ufofana's picture
Liberian ‘meningitis outbreak’ puts Sierra Leone on alert

By Kemo Cham

Last week Liberian authorities identified Meningitis as one of the suspect cases in an ongoing outbreak of a 'mysterious' illness.

The Ministry of Health (MoH) of Liberia said reports from test samples pointed to the tropical disease that affects the brain and spinal cord, even though the World Health Organisation (WHO) appears to be unsure of that explanation.

But with memories of the 2014 Ebola Outbreak still fresh in minds, concerns over the situation has left health authorities across the border in Sierra Leone edgy, with the Ministry of Health and Sanitation (MoHS) here heightening surveillance measures at all border crossing points and the institution of modalities to tackle any emergency in case of a spillover.

The current epidemic, which erupted in the southeastern Sino County, 350km from the capital, Monrovia, has since spread to two more counties - Montserrado and Grand Bassa, claiming 13 lives among 31 cases recorded, according to the latest WHO update on May 10.

Liberian health authorities said specimens from four patients tested by the United States Center for Disease Control and Prevention for 29 different diseases came back with results for 28 of them showing negative, while the Meningitis test proved positive.

“Although these most recent reports point to meningitis as the probable cause of illness and death in these patients, the investigation is still ongoing to determine if this bacteria is responsible for other reported illnesses in this cluster,” WHO said in the statement.

This development comes about a year after the end of the deadly West African Ebola epidemic which mostly affected the three neighboring Mano River Basin countries of Liberia, Sierra Leone and Guinea. Over 11, 000 people died in that outbreak.

Dr Foday Dafae, Director of the Public Health National Emergency Operation Center (PHNEOC) of Sierra Leone, said with lessons drawn from Ebola, all District Health Management Teams, especially those in regions bordering Liberia, have been put on high alert. He added that the Center's regular Emergency Preparedness and Response meeting also gets constant updates on development from across the border, and that top officials in Freetown and Monrovia  were in constant touch.

“We are stepping up our surveillance system so that when we have one case we are able to treat it there and we are able to contain it wherever it is,” Dafae told Politico in an interview.

Meningitis Belt

Meningitis is an acute inflammation of the protective membrane covering the brain and spinal cord. It is caused by both bacteria and viruses, as well as fungi, parasites and amoeba. A bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling.

Injuries, cancer, certain drugs, and other types of infections also can cause meningitis.

Among these lots, viral and bacterial Meningitis are said to be the most prevalent. And among the two, Bacterial meningitis is the most dangerous and can be life-threatening, hence the need for urgent treatment with antibiotics. The lower risk viral meningitis can easily be cured with over-the-counter medicine.

The most common symptoms of Meningitise are fever, headache and neck stiffness. Others include nausea, neck ache, vomiting and rashes.

The symptoms can also manifest in the form of confusion or altered consciousness, and inability to tolerate light or loud noise.

Like Liberia before now, Sierra Leone has never experienced a Meningitis outbreak. But according to Dr Dafae, because Sierra Leone  shares border with one of the countries lying on the so-called African Meningitis Belt - Guinea - concerns have been on two Sierra Leonean districts – Koinadugu in the north and and Kono in the east.

The Meningitis Belt consists of 26 countries that fall within an area of sub-Saharan Africa stretching from Senegal in the Western most part of the continent, to Ethiopia in the Eastern most end. This region, covering an at-risk population of over 300 million people, is where the rate of incidence of the disease is the highest.

Other countries within the Meningitis Belt include Gambia, Guinea-Bissau, Mali, Burkina Faso, Ghana, Niger, Nigeria, Cameroon, Chad, Central African Republic, Sudan, South Sudan, Uganda, Kenya, and Eritrea.

Burkina Faso, Chad, Ethiopia, and Niger have been the most affected by the disease, accounting for 65% of all cases recorded in Africa since 1988, according to the Meningitis Vaccine Project [http://www.meningvax.org], a WHO funded initiative.

Studies indicate that nearly 20 percent of the population in West Africa, mostly within the Meningitis Belt, carries a Meningitis strain in their respiratory tract. But they do not always fall sick.

Meningitis epidemic is known to occur during the dry season, usually between December and June. Children are mostly at risk both during and outside an outbreak.

The strains

There are six strains of Meningitis – A; B; C; W135; X; and Y.

The A strain is said to be the dominant group all over Africa, accounting for about 80 to 85 percent of all cases in the Meningitis Belt. Strain C, which is what is suspected in Liberia and is also the culprit in an ongoing outbreak in Nigeria, is rare but with a little more severe effect than the former. Both strains A and C are bacterial infections spread by saliva and close physical contact.

Dr Dafae said besides sporadic cases of type A Meningitis, there has been no outbreak in Sierra Leone. But, the infectious disease expert added: “While we are not in the Meningitis belt, our concern has always been with the upper part of Koinadugu and the upper part of Kono district, because they are very close to Guinea...”

The bad news, he noted, is that Meningitis vaccines are “very hard to come by.”

The good news though is that Meningitis is treatable, even though survivors may live with long-term or even permanent medical disabilities, such as visual impairment and neurological dysfunction.

According to WHO, the disease is fatal in 50 percent of cases, if untreated. And because its symptoms can advance very rapidly into a life threatening situation, early treatment is advisable.

But as in all illnesses, the best option is prevention, and the best way to achieve this is to stay away from crowded places, especially if you live in the Meningitis Belt, as the disease spread by close contact with infected people.

Meningitis is common among people who live in communities where access to hospitals is low and poverty is high.

Dr Dafae said while Sierra Leone can’t prevent people from crossing its borders, it expected visitors to cooperate in efforts to prevent any potential outbreak of any illness.

“Hopefully we will not get there, but, I will tell you, since the Ebola we have learnt our lessons. We are making sure that anywhere there is a disease, we are able to pinpoint it and contain it there,” he said.

Copyright (c) Politico 2017