Lessons Learnt from Cerebrospinal Meningitis Outbreak Surveillance Data-A Case for Public Health Action

BACKGROUND- Outbreak of cerebrospinal meningitis (CSM) remains a major public health concern in Nigeria, particularly in northern Nigeria. The paper evaluates the effect of mass vaccination against cerebrospinal meningitis outbreak in 2013 on the incidence rate in 2014 and 2015, and to document lessons learnt from field experiences of the meningitis epidemic surveillance in Kebbi State, North-west, Nigeria.METHODS- The authors analysed cerebrospinal meningitis surveillance data generated from the routine integrated disease surveillance and response (IDSR) programme executed by the Ministry of Health with support from the World Health Organisation (WHO). Cerebrospinal fluid (CSF) samples via lumbar puncture procedures from a small proportion of all suspected cases that met the standard case definitions were collected, and then tested using the rapid agglutination test kits (Pastorex) at the state public health laboratory. The WHO supported the trained Local Government Areas Disease Surveillance and Notification Officers to ensure data quality.RESULTS- A total of 544 and 1,992 cases were analysed in 2014 and 2015 respectively. In 2014, 14% CSF samples were taken and 55.1% tested positive to Neisseria meningitidis type C. Of all the cases in 2014, 14% were reported dead. Further, in 2015, 4% CSF samples were tested and 83% were positive to Neisseria meningitidis type C. Of the total 1,992 cases in 2015, 4% were reported dead. Gender and CSF sample testing significantly predicts survival in 2014 (p<0.05).CONCLUSION- Desired political will and comprehensive epidemic prevention and control strategies are needed for effective control of seasonal outbreaks of CSM and other epidemic-prone diseases. Need for infrastructural and capacity development of hospital and state public health laboratories for adequate surveillance, testing of samples collected and effective case management cannot be over-emphasized.