H5N1

MSF in Nigeria and meningitis C: “The lack of diagnostics and available treatments are the main challenges”

Via MSF.org: Nigeria, meningitis C: “The lack of diagnostics and available treatments are the main challenges” Excerpt:

Interview with Bart Bardock, Nigeria Emergency Response Unit (NERU) Project Coordinator. NERU has been working since February in Nigeria’s Sokoto, Zamfara, Kebbi and Niger states collecting samples, doing surveillance work and supporting the national vaccination campaign to reduce the impact of the latest meningitis C outbreak. 

How is MSF’s Nigeria Emergency Response Unit responding to the current meningitis outbreak in Nigeria’s Sokoto and Zamfara states? 

Since February, we have been active in the field supporting the Nigerian Ministry of Health to diagnose cases by collecting samples to confirm the type of meningitis through a rapid laboratory test. We’ve trained medical staff, donated antibiotics to treatment centres, and helped find new cases to reduce morbidity and mortality. We have been supporting two treatment centres in Sokoto and Zamfara states, and between 1 and 8 May we supported the Ministry of Heath with their vaccination campaign in Sokoto.  

How many people did you vaccinate per day in Sokoto state?  

We had 25 teams vaccinating people for seven days. At the end of the vaccination campaign we had vaccinated around 140,600 people in the three most-affected areas of Sokoto, 95 percent of our 148,000-person target from the Ministry of Heath campaign.  

Nigeria has repeated meningitis outbreaks. Why is that?  

Nigeria is part of what they call sub-Saharan Africa’s ‘meningitis belt’. The meningitis belt stretches from Senegal in the west to Ethiopia in the east, crossing 26 countries in the process, and has the highest rates of the disease in Africa. On average, vaccines provide coverage for three years and therefore immunity to this disease is only temporary. With around 300 million people in the belt, it is difficult to maintain this protection. 

Is this outbreak different from those of previous years?  

We have been responding to meningitis C since 2013, but this is reported to be the largest outbreak of meningitis C we have seen in nine years. Nigeria has had large meningitis outbreaks before but those were meningitis A. As a result of mass vaccination campaigns in the past, levels of meningitis A were drastically reduced, which allowed the C strain to become the dominant one. Since many people were not yet protected against meningitis C, it has spread widely among the population.

Hong Kong: CHP investigates imported case of invasive meningococcal infection

Via the Centre for Health Protection: CHP investigates imported case of invasive meningococcal infection. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (May 11) investigating an imported case of invasive meningococcal infection, a communicable disease transmitted by direct contact with droplets from carriers or infected persons.        

The case involves a 13-month-old boy with good past health. The patient, who travelled to Hong Kong with his mother and elder sister on April 28, has presented with fever, vomiting and drowsiness since April 26 while he was in the Mainland. He attended United Christian Hospital on May 1 and was admitted for treatment.      

His cerebrospinal fluid sample collected on May 8 tested positive for Neisseria meningitidis upon laboratory testing. His clinical diagnosis was meningitis. The patient has been in a stable condition.         

Initial enquiries by the CHP revealed that the patient lived in his relatives' home while in Hong Kong and his travel collaterals and home contacts in Hong Kong were asymptomatic.        

he CHP's investigation is continuing.        

This is the second confirmed case of invasive meningococcal infection reported to the CHP this year. Six cases and five cases were filed in 2016 and 2015 respectively.

WHO: Update on unexplained cluster of deaths – Liberia

WHO has published Update on unexplained cluster of deaths – Liberia.

On 25 April 2017, the Ministry of Health of Liberia notified WHO and partners of a cluster of sudden deaths of unknown aetiology in Sinoe County. The event began on 23 April 2017 when an 11-year-old child was admitted to hospital presenting with diarrhoea, vomiting and mental confusion after attending a funeral on 22 April 2017.  

As of 9 May 2017, a total of 31 cases including 13 deaths have been reported.  

The Ministry of Health of Liberia (MOH) responded quickly to the cluster using the emergency management and laboratory infrastructure it developed during the Ebola outbreak alongside WHO, and other public health partners. The Liberian MOH sent blood, urine, and plasma samples to the US Centers for Disease Control and Prevention (CDC) for testing of infectious diseases and environmental toxins. 

