22 February 2006

 

Meningococcal disease in sub-Saharan Africa

Meningococcal disease occurs sporadically all over the world with seasonal variations. Annual epidemics of disease occur in both temperate and tropical areas. However, the highest burden of disease occurs in the semi-arid area of sub-Saharan Africa known as the ‘meningitis belt’.  This extends from Senegal in the west to Ethiopia in the east. During epidemics this region has a disease incidence rate of > 1,000 cases per 100,000 population [1].

In 2002, countries further south of the belt in the Great Lakes region, including Tanzania, Rwanda and Burundi, reported more than 2,200 cases of meningococcal disease [2].

Epidemics in the meningitis belt countries occur in cycles, usually in the dry season, between November and May/June. The serogroups most commonly associated with the African meningitis belt are A and C, however, serogroup W135 emerged in Burkina Faso in 2002 [3].

During the current season cases of meningococcal disease have been reported from several countries including Kenya and Nigeria [4,5].

The World Health Organization (WHO) has also reported cases from Sudan and Uganda.

Sudan

WHO has reported a total of 136 suspected cases, including 15 deaths, of meningococcal disease between 1 -31 January 2006 [6].

Cases have been reported from six states in Sudan. The epidemic threshold has been crossed in two administrative units; Guli in Blue Nile State and Wad el Heleu in Kassala State. One specimen of cerebrospinal fluid has been found positive for Neisseria meningitidis serogroup A. Results from additional specimens sent to the National Public Health Laboratory in Khartoum are expected shortly.

Uganda

WHO has reported a total of 301 suspected cases, including 23 deaths, of meningococcal disease between 28 December 2005 and 3 February 2006 [7].

Cases have been reported from the districts of Nakapiripirit and Moroto in north-eastern Uganda. Laboratory tests have confirmed Neisseria meningitidis serogroup A.  An emergency vaccination campaign has begun in both affected districts.

Advice for travellers

The risk of meningococcal meningitis for tourists is low; the risk is higher for those travellers who will be living or working with local persons, especially during prolonged periods, in endemic areas.

In July 2004, NaTHNaC revised the recommendations for meningococcal meningitis vaccine for travellers visiting areas of risk [8]. Immunisation using the quadrivalent ACW135Y vaccine should be considered for

travellers who will be living or working with local persons

long stay and rural travellers visiting areas of risk

travellers visiting an area of risk during an outbreak

A list of countries with potential risk in Africa can be found here.

 

References

1. Committee to Advise on Tropical Medicine (CATMAT). Statement on meningococcal vaccination for travellers 1999; vol 25. [cited 22 February 2006] Available at http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/99vol25/25sup/acs5.html

2. World Health Organization. Meningococcal disease in the Great Lakes area (Burundi, Rwanda, United Republic of Tanzania) 23 August 2002. [cited 22 February 2006] Available at http://www.who.int/csr/don/2002_08_23a/en/index.html

3. World Health Organization. 2002 Meningococcal disease in the African meningitis belt - update 2. 6 may 2002. [cited 22 February 2006] Available at http://www.who.int/csr/don/2002_05_06/en/index.html

4. ProMED-mail. Meningococcal disease update 2006 (02) 15 February 2006 [cited 22 February 2006] Available at http://www.promedmail.org/pls/promed/f?p=2400:1001:

16806974765714615366::NO::F2400_P1001_

BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,32026

5. ProMED -mail. Meningococcal disease update 2006. 9 February 2006 [cited 22 February 2006] Available at http://www.promedmail.org/pls/promed/f?p=2400:1001:

9282865807770154583::NO::F2400_P1001_BACK_

PAGE,F2400_P1001_PUB_MAIL_ID:1000,31947

6. World Health Organization. Meningococcal disease in Sudan. 3 February 2006. [cited 22 February 2006]. Available at http://www.who.int/csr/don/2006_02_03/en/index.html

7. World Health Organization. Meningococcal disease in Uganda - update. 10 February 2006. [cited 22 February 2006] Available at http://www.who.int/csr/don/2006_02_10/en/index.html

8. NaTHNaC. Update: Changes to meningococcal meningitis recommendations for travellers. 21 July 2004. [cited 22 February 2006] Available at http://www.NaTHNaC.org/pro/clinical_updates/

meningitis_update.htm