West Africa: Major meningitis epidemic is finishing

The huge emergency response to the meningitis outbreaks in West Africa, mainly in Nigeria and Niger, is almost over now. During the last four months, Médecins Sans Frontières teams in cooperation with the Ministries of Health have moved quickly and assisted in the treatment of thousands of patients as well as carrying out a massive vaccination campaign for 7.5 million people.

The magnitude of the meningitis outbreak in West Africa required a huge response. The epidemic began early in the season, in January, and is just about to end. More than 65,000 people have been infected with meningitis since the beginning of the year in the areas where Médecins Sans Frontières has launched emergency operations: northern Nigeria, southern Niger and in the south of N’Djamena, the 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 immunised during the outbreak by joint teams made up of national health ministries and Médecins Sans Frontières.

With Médecins Sans Frontières support, health ministries monitored the epidemic’s evolution across hundreds of thousands of square kilometres containing about 44 million people, more than double the population of Australia. The large-scale mobilisation 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 , in Katsina State, Nigeria. “We have to provide the health staff with the adequate drugs and equipment or training when needed. People infected with meningitis might die or develop complications if they are not treated quickly enough. We have had many patients who were really bad; it’s been an emotional rollercoaster.”

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.

Over the last weeks, up to 400 vaccination teams of five people each have been immunising thousands of people every day. In total, 2.8 million people have been vaccinated in Zinder, Maradi and Dosso regions in Niger and 4.5 million people have been vaccinated in Katsina, Jigawa, Bauchi, Kebbi, Sokoto, Niger, Zamfara, Kaduna and Gombe States in Nigeria. Vaccination campaigns are still ongoing in some places in Nigeria for a total of 255,000 people.

Intervention in Niger    
Médecins Sans Frontières teams have been working in close partnership with the Ministry of Health to treat the affected people in three regions (Maradi, Zinder, Dosso) in southern Niger, as well as in the capital, Niamey. Teams have assisted with case definition and patient treatment, have provided training and also donated meningitis kits to clinics and hospitals. Médecins Sans Frontières and Ministry of Health teams have also carried out a mass vaccination campaign. Around 2,838,000 people have been vaccinated.


Zinder region
Médecins Sans Frontières has been supporting the health structures for the treatment of the meningitis patients in 6 districts of Zinder region. Around 3,300 patients have been treated and148 have died. During the epidemic, a total of 1,510,000 people were vaccinated. Médecins Sans Frontières teams, in collaboration with the Ministry of Health,  have carried out vaccination campaigns in the districts of Matameye, Zinder town, Mirriah, Magaria Tanout and Goure, for 1,316,000 people. Vaccination is over but still a small team is doing follow-up for two weeks. Regular activities (nutritional programs) are ongoing.


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

Dosso region
Some 1,745 patients have been treated and 102 have died during the length of the Médecins Sans Frontières emergency intervention in this region (between weeks 11 and 18). In collaboration with the Ministry of Health, Médecins Sans Frontières carried out vaccination campaign in Dosso, Doutchi and Boboye districts. Around 671,266 people have been vaccinated against meningitis. A total of 2,111 daily workers, 38 Médecins Sans Frontières local staff and around 26 expats have been mobilised for this intervention.

Niamey
In the capital of Niger, Médecins Sans Frontières supported local health structures to treat meningitis patients. A total of 285 cases, including 24 deaths, have been recorded since the beginning of the year in Niamey.

Intervention in Nigeria
After many weeks of scaling up, Médecins Sans Frontières has started to scale down its activities and the vaccination campaigns are over in most the nine northern states where teams have been working since the end of January. Teams will remain in place in some states to continue case management and patient treatment for a few more weeks in Kebbi, Sokoto, Niger, Zamfara, Katsina, Jigawa and Bauchi. Activities are finished in Gombe and Kaduna States.

Joint Ministry of Health and Médecins Sans Frontières teams have so far recorded 57,795 cases, along with 1,795 deaths among a population of 38 million people.

Vaccination campaigns have also been carried out. So far, 4,541 000 people have been vaccinated, in the nine States where Médecins Sans Frontières was working with the Ministry of Health. Vaccination is ongoing for 255,000 people, which means that at the end of the intervention, a total of almost 4.8 million people will have been vaccinated by Médecins Sans Frontières and the 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 the Ministry of Health. Médecins Sans Frontières supported health structures for the treatment of meningitis in some districts where the epidemic threshold had been reached and in the capital, N’Djamena. Around 106,000 people have been vaccinated by Médecins Sans Frontières in collaboration with the Ministry of Health in Durbali, Pala and Goundi districts.

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