A severe epidemic of meningococcal meningitis in Nigeria, 1996

A particularly severe epidemic of meningococcal meningitis (cerebrospinal meningitis, CSM) occurred in Nigeria between January and June 1996. There were 109 580 recorded cases and 11 717 deaths, giving a case fatality rate of 10.7% overall. This is the most serious epidemic of CSM ever recorded in Nigeria, and may be the largest in Africa this century. It took over 3 months and the combined efforts of a National Task Force set up by the Federal Ministry of Health, the WHO, UNICEF, UNDP, Medecins Sans Frontieres, the International Red Cross and several other non-governmental organizations to bring the epidemic under control. The main control measures centred on active treatment of infected persons, mass vaccination and health education. The exact number of persons treated cannot be ascertained, but there were treatment centres in almost every Local Government Area in the affected States. A study of 1577 patients admitted at the Infectious Diseases Hospital, Kano, showed that 84% of those infected were aged less than or equal to 20 years and that, for the first time, infants aged less than or equal to 2 months were affected. Despite intervention, the case fatality rate of 9.1% among this group of patients was similar to the nationwide figure of 10.7%. Long-acting oily chloramphenicol proved highly effective in the treatment of patients, and its routine use in epidemic CSM is recommended. Over 13 million persons were vaccinated in the course of the epidemic. For the first time, cases of CSM were reported from States south of the 'African meningitis belt', suggesting an extension of the belt. The severity of this epidemic yet again underscores the need for a clear policy regarding control measures aimed at forestalling future epidemics. The availability of the recently developed polysaccharide-protein conjugate vaccine should facilitate a decision on mass vaccination for the prevention of epidemic CSM in Africa.