Large Outbreak of <i>Neisseria meningitidis</i> Serogroup C — Nigeria, December 2016–June 2017

Nnadi, Chimeremma; Yennan, Sebastian; Ogunleye, Adesola; Agbai, Chidinma; Bakare, Lawal; Mohammed, Abdulaziz; Mohammed, Abdullahi; Stephens, Matthew; Sumaili, Kyadindi; Ronveaux, Olivier; Maguire, Helen; Karch, Debra L.; Dalhat, Mahmood; Antonio, Martín; Bita, André; Okudo, Ifeanyi; Nguku, Patrick; Novak, Ryan T.; Bolu, Omotayo; Shuaib, Faisal; Ihekweazu, Chikwe

doi:10.15585/mmwr.mm6649a3

Cited by 45 publications

(35 citation statements)

References 7 publications

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“…We report the largest NmC meningitis outbreak to hit a single state in Nigeria to date. Zamfara state in North-western Nigeria accounted for more than half of the 14,280 suspected meningitis cases reported across the country during the reported period of the outbreak 20 . This outbreak followed three previous outbreaks that occurred in North-western Nigeria after the successful MenAfriVac mass vaccination campaigns.…”

Section: Discussionmentioning

confidence: 99%

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Meningococcus serogroup C clonal complex ST-10217 outbreak in Zamfara State, Northern Nigeria

Kwambana-Adams

Amaza

Okoi

et al. 2018

Sci Rep

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After the successful roll out of MenAfriVac, Nigeria has experienced sequential meningitis outbreaks attributed to meningococcus serogroup C (NmC). Zamfara State in North-western Nigeria recently was at the epicentre of the largest NmC outbreak in the 21st Century with 7,140 suspected meningitis cases and 553 deaths reported between December 2016 and May 2017. The overall attack rate was 155 per 100,000 population and children 5–14 years accounted for 47% (3,369/7,140) of suspected cases. The case fatality rate (CFR) among children 5–9 years was 10%, double that reported among adults ≥ 30 years (5%). NmC and pneumococcus accounted for 94% (172/184) and 5% (9/184) of the laboratory-confirmed cases, respectively. The sequenced NmC belonged to the ST-10217 clonal complex (CC). All serotyped pneumococci were PCV10 serotypes. The emergence of NmC ST-10217 CC outbreaks threatens the public health gains made by MenAfriVac, which calls for an urgent strategic action against meningitis outbreaks.

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Section: Discussionmentioning

confidence: 99%

“…Between December 2016 and May 2017, a total of 14,280 suspected meningitis cases were reported across 23 of the 36 states in Nigeria. The descriptive characterization of the 2016–2017 cerebrospinal meningitis outbreak in Nigeria is reported elsewhere 20 . There were 1,145 deaths (8% case fatality rate) amongst suspected cases.…”

Section: Introductionmentioning

confidence: 99%

Meningococcus serogroup C clonal complex ST-10217 outbreak in Zamfara State, Northern Nigeria

Kwambana-Adams

Amaza

Okoi

et al. 2018

Sci Rep

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“…Cases of serogroup C were also increasing in the region. From December 2016 to June 2017, Nigeria experienced a large outbreak of IMD, and, of the 433 confirmed cases, 358 (82.7%) were attributable to serogroup C [ 19 ]. This outbreak may represent the largest global outbreak of serogroup C to date, and a number of factors likely contributed to the large number of cases, including procedural and resource allocation inadequacies pertaining to specimen collection and identification, and delayed access to vaccines [ 19 ].…”

Section: Global Epidemiology Of Invasive Meningococcal Disease In Tramentioning

confidence: 99%

A Review of Meningococcal Disease and Vaccination Recommendations for Travelers

et al. 2018

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International travel has been steadily increasing since the middle of the twentieth century, including travel to regions with high levels of endemic meningococcal disease and areas with sporadic or sustained meningococcal outbreaks. Although invasive meningococcal disease (IMD) is relatively rare in travelers since the advent of quadrivalent meningococcal vaccines, it remains a serious concern because of its rapid progression, poor prognosis and outcomes, associated treatment delays, and the potential to precipitate outbreaks. Moreover, fatality occurs in up to 22% of those infected. This review will focus on IMD in travelers, with an emphasis on IMD epidemiology and the geographic regions of potential concern for international travelers. As vaccination is the best approach for preventing IMD among travelers, currently available meningococcal vaccines and corresponding country-specific national meningococcal vaccination recommendations, where available, will be summarized by age and type of vaccine recommended. The use of the quadrivalent meningococcal vaccines, specifically the tetanus toxoid conjugate vaccine (including MenACWY-TT; Nimenrix®), as a protective measure against IMD in travelers will be emphasized.FundingPfizer Inc.

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“…In 2015, however, yet another epidemic caused by NmC occurred, affecting a wider region of northern Nigeria ( 15 ) but also spreading to the neighboring country of Niger, where 8,500 cases including 573 deaths were reported ( 16 ). Cases were reported in the region in 2016 and 2017, and in 2017 the largest NmC epidemic ever globally recorded occurred in northern Nigeria, with more than 14,000 suspected cases ( 17 ). Because availability of serogroup C vaccines is severely limited ( www.who.int/emergencies/nigeria/meningitis-c/en/ ), spread to additional countries in the region is a likely and alarming scenario.…”

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confidence: 99%

Acquisition of virulence genes by a carrier strain gave rise to the ongoing epidemics of meningococcal disease in West Africa

Brynildsrud

Eldholm

Bohlin

et al. 2018

Proc. Natl. Acad. Sci. U.S.A.

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SignificanceHistorically, Neisseria meningitidis serogroup A strains have caused large epidemics of meningitis across sub-Saharan Africa. Following mass vaccination from 2010, serogroup A outbreaks have been mostly eliminated. Starting in 2013 however, yearly epidemics of a previously unknown serogroup C strain have led to tens of thousands of cases in Nigeria and Niger. We show how this new strain evolved from a benign ancestor through the acquisition of virulence genes encoding the serogroup C capsule and a phage linked to invasiveness, illustrating that minor genetic changes in a microbe can have major public health consequences. Our reconstruction of the spatiotemporal outbreak dynamics in the Niger–Nigeria border region suggests direct epidemiological consequences of contrasting outbreak responses in the two countries.

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Large Outbreak of Neisseria meningitidis Serogroup C — Nigeria, December 2016–June 2017

Cited by 45 publications

References 7 publications

Meningococcus serogroup C clonal complex ST-10217 outbreak in Zamfara State, Northern Nigeria

Meningococcus serogroup C clonal complex ST-10217 outbreak in Zamfara State, Northern Nigeria

A Review of Meningococcal Disease and Vaccination Recommendations for Travelers

Acquisition of virulence genes by a carrier strain gave rise to the ongoing epidemics of meningococcal disease in West Africa

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