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Niger: MSF Concludes Emergency Response to Meningitis Epidemic
June 9, 2008
At the beginning of May, at the request of the health ministry of Niger, MSF provided backup assistance for a meningitis epidemic in the Dosso region. Here, Issiaka Abdou, MSF emergency co-ordinator, talks about the operation.
What is Meningitis?
Meningococcal meningitis is a contagious and potentially fatal infection of the brain membrane. Infected people often carry the disease without showing symptoms, and spread the bacteria to others when they cough or sneeze. Death may occur within hours of the onset of symptoms— sudden, intense headaches, fever, nausea, vomiting, photophobia, and stiffness of the neck. Timely mass vaccinations are the most effective means of limiting the spread of epidemics.
Where and when did this meningitis epidemic break out?
The first cases appeared in mid-February, then the illness propagated through the five districts of Dosso region, about 150 kilometres east of the capital of Niger. The epidemic threshold–which is more than 15 recorded cases in one week for a population of 100,000 inhabitants–was exceeded during April or at the beginning of May in ten health centers. The health authorities of Niger responded rapidly by organizing emergency vaccination campaigns. However, because of limited means, vaccination coverage was only 10 to 20 percent, whereas at least 70 percent of the population needs to be vaccinated to prevent development of the epidemic. That is where the health ministry of Niger sought support from MSF.
What did the MSF operation entail?
After going out to verify the number of recorded cases in the region's health centers, we decided at the beginning of May to target the most affected districts. To ensure patients could be treated properly, we provided 23 health centers with full treatment doses of oily chloramphenicol, and equipment for lumbar-puncture diagnosis and for intramuscular injection of treatment. Additionally, two MSF physicians briefed health-center staff on diagnosing cases and the treatment protocol, then regularly visited the centers to record the number of cases and ensure restock of treatments. In all, the centers supported by MSF managed 107 patients, of whom six died.
Additionally, we provided the district's two hospitals, in Dosso and Doutchi, with kits to allow the treatment of complicated cases.
In parallel, we carried out a vaccination campaign in five health areas particularly affected by the epidemic with a team of 12 people to reinforce health-ministry staff. Out of a target population of 136,000 between the ages of 2 and 30, we vaccinated almost 95,000. In four districts, we attained our objective of an 85 percent vaccination coverage rate. In the district of Doutchi, on the other hand, we attained only 70 percent, and are trying to understand why: either we overestimated the population of the district, or people did not come in for vaccinations because they were working in the fields, following the first rains.
Is the epidemic now over?
Yes. Last week, only four new cases were treated, bringing the total number of recorded cases since the start of the epidemic to 425. Moreover, the start of the rainy season should bring a final halt to the epidemic, since meningitis-propagation is encouraged by the dry season.
MSF is wrapping up the operation by retrieving treatment kits distributed to health centers, in order to create stocks for future cases in the district's hospitals. We are also donating vaccines and syringes to the health centers that we supported, and also in those where the rate of vaccination coverage was insufficient.