Averting a CSM epidemic

Sequel to the recent arrival of the harmattan season with its harsh wind, dry weather and bitter cold, Nigerians have been cautioned to stop living in crowded rooms and to be alert to the likely outbreak of Cerebrospinal Meningitis [CSM]. The Nigeria Center for Disease Control [NCDC] issued this advice recently following the likely onset of the CSM season, which usually starts from November, reaches a peak in April and ends in June.

Nigeria is one of the African countries within the meningitis belt which makes the disease’s outbreak an annual occurrence in at least 26 states of the federation including the Federal Capital Territory, FCT. The states include Zamfara, Katsina, Sokoto, Kebbi, Niger, Adamawa, Yobe, Gombe, Nasarawa, Borno, Cross River, Jigawa, Taraba, Kaduna, Kano, Lagos, Plateau, Osun and FCT.

To forestall a repeat of the 2016/2017 CSM epidemic, NCDC in its weekly epidemiological report called on all the country’s 36 states and FCT to strengthen preparation and improve surveillance because the disease could spread from the 26 states that are prone to CSM to other parts of the country. CSM is transmitted through human contact or migration. On suspected cases, NCDC advises states to ensure immediate collection of cerebrospinal fluid [CSF] samples and send same to the State Public Health Laboratory.

Olawu Aderinola, head of the technical working group on CSM at NCDC, said the disease is very deadly and “if not treated can kill up to 50 percent of patients who have it.” He also said “the bane of the disease is that though it can be treated if detected early, 10 to 20 percent of those who survive it could suffer some permanent disabilities. Long-term consequences of CSM include deafness, epilepsy and cognitive deficits, especially if not treated quickly. Aderinola advised Nigerians to promptly report cases of fever at the nearest health facility.

CSM is a disease characterized by an acute inflammation of the protective membranes covering the brain and the spinal cord. In Nigeria, different classes of bacterial meningitis exist including type A, B, C, W, X and Y. The most common symptoms of CSM are fever, headache and neck stiffness. Other symptoms include confusion or altered consciousness, vomiting and inability to tolerate light or loud noises. While the causes of CSM could be bacterial or viral, only some forms of meningitis are preventable through vaccination. Meningitis can be lifethreatening because of the inflammation’s proximity to the brain and spinal cord. This is why the condition is classified as a medical emergency.

Governments at local and state levels should urgently embark on enlightenment campaigns to educate citizens about causes and symptoms of meningitis. The public should be educated on the need to sleep in well-ventilated rooms and to avoid crowded living rooms especially at night. Public health specialists maintain that personal hygiene remains a key approach to the prevention of CSM especially in overcrowded settings such as Internally Displaced Persons’ [IDP] camps, prisons, schools and hospitals. Health education on meningitis should therefore begin with this set of crowded environments.

It is important for States and LGAs to provide information to the public on designated CSM treatment centers. As a medical emergency, now is the time to adequately equip laboratories with testing reagents and kits. As part of preparedness strategy for CSM, government at all levels should develop plans for emergency response operations which should include adequate supply of drugs at treatment centers. In case of an outbreak within the meningitis belt, prompt efforts must be made by affected states and LGAs to contain it by requesting for relevant vaccines through the emergency request mechanisms from global stockpiles.

Federal Ministry of Health should also synergize with relevant stakeholders and MDAs including the National Primary Health Care Development Agency [NPHDA] and NCDC to ensure that necessary strategic and logistic measures are put in place by CSM-prone states and LGAs to forestall any large-scale outbreak of the disease.