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Nigeria: Lessons from Ebola, what benefits for meningitis?

In July 2014, the Liberian, Patrick Sawyer introduced Ebola Virus Disease (EVD) to Nigeria. The disease killed him in Lagos five days after arrival and…

In July 2014, the Liberian, Patrick Sawyer introduced Ebola Virus Disease (EVD) to Nigeria. The disease killed him in Lagos five days after arrival and the infection caused seven other deaths.

The number of deaths was curtailed due to the swift response from government agencies and stakeholders that intervened and provided care to victims.The massive sensational campaigns on various platforms educated Nigerians, cautioned them and also encouraged them to seek help if they noticed symptoms that had been widely advertised.

The government instituted a high level committee of experts through the Ministry of Health, which along with the Lagos State government swung into action implementing public health measures, whichforestalled the spread of the disease across the country.

This efficient response to the august visitor in Nigeria’s health system, is one that saved the country, what would have otherwise have been a major disaster. The success of government’s effort on the matter is still widely celebrated and referenced.

Akaninyene Otu of the University of Calabar, in a research, said, “The principal strategy was an incident management approach, which saw them identified and successfully followed up 894 contacts. The infected EVD cases were quarantined and treated. The Nigerian private sector and international organizations made significant contributions to the control efforts. Public health enlightenment programmes using multimodal communication strategies were rapidly deployed, whiles water and sanitary facilities were provided in many public schools in Lagos.”

Otu and his team concluded that, the disease was effectively controlled using the incident management approach with massive support provided by the private sector and international community.

Their findings revealed that apart from the confirmed deaths the twelve infected people were nursed back to good health.

“The Nigerian EVD, experience provides valuable insights to guide reforms of African health systems in preparation for future infectious diseases outbreaks.”

Regardless this success recorded with eradicating Ebola and recommendations like that of Otu, only three years down the road in 2017, the country, especially the north west part, was ravaged by serogroup C strain of Cerebrospinal Meningitis (CSM) -a new strain of the disease occurring for the first time in Nigeria as against the more commonly known strains, – which occur annually.

Public Health Specialist and Researcher, Amy Hansen in her article ‘Cerebral Spinal Meningitis (CSM) spreads in Nigeria’ describes CSM as, a disease“most often caused by the bacteria Neisseria meningitides.

Bacterial meningitis, is an infection of the meninges, the thin covering of the brain and spinal cord. Symptoms of the disease include stiff neck, high fever, rash, headache, vomiting, and confusion.”


 A woman pacifies her daughter, who is suffering from brain damage resulting from meningitis at Molai General Hospital in Maiduguri, Nigeria, on November 30, 2016 PHOTO – AFOLABI SOTUNDE-REUTERS.

A May 2017, report by Premium Times, there were 1,114 deaths recorded in the first 22 weeks of theCMS outbreak – after it hit the country in November 2016. 

According to the Nigeria Centre for Disease Control, (NCDC) the outbreak affected Zamfara State, which recorded the first and highest casualties from the disease followed by Sokoto, Kano, Katsina, Kebbi and Yobe, andthat reached the alert/epidemic threshold in four additional local government areas.

According to the World Health Organisation, between December 2016 and 23 June 2017, a total of 14,513 cases with 1,166 deaths had been reported from 24 states. Of the reported cases, 1,002 were laboratory tested; of which 463 were confirmed positive for bacterial meningitis. Neisseria meningitides serogroup C was the predominant cause of meningitis amongst those who tested positive.

WHO said children between five to 14-year age group were the most affected, accounting for 6,791 cases. The states which were most affected by this outbreak were Zamfara, Sokoto, and Katsina, which accounted for nearly 89 percent of these cases.

FromTalata Mafara, Zamfara State, Zulaihatu’s (not real name), there were five children who me up these statistics. She said, “I noticed they were feverish but thought it was malaria. I gave them traditional medicine to treat it.

“Our emir had told us to go to the Isolation Centre in the community if we suspected anything. After about two days, they were getting worse. So I called my husband in Abuja to let him know because I wouldn’t have been able to take them to the Centre myself without his permission. He asked his brother to come and help me but by the time he came the day after, they were already in very bad shape.”

The children, ages four to 11 were taken to the Isolation Centre but died one after the other within one week.

Such cultural norms further widen the gap to achieving health for all and is one of the reasons Zulaihatu didn’t want her name mentioned since she needed permission to speak with our reporter.

Although she admits that her delay in seeking help, worsened the situation, she said, “even if we got there the first day I noticed their fever, we wouldn’t have gotten any help because there were no medicines or even vaccines for people who came.”

Virology expert and member of the United State National Academy of Science, Prof. Oyewale Tomori, had in April 2017 warned that Nigeria was not yet out of the woods.

