West Africa: Major Meningitis Epidemic Nears End

During the last four months, MSF teams in cooperation with the national health officials have been moving quickly, following the epidemic trend, to help treat tens of thousands of patients and to proceed swiftly on a massive vaccination campaign for 7.5 million people.

The huge emergency response to a meningitis outbreak in West Africa, mainly in Nigeria and Niger, is almost over now. During the last four months, Doctors Without Borders/Médecins Sans Frontières (MSF) teams in cooperation with national health officials have been moving quickly, following the epidemic trend, to help treat tens of thousands of patients and to move swiftly in a vaccination campaign for 7.5 million people.

The magnitude and length of meningitis outbreak in West Africa required a huge effort in response, beginning early in the season, in January, and just about to end. Since the start of the year, more than 65,000 people have been infected in the areas where MSF launched emergency operations; northern Nigeria, southern Niger and in the south of N’Djamena, capital of Chad.

The epidemic was one of the largest in a region known for years as the “meningitis belt”. At least 2,132 people have died. In total, around 7.5 million people were immunized during the outbreak by joint teams made up of national health ministries and MSF.

With MSF support, health ministries monitored the epidemic’s evolution across hundreds of thousands of square kilometers containing about 44 million people, more than the total population of Spain. The large-scale mobilization included 200 international staff (mainly doctors, nurses, and logisticians), 7,500 local staff, and Ministry of Health staff.

“In a typical day, our teams cover the 34 local government areas in Katsina State.” explains Dr Laurentia Enesi, of Katsina State, Nigeria. “We have to provide health staff with adequate drugs and equipment or training when needed. People infected with meningitis might die or develop complications if they are not treated quickly enough.”

Up to 400 vaccination teams of five people each immunized thousands of people every day in the region for a few weeks. In total, 2.8 million people were vaccinated in Zinder, Maradi, and Dosso regions in Niger, and 4.5 million people in Katsina, Jigawa, Bauchi, Kebbi, Sokoto, Niger, Zamfara, Kaduna, and Gombe States in Nigeria. Vaccination campaigns continue at some sites in Nigeria for a total of 255,000 people.

Four months later, in spite of the global toll, the number of deaths has remained relatively low. This was due partly to good case management and also because disease transmission was limited by vaccination campaigns launched quickly once epidemic thresholds were met.

Intervention in Niger
MSF teams have been working in close partnership with the Ministry of health to treat affected people in three regions (Maradi, Zinder, Dosso) of southern Niger, as well as in the capital, Niamey. They helped staff of local health structures with case definition and patient treatment. They provided training, and donated meningitis kits to hospitals and clinics. In parallel with the treatment strategy was a mass vaccination campaign carried out with health ministry workers. 2,838,000 people were vaccinated by MSF and Niger’s Ministry of Health.

MSF supported health structures for treatment of meningitis patients in six districts of Zinder region. Some 3,300 patients were treated, 148 have died. During the epidemic, a total of 1,510,000 people were vaccinated. MSF teams carried out vaccination campaigns in collaboration with the Ministry of Health for 1,316,000 people in the districts of Matameye, Zinder town, Mirriah, Magaria Tanout, and Goure. Vaccination is now over but a small team is doing follow-up for 2 weeks. Regular activities (nutritional programs) are ongoing.

Some 1,954 people with meningitis have been reported in the region by the Ministry of Health since the beginning of the year, among whom 63 died. In total, 1,117,410 people were vaccinated. MSF teams carried out vaccination campaigns, in collaboration with the Ministry of Health, in the districts of Maradi city, Madarounfa, Tessaoua, and Aguié and also in Tibiri health center in Guidam Roumji district and at eight health centers in Mayahi district. This represents 851,288 among the people vaccinated. In these areas, on average 92 percent of the target population (aged 2 to 30) has been immunized. The emergency intervention is now over and regular activities (medical and nutritional) are ongoing.

A total of 1,745 patients were treated and 102 died during MSF’s emergency intervention in this region (between weeks 11 to 18). MSF carried out a vaccination campaign with the Ministry of Heath in Dosso, Doutchi, and Boboye districts. Some 671,266 people were vaccinated. A total of 2,111 daily workers, 38 MSF local staff and around 26 expats were mobilized for this intervention.

In the capital of Niger, MSF supported local health structures to treat meningitis patients. Some 285 cases, including 24 deaths, were recorded since the beginning of the year.

Intervention in Nigeria
After many weeks of scaling up, MSF started to close down its activities and the vaccination campaigns are over in most of the nine northern states where it has worked since the end of January. Teams will remain in place for a few more weeks to continue case management and patient treatment in Kebbi State, Sokoto, Niger, Zamfara, Katsina, Jigawa, and Bauchi. Activities are finished in Gombe and Kaduna States. Joint Ministry of Health and MSF surveillance teams have so far recorded 57,795 cases, along with 1,795 deaths among a population of 38 million.

In parallel with the treatment strategy, vaccination campaigns were carried out by MSF teams with health ministry workers. So far, 4,541,000 people have been vaccinated in nine states where MSF worked with the Ministry of Health. Vaccination is ongoing for 255,000 people. At the end of the intervention, almost 4.8 million people will have been vaccinated by MSF/Ministry of Health in Nigeria during this epidemic.

Intervention in Chad
A total of 1,204 meningitis cases and 133 deaths have been recorded by Chad’s Ministry of Health. MSF supported health structures for meningitis treatment in some districts where the epidemic threshold had been reached and in the capital N’Djamena. Some 106,000 people were vaccinated by MSF jointly with the Ministry of Health in Durbali, Pala, and Goundi districts.