THE INCONVENIENT TRUTH ABOUT THE CURRENT OUTBREAK OF MENINGITIS IN WEST AFRICA
One too often, Nigerians forget that we remain exposed as a nation in Africa, to the countless peril that may be environmental, socio-economical and physical, solely because most African government or leadership don’t have the proper visions of where their country need to or suppose to be. Greed, nepotism, ethnicity, mediocre projects that are not in keeping with ecologically sustainable development goals and corruption of all the existing systems from agriculture, to health, to technology to sport to religion and culture. If we don’t seat back presently to plan our respective countries before the end of this century, I fear for my continent (Africa) and I often feel sorry for Africans especially Nigerians who still sentimentally live under the cover of the human attributes listed above.
Introduction
Meningitis is a tough disease, caused majorly by an infectious agent. Neisseria meningitidis is a gram-negative diplococcus. They can be grouped on the basis of the composition of the capsular polysaccharide into 6 major sero-groups: A, B, C, W, X, and Y.
The STEREOTYPE C is current the new strain causing the recent outbreak in Nigeria. The last century has recorded many meningitis outbreaks occurring globally, with Africa being the focus of the most reported cases, the distribution of these outbreaks stretches from the West Africa region in Senegal to the East Africa area in Ethiopia now called the “Meningitis Belt” region where they are commonly seen. It is transmitted from human-to-human through close contact with salivary secretions or close respiratory secretions of infected person.
Meningitis infection occurs during the dry season (December–May) with reported cases averaging 1,000 cases per 100,000 population, but in light of the current climate change crisis and from the news report coming from Nigeria, the reported cases from Mid-December 2016 till March 2017 have been over 2, 355. By contrast, there is a decreased rate of the disease in the United States, Europe, and South America ranging from 0.3 to 3 cases per 100,000 population per year with Sero-group A accounting for 80% of all cases, although rare sero-groups like C, X, and W can be present. A small percentage of the population about 5%–10% are regarded as carriers of N. meningitidis. Those majorly affected are infants, young adults and travelers visiting the meningitis belt countries.
There also have been reported cases of pilgrimage participants to Saudi Arabia having outbreaks of meningococcal disease upon returning from pilgrims. Clinical presentation generally occurs from 1–10 days after initial exposure with meningitis presenting in more than half of the cases, patients present with the following features; a sudden headache, fever, stiffness of the neck, nausea, vomiting, photophobia, or altered mental status. Up to 20% of people present with meningococcal sepsis, characterised by a purpuric rash and in extreme cases can lead to multi-organ failure.
Among children less than 2 years, the meningococcal disease may have non-specific symptoms further making it very deadly, if they are affected because the usual neck stiffness, seen may not be present in this age.
Therefore, early diagnosis and treatment are key treatment modalities. Diagnosis is generally made by isolating N. meningitidis from blood or CSF through culture, by detecting meningococcal antigen in CSF by latex agglutination via a lumbar puncture procedure where the cerebrospinal fluid (CSF) is extracted and a Gram stain performed or by evidence of N. meningitides DNA by Polymerase Chain Reaction test. Other types of bacteria can cause meningitis, such as Haemophilus influenzae and Streptococcus pneumonia and also few reported cases caused by virus and fungi. Their clinical signs and symptoms are similar to those of N. meningitides.
Therefore the causative organisms need to be identified, so as to commence antibiotics used for treatment. According to the WHO even when the disease is diagnosed early and adequate treatment begins, 5% to 10% of patients die, typically within 24 to 48 hours of the onset of symptoms. Hence Meningitis is viewed as a medical emergency and preventive measures are still cost effective.
The preventive measures involve the use of Vaccine, especially in regions known to exhibit reactive immunisation; a vaccination campaign should be initiated, when the number of reported cases reaches the alert threshold for infection, which is defined as 5 cases per week per 100,000 populations. The success of this strategy is greatly dependent on timely surveillance during reported outbreak and rapid medical emergency response.
Sadly, on writing this article, Nigeria and other affected African countries are just requesting for vaccines from World health organization, after over 345 deaths in Nigeria have been recorded.