On 8 May, WHO was informed by Liberia’s MOH that samples from four of the deceased patients had tested positive for meningitis C (Neisseria menigitidis). 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.  

While awaiting full toxicology reports, the Liberian MOH is exploring whether vaccination against meningitis is an appropriate course of action. WHO supports the ongoing epidemiological and laboratory investigations to identify the aetiological agent of this cluster of cases to guide additional control measures. 

Since it was notified of the cluster of sudden deaths, WHO has worked closely with Liberian Ministry of Health and other partners in areas of overall coordination, surveillance, contact tracing, case management, social mobilization, community engagement, laboratory investigation, and infection prevention and control.

MSF in Nigeria: Fighting the worst meningitis C outbreak since 2008

Via MSF.org: Nigeria: Fighting the worst meningitis C outbreak since 2008. Excerpt:

Thousands of men, women, and children in northern Nigeria have been affected by a meningitis C outbreak, reportedly the largest to hit the country in the past nine years. Almost six months after the first cases were recorded in Zamfara State, Nigeria’s Ministry of Health (MoH) is still struggling to fight this epidemic in seven states of the country. 

Médecins Sans Frontières has supported the health authorities with surveillance and case management in the most-affected areas since February, when the outbreak was officially declared. However, the slow reaction of the country and a global shortage of vaccines have hampered the response.  

On 15 April MSF set up a 200-bed treatment centre in Sokoto Town, followed by a 20-bed facility in Anka, Zamfara. In these locations, MSF’s Nigeria Emergency Response Unit (NERU) works intensively to provide free, high-quality medical care and reduce mortality rates as much as possible. 

These teams treat challenging cases in a difficult environment. “A few days ago a nine-year-old boy was brought in unconsciousness and with severe meningitis,” recalls Caroline Riefthuis, an MSF nurse in Sokoto. “He received treatment for five days and recovered, but unfortunately we found out that he had become deaf and blind— some of the side-effects of severe meningitis.”  

This little boy is one of 614 patients treated in Sokoto Mutalah Mohamad Hospital since April, when MSF took over the management of the centre from the MoH due to a lack of supplies and qualified staff to run it. In Anka General Hospital, 137 patients were admitted since the beginning of the outbreak. Most are between five and 20 years old. 

Tackling the outbreak 

In addition to the staff working in the treatment centres, 11 MSF surveillance teams visited health facilities to determine the origins of new cases in Sokoto, Zamfara, Yobe, Niger and Kebbi. These visits also allowed MSF to implement additional activities, such as health promotion, to increase community awareness of the signs and symptoms of meningitis and active case finding.  

At the end of April, the Nigerian MoH reported 9,646 suspected cases of meningitis C, with a total of 839 deaths since late 2016. And on 1 May, MSF was finally able to join a vaccination campaign launched by the health authorities in Sokoto. In the three most-affected Local Government Areas (LGAs), 25 MSF teams vaccinated approximately 850 people per day for seven days to reach a target population of 148,000 people—of a total target of 800,000—between the ages of one and 20. An additional campaign with a target population of nearly 130,000 people will start later this month in the four most-affected LGAs of Yobe State.

Liberian mystery disease may be solved

Via Science, Kai Kupferschmidt writes: Liberian mystery disease may be solved. Excerpt:

A Kenyan pathologist who did autopsies this weekend on two of the bodies noted signs consistent with meningitis, Nagbe says. Although few patients had fever, a common sign of meningitis, other symptoms and the short time between onset of disease and death are typical. 

“The clinical presentation was very unusual, that is why meningitis was not at the top of our list,” Gasasira says. Samples from the other patients will be tested for N. meningitidis as well, Gasasira says. “Then we’ll be much more confident.” 

A big question is why N. meningitidis should suddenly appear in Liberia. Since a new vaccine was introduced in 2010, the number of meningitis cases in Africa has dropped dramatically. But that vaccine protects only against serotype A. The number of infections with serotype C has gone up; Nigeria and Niger are now battling a large outbreak. 

“Meningitis C is filling the vacuum created where meningitis A was a problem,” Gasasira says. “But we never had Type A.” Another possibility is that the disease was present in Liberia but just wasn’t picked up in the past.  

