Published Date: 2009-01-15 16:00:42
Subject: PRO/EDR> Meningitis, meningococcal - Uganda: (ARU,HOI)
Archive Number: 20090115.0170

MENINGITIS, MENINGOCOCCAL - UGANDA: (ARUA, HOIMA)
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Date: Tue 13 Jan 2009
Source: The New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/18/667975>


The number of patients admitted in Hoima district with suspected meningitis
has increased to 34 since the outbreak was first reported last week [week
of 5 Jan 2009]. Paul Kaggwa, the assistant commissioner for health
education and promotion in the Ministry of Health, on Monday [12 Jan 2009]
said 27 cases were first reported last Monday [?Mon 5 Jan 2009] in
Kigorobya sub-county [the affected sub county in Hoima]. Kaggwa added that
3 cases had been confirmed to be meningitis, while 9 deaths had been reported.

He added that 42 people were admitted with meningitis in Arua district
[Dadama and Oluko are the affected sub counties of Arua according to
<http://www.reliefweb.int/rw/rwb.nsf/db900SID/KHII-7NB8FJ?OpenDocument>. -
Mod.ML]. Kaggwa said 2 cases were confirmed to be meningitis, while 9
deaths had occurred. He added, however, that the ministry could not confirm
whether the deaths were due to meningitis.

Last week, the health ministry identified the Hoima outbreak to be the
meningococcal meningitis, which is caused by a bacterium and is transmitted
from person-to-person through contact with throat secretions.

Meningitis is an inflammation of the meninges, which is the lining
surrounding the brain and spinal cord. The ministry said overcrowding,
keeping in close contact with patients, living in congested and poorly
ventilated premises aids the spread of the disease. Kaggwa said the
Ministry of Health had embarked on a mobilisation drive to sensitise the
communities in the 2 districts to avoid congestion within their homes. "We
are on an active surveillance and the situation is being observed
seriously," Kaggwa said.

Meningitis last broke out in Hoima in February 2008. During the last
outbreak, 6 people died and many people were admitted in hospitals.

[byline: Raymond Baguma]

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ProMED-mail
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[The following is extracted from Mod.ML's comments in a prior ProMED-mail
post [Meningitis, meningococcal - Uganda (Arua) 20071207.3954].

"Meningococcal meningitis occurs sporadically or as epidemics in
sub-Saharan Africa, which is known as the "Meningitis Belt", an area that
stretches from Senegal in the west to Ethiopia and Eritrea in the east and
that includes northern Uganda
(<http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx>). Numerous cases of
meningococcal meningitis are reported in this region of Africa each year
during the dry season, between December and June, and every 6-12 years a
large outbreak occurs (<http://www.cdc.gov/ncidod/eid/vol9no10/03-0170.htm>).

"During the 1st 10 weeks of the 2006 meningitis season, outbreaks in
eastern Africa were mainly caused by _Neisseria meningitides_ serogroup
W-135, whereas in West Africa the outbreak was due to mainly serogroup A.
In the Gulu district of Uganda the predominant serogroup was W-135, but
serogroup A predominated in Uganda outside this district. Gulu is located
in the center of the northern region, bordering Sudan and east of Arua
(<http://www.ugpulse.com/images/articles/daily/20060307_100_447.jpg>).

"In the Gulu district, the disease was noted in "Internally Displaced
Persons" camps. Overcrowded housing and large population displacements that
undoubtedly characterized these camps likely favored the transmission of
_N. meningitides_. At that time, the International Coordinating Group (ICG)
on Vaccine Provision for Epidemic Meningitis Control provided 360 000 doses
of trivalent vaccine (polysaccharide vaccine for serotypes A, C, and W135)
in an attempt to control the outbreak
(<http://www.who.int/csr/don/2006_03_21/en/index.html>).

"In January 2007, a meningitis outbreak was again reported in Uganda,
according to the WHO
(<http://mediaglobal.org/article/2007-01-26/deadly-outbreak-in-africas-meningitis-belt>)
in an "area, which borders southern Sudan and the Democratic Republic of
Congo... [among] both refugees and nationals living in 'rural, densely
populated settlements." The most affected district was said to be Arua. At
the time, the meningitis outbreak in South Sudan was reportedly caused by
serotype A, but the serotype causing the meningitis outbreak in Uganda was
not given. The current outbreak is again occurring in the Arua district,
but "this time round, it is counties like Vurra in Arua, which were not
covered during the [prior] immunization [program].

"To control an outbreak, WHO recommends mass vaccination with the
appropriate vaccine, depending on availability, in every involved district
in an attempt to induce herd immunity (whereby transmission is blocked when
a critical percentage of the population have been vaccinated
(<http://www.who.int/mediacentre/factsheets/fs141/en/>). There are several
different types of meningococcal vaccines. Polysaccharide vaccines, which
have been available for over 30 years, exist against serogroups A, C, Y,
and W-135 in various combinations (such as, a bivalent AC, trivalent
ACW-135, and a tetravalent ACYW-135 polysaccharide vaccine). There is a
monovalent conjugate vaccine against serogroup C and a tetravalent against
serogroups A, C, Y and W-135. The conjugate vaccines are immunogenic for
children under 2 years of age whereas polysaccharide vaccines are not. All
these vaccines have been proven safe and effective with infrequent and mild
side effects. For both the meningococcal conjugate and the polysaccharide
vaccines, approximately 7-10 days are required following vaccination for
development of protective levels of anti-meningococcal antibodies."

According to another recent news release concerning the Ugandan current
meningitis outbreak date Jan 14 2009
(<http://www.reliefweb.int/rw/rwb.nsf/db900SID/KHII-7NB8FJ?OpenDocument>),
the Ugandan Red Cross "discovered that the [meningitis] epidemic broke out
in an area with no history of vaccination for meningitis and that the case
fatality is high mainly due to the limited number of health units in the
area. It was also found that the affected homesteads are congested which
easily leads to the spread of the disease."

A map of Uganda showing the affected districts can be found at
<http://www.un.org/Depts/Cartographic/map/profile/uganda.pdf> and a map of
the African bacterial meningitis belt can be found at
<http://www.medic8.com/images/map4-9.gif>. - Mod.ML

The HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/promed/en?g=443328&g=443332&v=1.417,33.083,6>. -
CopyEd.MJ]

See Also

2008
---
Meningitis, meningococcal - Burkina Faso (02): vaccinated areas 20080412.1334
Meningitis, meningococcal - Burkina Faso 20080314.1017
Meningitis, meningococcal - Africa: meningitis belt 20080225.0756
Meningitis, meningococcal - Central African Republic: RFI 20080212.0567
Meningitis, meninges - Africa: W. Africa, Congo DR 20080125.0309
2007
---
Meningitis, meningococcal - Italy (Veneto) 20071222.4120
Meningitis, meningococcal - Uganda (Arua) 20071207.3954
Meningitis - Namibia (North): RFI 20070906.2942
2000
---
Meningitis - Namibia (North) 20001214.2182

.................ml/mj/sh


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