However, with a better weather forecast, these governments would have applied early for the vaccine or if they have excellent health system they would not have recorded the current fatalities been presented to the public.
Another important point to note about prevention strategy using Vaccine is that vaccines for meningitis typically provide immunity just for two to three years. The gold standard policy, therefore, has been reactive immunization which has been discussed above. If the number of cases in an area reaches a certain threshold, then vaccinations and antibiotics are ordered for that area and usually, the response to such request can be too late.
The drawback with relying on the alert threshold is the strong reliance on disease surveillance and the occasional delays in reporting majorly due to poor planning and communication system. Recently, newer vaccines that guarantee long-term immunity have been developed and is in use already. These vaccines help to reduce the threat of epidemics, but other meningitis sero-groups are likely to continue to be a challenge, like the current form Sero-group C causing problems in Nigeria because they are not yet commercially available.
FACTORS THAT SUPPORT THE OUTBREAKS
The spread of any infectious disease can be determined by a lot of factors, such as the level of immunity of the human, the types of social interactions with the society, but environment factors do play an important region like; the change in temperature, humidity and dust. The amount of dust is particularly high in Sub-Sahara Africa due to the strong northeastern wind called the Harmattan.
The Harmattan picks up dust as it blows over desert regions like the Bodélé Depression, a dried-up lake bed situated in Chad, it is regarded as the largest deposit of dust in the world. The dust storms formed when these strong wind flexes are so thick that they can prevent the sunshine for weeks. Dust then cause the spread of meningitis through aerosolization with the bacteria embedded into the particulate it can lodge in the throat of human causing irritation and breach the mucosa membrane and get into the blood stream where it is transported to the brain, which results in the meningitis infection. The individuals who then fall stick remain indoors critically ill, where they then carry out the human to human transmission of the disease more easily other family relatives or friends.
DETAILED DISCUSSION
I will start this discussion from the sad news carried by CNN two days ago tagged “Meningitis outbreak in Nigeria kills nearly 300” by Stephanie Busari . As at the beginning of April 2017 the local newspapers were estimating over 400 dead since the commencement of the new outbreak. As Africans, we can start to pull our resources together to develop a research hub for all these environmental variables and how they impact our lives. Consequently having detail knowledge of climatic patterns and understanding what’s going on other parts of the world and more importantly we acting to forestall further worsening of the humanitarian issues on the continent and health matters like current meningitis incident in West Africa is key especially in light of the fact that it has occurred before in the past.
Travel advisory already has been issued by few western nations. In Nigeria and other West African nations namely, Niger, Mail, Burkina Faso, Ghana, Gambia, Togo and others there have been reported cases this year 2017. It is officially a health emergency in Nigeria with her government issuing a public warning and precautionary advice to citizens. With every human system linked together, one way or another, any infectious disease that can spread with the help of environmental variables will be disastrous and it can compromise human systems existing, hence the climate change phenomenon is an important determinant of the current outbreak in west Africa.
It is my belief that if we are able to properly determine the role of climate in the continuous spread of common diseases like meningitis, we may well be able to assist a lot of African governments and health professionals in forecasting likely periods of epidemics and better prepare for likely consequence, all of which require satellite’enhanced and technology-supported appliances to study weather variables and collate data from the area affected with meningitis. Being able to forecast an outbreak could help save lives.
The National Aeronautics and Space Administration (NASA) Goddard Institute for Space Studies is a research-based institutions that have an understanding of the climate science with strong emphasises on the natural and human changes experience here on earth. They achieve these results by combining the analysis gotten from observatory stations and satellite data in strict consultation with available planetary models of atmospheric, land surface, and oceanic processes.
The research scientists from NASA have known that the outbreaks of meningitis in the West African region have a very strong link and association to climate and environmental conditions. However, the usually lack of credible data solely because African governments do not fund such ventures plus they usually want to continue with the business as usual attitude of most Africans leaders towards environmental matters due partly to cultural and religious belief system have sincerely hindered the full link of this relationship which we now know is obvious. These scientists studied the climate variables and meningitis incidence in Niger for over two decades and in the Journal Environmental Health Perspectives, they revealed that the strength of the wind and surface dust concentration can be used to predict the rate of meningitis infection especially during drier seasons. Newer researches on meningitis and climate in sub-Saharan Africa also support these claims identifying wind and dust conditions as predictors of the disease. This result may help in developing vaccination strategies that aim to prevent meningitis outbreaks.