Some of the precautionary measures that have already been taken could help limit any further spread. For instance, patients were given prophylactic antibiotics, and lists of people who had contact with cases were quickly drawn up. The response suggests that Liberia’s capacity for detecting a disease outbreak has greatly improved in the wake of Ebola, says Vincent Munster, a virologist at the National Institute of Allergy and Infectious Diseases’ Rocky Mountain Laboratories in Hamilton, Montana. 

But West Africa, with all the international resources poured into it, is a special case, he adds. “There are number of countries that are nowhere near that situation.”

Meningitis: Another disease new to Liberia

Via GNN Liberia: Liberian Health Authorities Say Recent Deaths In Sinoe Caused By Meningitis. The complete report and then a comment:

Liberia’s ministry of health has attributed the recent deaths in southeastern Sinoe County to an outbreak of meningitis. 

Addressing a news conference in Monrovia Monday, Health Minister Bernice Dahn said based on the Centers for Disease Control (CDC) initial report on the cluster of deaths in Sinoe, which later spread to Montserrado and Grand Bassa counties, the Ministry believes that it is dealing with a probable outbreak of Meningitis.  

According to Minister Dahn, the CDC tested specimens from four patients for 29 different diseases, noting that the tests for 28 of the diseases proved negative, while the Meningitis test proved positive. 

“As a public health measure, we are taking it as that and we are working on it so that we do not have further spread.” Minister Dahn said. 

She noted that the MOH will continue to conduct the previous investigation that is currently on the table so that it can clear all doubts, adding, “Today the MSF was instructed to do a Meningitis test on the specimens that we have.” 

Meningitis is an acute inflammation of the protective membrane covering the brain and spinal cord, known collectively as the meninges.

The most common symptoms are fever, headache and neck stiffness. Other symptoms include confusion or altered consciousness, vomiting and inability to tolerate light or loud noise. 

Meanwhile, Minister Dahn has said as of May 7, a total of 31 cases, including 13 deaths have been reported from three counties.  

She said a total of 27 cases and 10 deaths have been reported from Sinoe County, while Montserrado County recorded two cases and two deaths, and Grand Bassa County two cases and one death. 

“Liberia has never experienced Meningitis before,” Dahn said, noting that Meningitis normally affects countries that are hot and have long dry season; such as Mauritania, Burkina Faso, Sudan, Ethiopia and other sub-Sahara countries which usually experience Meningitis every two years or sometimes annually.  

“Meningitis can be transmitted through saliva and close body contacts,” Dahn said, and urged the public not to panic because Meningitis can be treated and prevented. 

She is urging the public to report to health authorities anyone showing signs and symptoms of Meningitis so that the person can be treated immediately.

If this is indeed meningitis, Liberia's outbreak is coinciding with a much larger one in Nigeria. See this report on ReliefWeb for an update indicating almost 4,000 meningitis cases and over 438 deaths in Nigeria as of early April.

Meningitis suspected in unexplained cluster of deaths in Liberia

Thanks to Greg Folkers for sending the link to this Huffington Post report: Meningitis Suspected In Unexplained Cluster Of Deaths In Liberia. Excerpt:

Four of the 13 patients who died of a mysterious illness in Liberia since April 23 have tested positive for Neisseria meningitidis serogroup C, a bacterial form of meningitis, according to the U.S. Centers for Disease Control and Prevention.  

The news confirmed what Dr. Francis Kateh, Liberia’s deputy health minister and chief medical officer, told HuffPost Sunday.  

Additional testing is ongoing to determine if the other deaths and 30 other illnesses in Sinoe County, Grand Bassa County and the capital city of Monrovia following the wake and funeral of a religious leader in Sinoe County are also due to this type of infection. 

According to the CDC’s website, meningitis can be spread by respiratory excretions and saliva. Kateh and Dr. Alex Gasasira, the World Health Organization’s representative in Liberia, told HuffPost on Saturday that tea served at the wake and funeral is suspected in an accidental “poisoning event.” 

Those who attended the wake and funeral had a higher likelihood of falling ill if they drank the tea and reported it tasted different than it should have. 

Only 1 of the 30 who got ill and survived was still hospitalized as of Saturday.   