Tomori in an interview with Vanguard said, “now that efforts had been made to identify the type of agent causing the outbreak, the country must prepare immediately to stockpile vaccines and antibiotics in preparation for possible outbreak.

“How well we succeed with the current vaccination will, to a large extent, determine the magnitude of future outbreaks. If we cover a substantially large number of our population with the vaccine, improve our surveillance and ensure proper care of cases, then we may be free of huge outbreaks in years to come.

“But knowing our country, as soon as we take care of the current outbreak, or the disease burns itself out, we will pack up bags and baggage and return to battling with the common issues of our national life: non-payment of salaries, strident whistle blowing exhuming illegally acquired millions of naira, pounds and dollars, and wait for the next recurring decimation by disease outbreaks.

“We currently do not have enough vaccines to cover the population in the states reporting the outbreak.”

In this light, when our reporter visited the Ministry of Health to be vaccinated and have it documented in her yellow card, she was told that it was unavailable and only the polio vaccine was available. However, the staff went ahead to document that she had been vaccinated against the disease “to avoid travel crisis.”

In response to what preparations were on ground to avert a repeat of last year’s meningitis saga, Dr. OlaoluAderinola, Incident Manager, Cerebrospinal Meningitis Emergency Operations Centre at the NCDC said, following the large outbreak of the 2016/2017 season with 14, 542 cases and 1,166 deaths, a national after action review meeting was conducted in July, 2017 to learn lessons and better strategize for the next harmattan season.

He said   national preparedness and response plan was developed following a national risk assessment in which11 high risk states in the northern part of the country were prioritized for support by NCDC.

The priority states – Sokoto, Zamfara, Katsina, Kano, Jigawa, Kaduna, kebbi, Yobe, Borno, Niger and Plateau, he explained also conducted a risk assessment in their states and a state based preparedness and response plan was developed for implementation.

Aderinola said, NCDC followed the  key strategies recommended by the World Health Organisation  adopted for managing cerebrospinal meningitis epidemics to enhance surveillance, effective case management and reactive vaccination.”

 Nigerian doctor Rilwanu Mohammed vaccinates a child against meningitis in Dakwa village in Bwari, Nigeria. 

The NCDC and its partners supported the states with the provision of sample collection kits, testing kits as well as medicines before the harmattan season. The move ensured that all necessary items were available for diagnosis and prompt treatment by health workers and also determined the organism responsible for the outbreak.

According to Aderinola, “This season, the Federal Government through the National Primary Health Care Development Agency has procured some doses of polysaccharide C containing Neisseria meningitis vaccines to respond to outbreaks occurring in some wards that entered the epidemic threshold.  It was to complement the vaccines that were released to the country by the International Coordinating Group of meningitis vaccine provision in three states – Zamfara, Katsina and Sokoto.”

The intervention has recorded some successes. For the 2017/2018 CSM outbreak season, the country recorded over 70% reduction in cases and deaths. As at 22nd May, 2018, the reported cases were 3,307 and 302 deaths.

Aderinola expressed concern about the cultural beliefs and practices of the people, whichhe described as posing as hindrances for early reporting and treatment. “Practices such as treating with herbs and the belief that CSM is a spiritual attack have led to the death of some of the sick at home is worrying asour active case search revealed this, following verbal autopsy of suspected cases that died,” Aderinola added.

On the way forward for the next season, he said, stakeholders will be reviewing this season’s response, identify gaps and focus more on strengthening strategies especially with more information dissemination in local languages for the populace to know.

Preventive vaccination will also be discussed to address the Neisseria meningitis C serogroup following the successful preventive vaccination against the Neisseria meningitis A serogroup, which is no longer a threat in causing outbreaks.

In only 93 days Nigeria was able to address the Ebola outbreak with only eight deaths of the 20 confirmed cases. On October 20, 2014, Nigeria reached the 40-day mark and WHO declared her Ebola free.

The WHO, United States Centers for Disease Control and Prevention

Médecins Sans Frontières (MSF), UNICEF and other partners supported the country with expertise for outbreak investigation, risk assessment, contact tracing and clinical care.

This was backed by strong public awareness campaigns, early engagement of traditional, religious and community leaders.

With the looming strike threatened by resident doctors under the aegis of the National Association of Resident Doctors of Nigeria (NARD) and current struggle to contain the recent lassa fever cases as facilities remain stretched, Nigeria is on the alert following EVD cases in the Democratic Republic of Congo, preparing for meningitis as the heat sets in, is not visible anywhere on the horizon.

Like Zulaihatu’s children, there are many others whose deaths were needless. As the heat season approaches this year, it is important for Nigeria to step up its intervention plans to avoid another unexpected disaster as that of 2017 caught them completely off guard.

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