Conference abstract

Outbreak of cerebrospinal meningitis due to Neisseria meningitidis serogroup C, Sokoto State, Nigeria - May 2017

Pan African Medical Journal - Conference Proceedings. 2018:8(7).21 Dec 2018.
doi: 10.11604/pamj-cp.2018.8.7.589

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Keywords: Meningitis, Sokoto State, risk factors
Opening ceremony

Outbreak of cerebrospinal meningitis due to Neisseria meningitidis serogroup C, Sokoto State, Nigeria - May 2017

Assad Hassan1,&, Garba Mustapha1, Rahmatu Abdu-aguye1, Kassim Abdulmumini1, Bola Lawal1, Usman Yashe2, Halimatu Ayanleke3, Mahmood Dalhat1

1Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria, 2Nigeria Centre for Disease Control, Abuja, Nigeria, 3African Field Epidemiology Network, Nigeria

&Corresponding author
Assad Hassan, Nigeria Field Epidemiology and Laboratory Training Program, Asokoro, Abuja, Nigeria


Introduction: between 2013 and 2016, consecutive outbreaks of cerebrospinal meningitis (CSM) caused by a new strain of Neisseria meningitidis serogroup C (NmC) led to a reported 7,583 cases and 434 deaths in Northwest Nigeria with 1536 cases and 87 deaths from Sokoto state. In March, 2017 a suspected outbreak of CSM was reported in Sokoto State. We investigated the outbreak to describe the epidemiology, identify risk factors, and recommend preventive measures.

Methods: we conducted a 1:1 unmatched case-control study using a structured questionnaire to identify risk factors. We defined a suspected case as any resident of Sokoto, with sudden onset of fever (> 38.5C rectal or 38.0C axillary) and one of the following signs; neck stiffness, altered consciousness, vomiting, diarrhea and/or other meningeal signs including bulging fontanelle in toddlers between February 27 and May 3, 2017. We identified cases at treatment camps and through active case search. Cerebrospinal fluid (CSF) samples were collected for laboratory investigations.

Results: we recorded 133 cases with attack rate 89.7 per 100,000. 73 (56%) were female. Mean age (standard deviation) 16 (10.1) years. Bivariate analysis revealed socio-economic status (OR = 3.5 [95% CI = 2.1-5.8]) and previous vaccination against CSM (OR = 2.5 [95% CI = 1.4-4.5]) were associated with the outbreak. On multivariate analysis, socio-economic status (aOR = 2.80 [95% CI = 1.61-4.87]) and previous vaccination against CSM (aOR = 2.05; [95% CI = 1.05-3.99] ) emerged as independent risk factors of CSM in the outbreak. Of the 84 CSF samples collected, 11 (13%) had NmC isolated.

Conclusion: this was an outbreak of CSM due to NmC associated with low socio-economic status and previous vaccination against CSM. We supported enhanced case-based surveillance, standard case management, and reactive vaccination with meningococcal C conjugate vaccines. We recommend targeted health promotion campaigns in poor communities and regional vaccination campaigns with a long lasting meningococcal C conjugate vaccine to curtail the current outbreak and to prevent future outbreaks.