as recommended by experts,” said Dr. Sheriff, adding that “most often than not, the campaigns are started after an outbreak or in the middle of an epidemic- a case of too little too late often. This is an indictment of us all!”