Patients suffered abdominal pain, vomiting, weakness, headache and mental confusion. Gasasira said some of the patients had a hard time breathing and others foamed at the mouth. According to Kateh, an unusual rash called petechiae has developed around the feet and wrists of those who have recovered.   

Senior Press Officer Sharon Hoskins wrote in a statement to HuffPost that the CDC is sending two meningitis laboratory scientists and one meningitis senior epidemiologist to Liberia this week to join the staff from the CDC Country Office in Liberia in the investigation. 

Nigeria: 66 Lassa fever deaths so far this year

Via Independent Online in South Africa, an ANA-CAJ report: 66 die as severe Lassa fever outbreak grips Nigeria. Excerpt:

At least 66 people have been confirmed dead from a severe outbreak of the Lassa fever in Nigeria.  

Nigeria is already battling to halt a meningitis outbreak that has killed more than 800 people since the beginning of the year.  

Government has confirmed that 16 of the country’s 36 states were affected in the latest Lassa fever outbreak since the beginning of 2017. About 160 cases have been confirmed. 

Lassa fever is an acute viral disease usually acquired from infected rats. There is no vaccine. Prevention requires isolating those who are infected and decreasing contact with rats.  

The meningitis outbreak started in December 2016. Some 840 people have died from more than 9 000 cases reported.

WHO and partners provide vaccines to control meningitis C in Nigeria

A new release: WHO and partners provide vaccines to control meningitis C in Nigeria. Excerpt:

A vaccination campaign is underway in Nigeria to contain an outbreak of meningitis C, a strain of meningitis which first emerged in the country in 2013. Since the beginning of this year, the country has reported 4637 suspected cases and 489 deaths across five states. 

The International Coordinating Group (ICG) on Vaccine Provision, which coordinates the provision of emergency vaccine supplies during outbreak emergencies, has sent 500 000 doses of meningitis C-containing vaccine to Nigeria to combat the epidemic. The vaccines, funded by Gavi, the Vaccine Alliance, have been administered in Zamfara and Katsina states, which are the worst affected by the outbreak. An additional 820 000 doses of a meningitis C conjugate vaccine – a donation from the UK government to the World Health Organization (WHO) - is being sent to the country. 

In the last week, the ICG, which is managed by the International Federation of Red Cross and Red Crescent Societies (IFRC), Médecins sans Frontières (MSF), the United Nations Children’s Fund (UNICEF), and WHO, has also sent 341 000 doses of the Gavi-supported meningitis C-containing vaccine to Niger, where there are over 1300 suspected cases of the disease in districts that border with Nigeria and in the Niamey region of the country.  

Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the thin lining that surrounds the brain and spinal cord and can cause severe brain damage. Meningococcal meningitis is fatal in 50% of cases if untreated. Though cases of meningitis occur throughout the world, large, recurring epidemics affect an extensive region of sub-Saharan Africa known as the “meningitis belt” which includes 26 countries from Senegal in the west to Ethiopia in the east.

CIDRAP: News scan for April 13, 2017

Via CIDRAP: News Scan for Apr 13, 2017 | Severe H5N6 infections; Deadly hantavirus; Meningitis C in Nigeria. Excerpt:

A new analysis of all 17 H5N6 avian flu cases reported in China since 2014 found that 15 out 16 hospitalized patients required mechanical ventilation, while 12 patients (75%) died from their infections. 

The case-fatality rate was much lower in patients hospitalized for H5N1 infection (70% or 30 out of 43) and H7N9 infection (41%, or 319 out of 782) during the same period. Patients with confirmed H5N6 were older than those with confirmed H5N1 and H7N9 cases. All H5N6 patients reported close contact with live poultry in the 10 days preceding illness, and they were all located in south and southwest China, compared with wider geographic spread in H5N1 and H7N9 cases. 

The analysis was conducted by Chinese officials, the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) and published yesterday in Clinical Infectious Diseases. 

"The laboratory-confirmed H5N6 cases were characterized by severe illness among the 16 hospitalized cases, with a high risk of fatal outcome," the authors wrote. 

"It remains to be seen whether HPAI [highly pathogenic avian influenza] H5N6 virus will continue to circulate among poultry and cause sporadic human infections in coming years, as H7N9 virus has done for four years now."