HOW DOES CLIMATE CHANGE INFLUENCE OUTBREAK OF MENINGITIS?
It is made possible by the increased temperature with a contributory effort from the dry wind. Scientists from NASA believe that the increase in temperature and the active presence of dry winds from the northeast affects the mucous membranes in the human body, that way increasing the chances of the N. meningitides organism getting into the human host.
Benjamin Sultan and his colleagues from a climate research institute and an infectious disease center in France revealed in 2005 that Climate changes indeed drives the meningitis outbreak in West Africa. They discovered this result after looking at the relation between climate and meningitis outbreaks in Mali in West Africa, a region that annually experience meningococcal meningitis between February and May affecting up to 100,000 to 150,000 people.
An important yet common climatic variable in this region was the dry wind, called the Harmattan, there is a great reduction in humidity and a lot of dust is generated. They discover that from 1994 to 2002, the meningitis epidemic peaks and results in an outbreak about the same time as when the dry Harmattan wind peaks. This empirical observation was able to show the positive association between an external environmental element (in this case dry wind) and the initiation of disease outbreaks.
Current research work on meningitis incidence in meningitis belt of Africa reveals that dry wind and dusty scenarios are predictive factors for the spread of meningitis but with this understanding, it can help in developing better vaccination delivery strategies which can be targeted to periods of outbreaks.
It is a general knowledge that disease outbreaks can be seasonal an example is a cold flu (influenza), which record its highest incidence during the cold period in the year. Meningitis, an infection of the thin lining surrounding the brain and spinal cord is also a seasonal disease, especially during the dry season. The Meningitis Belt in Africa comprise majorly arid regions stretching through Guinea Bissau, Ghana, Burkina Faso, Niger, Togo, Chad, Nigeria and extending east to Ethiopia. The current epidemic in Nigeria is greater in impact and covers much more area than it did 20 years ago. In Nigeria already 15 states out 36 states have reported cases with even few reported cases in one of the southern states originally not affected. Therefore, dust and dry wind conditions have predictability factored in on the seasonal cases of meningitis. With the intense research in both present and past climate change on earth and its resultant effect on disease distribution, it indeed gives mankind a futuristic knowledge and better understanding of the atmosphere and avails mankind additional tool in monitoring or impact on existing human system especially health system.
Recommendations
1. It is suggested that the metrological agency in Nigeria and other Africa countries properly fund and develop capacity using current technology.
2. There should be a more resilient national healthcare system across Africa countries that can withstand for emergency/humanitarian cases though a go forecast/warning system can allow the health professional and various government at different level better prepare ahead of the health crisis by giving more lead time minimize and save lives and facilitate distributing vaccines to vulnerable districts.
3. A robust campaign for meningitis should be done regulars.
4. African leaders should encourage the research of these diseases by funding works; they can do these by collaboration and tasking each African country to contribute.
5. In order to better anticipate future outbreaks or any form of outbreaks, An African Environmental Management committee needs to be formed, it will have multi-disciplinary representation from the various professional groups in Africa Led by AU and Supported by WHO and all health ministries in Africa, especially those in the meningitis belt region, their core mandate is to create predictive models for the disease based on climate and environmental variables. By doing this Africa may be able to speed up the research effort and develop capacity and technical knowledge in these areas in all these areas which can translate to better healthcare outcomes and a progressive society.
6. African governments at all level must ensure the advancement and implementation of Sustainable Development Goals (SDGs) which will further mitigate some of the challenges.
Best regards,
DR. GBUJIE DANIEL CHIDUBEM
Founder/Chief Executive Officer, TEAM 54 PROJECT Twitter handle: @team54project Whatsapp only:+2348033041426
http://www.thehealthpilot.org/inconvenient-truth-current-outbreak-meningitis-west-africa/
