Clinical Neurology and Neuroscience
Volume 1, Issue 3, August 2017, Pages: 70-75
Received: Apr. 10, 2017;
Accepted: Apr. 25, 2017;
Published: Jun. 20, 2017
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Gemechu Defi, Addis Ababa University, Ethiopia Field Epidemiology Training Program, Addis Ababa, Ethiopia
John Fogarty, Addis Ababa University, Ethiopia Field Epidemiology Training Program, Addis Ababa, Ethiopia
Meningococcal meningitis is a serious bacterial infection of the meninges often caused by N. meningitides. Epidemics occur in 8-12 year cycles, usually in the dry season, across the African meningitis belt. In February 2013, West Arsi zone reported a suspected meningitis outbreak to Regional Public Health Emergency Center. Investigation was done to confirm the etiology, identify risk factors, and establish control measures. A suspected case was defined as any person with sudden onset of fever (>38.5°C rectal or 38.0°C axillary) and one of the following signs: neck stiffness, flaccid neck, bulging fontanel, convulsion or other meningeal sign and confirmed case as identified N. meningitidis from the CSF of a suspected case by culture, PCR or agglutination test. From January 23, 2013 up to April 17, 2013, a case investigation was conducted to identify suspected patients and confirmed meningitis for patients cerebrospinal fluid collected. We also conducted case-control study. Descriptive statistics and odds ratios with 95% confidence intervals were calculated to compare risk factors among cases and controls. A total of 99 cases and 3 deaths were occurred from January 23- April 27, 2013. The median age was 12 years with a range from 3 months to 68 years. Majority (89.9%) of the cases were below 30 years of age and children under five years of age were the most affected (28%) and Attack Rate (AR=4.2/100000). Ten (59%) patients with N. meningitidis were confirmed as serotype “A”, 6 (35.3%) patients were confirmed by latex agglutination test and PCR as serotype W135 and 1 (5.9%) patient was confirmed as mixed serotype. 24 confirmed and suspected Meningococcal meningitis patient cases and 96 community matched by sex, age and place of residence controls were included in the case control study. Recent travel to an area where patients with meningitis were reported (Odds Ratio (OR): 10.0, 95% Confidence Interval (CI): 3.7-27.3), attending in the occasion of gathering of population (OR: 7.7, 95% CI: 2.9-20.6) and a history of upper respiratory tract infection (OR: 7.2, 95% CI: 2.6-19.9) were risk factors. We verified sporadic cases of meningococcal meningitis in the areas. Incidence of disease was highest in children under five years of age. This was the first season that W135 was identified in Ethiopia. Further surveillance for W135 should be conducted in Ethiopia to guide vaccination policy.
Sporadic Cases of Meningococcal Meningitis Serogroup W-135 — Ethiopia, 2013, Clinical Neurology and Neuroscience.
Vol. 1, No. 3,
2017, pp. 70-75.
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World Health Organization (WHO). Control of epidemic meningococcal disease. WHO practical guidelines 2nd edition. World Health Organization Emerging and other Communicable Diseases, Surveillance and Control WHO/EMC/BAC/98.3, 1998.
World Health Organization (WHO). Managing meningitis epidemics in Africa. A quick reference guide for health authorities and health-care workers, World Health Organization 2010. WHO/HSE/GAR/ERI/2010.4, 2010.
The Lancet. Epidemic meningitis, meningococcaemia, and Neisseria meningitides: www.thelancet.com Vol 369 June 30, 2007.
Rosenstein NE, Perkins BA, Stephens DS, Popovic T, Hughes JM. Meningococcal disease. N Engl J Med 2001; 344: 1378–88.
World Health Organisation. Epidemic and pandemic alert and response (EPR): disease outbreak news. 2002. Available at: http://www.who.int/ csr/don/2002_09_12a/en/index.html. Accessed 24 March 2006
Shao Z, Li W, Ren J, et al. Identification of a new Neisseria meningitidis serogroup C clone from Anhui province, China. Lancet 2006; 367: 419–23.
Jodar L, Feavers IM, Salisbury D, Granoff DM. Development of vaccines against meningococcal disease. Lancet 2002; 359: 1499–508.
Bilukha OO, Rosenstein N. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2005; 54 (RR-7): 1–21.
Trotter CL, Andrews NJ, Kaczmarski EB, Miller E, Ramsay ME. Effectiveness of meningococcal serogroup C conjugate vaccine 4 years after introduction. Lancet 2004; 364: 365–7.
Centers for Disease Control and Prevention (CDC). Control and prevention of meningococcal disease and Control and prevention of serogroup C meningococcal disease: evaluation and management of suspected outbreaks: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997; 46 (No. RR-5).
Greenwood B. Manson lecture: meningococcal meningitis in Africa. Trans R Soc Trop Med Hyg 1999; 93: 341–53.
Popovic T, Sacchi CT, Reeves MW, et al. Neisseria meningitidis serogroup W135 isolates associated with the ET-37 complex. Emerg Infect Dis 2000; 6: 428–9.
Taha MK, Achtman M, Alonso JM, et al. Serogroup W135 meningococcal disease in Hajj pilgrims. Lancet 2000; 356: 2159.
Molling P, Backman A, Olcen P, Fredlund H. Comparison of serogroup W-135 meningococci isolated in Sweden during a 23-year period and those associated with a recent Hajj pilgrimage. J Clin Microbiol 2001; 39: 2695–9.
Fonkoua MC, Taha MK, Nicolas P, et al. Recent increase in meningitis caused by Neisseria meningitidis serogroups A and W135, Yaounde, Cameroon. Emerg Infect Dis 2002; 8: 327–9.
Aguilera JF, Perrocheau A, Meffre C, Hahne S. Outbreak of serogroup W135 meningococcal disease after the Hajj pilgrimage, Europe, 2000. Emerg Infect Dis 2002; 8: 761–7.
Taha MK, Parent Du Chalet, I, Schlumberger M, et al. Neisseria meningitidis serogroups W135 and A were equally prevalent among meningitis cases occurring at the end of the 2001 epidemics in Burkina Faso and Niger. J Clin Microbiol 2002; 40: 1083–4.
Meningococcal disease, serogroup W135, Burkina Faso: preliminary report, 2002. Wkly Epidemiol Rec 2002; 77: 152–5.
Nicolas P, Djibo S, Moussa A, Tenebray B, Boisier P, Chanteau S. Molecular epidemiology of meningococci isolated in Niger in 2003 shows serogroup A sequence type (ST)-7 and serogroup W135 ST-11 or ST-2881 strains. J Clin Microbiol 2005; 43: 1437–8.
Nicolas P, Norheim G, Garnotel E, Djibo S, Caugant DA. Molecular epidemiology of Neisseria meningitidis isolated in the African Meningitis Belt between 1988 and 2003 shows dominance of sequence type 5 (ST-5) and ST-11 complexes. J Clin Microbiol 2005; 43: 5129–35.