The meningitis outbreak returns to Niger: Concern, efforts, challenges, and recommendations

Abstract

Meningitis, a disease that commonly manifests in African meningitis belt, continues to be a public health problem as it is a fatal disease that leave survivors with long-term effects. Most cases of meningitis are due to bacterial and viral infection, although parasites, fungus, cancer, drugs, and immune disorders can rarely cause meningitis. Stiff neck, high temperature, light sensitivity, disorientation, headaches, and vomiting are the most typical symptoms of meningitis. Niger, being in African meningitis belt, has been affected by many meningitis outbreaks. Since 2015, a total of 20,789 cases and 1369 fatalities (CFR 6.6%) have been documented in Niger. In contrast to earlier seasons, the current outbreak of meningitis in Niger exhibits both an increase in the number of cases and a rise in the growth rate. A total of 559 cases of meningitis, including 18 fatalities (overall CFR 3.2%), were reported in the Zinder Region, southeast of Niger, from 1 November 2022 to 27 January 2023, compared to 231 cases reported from 1 November 2021 to 31 January 2022. In the current outbreak, the Neisseria meningitidis serogroup C (NmC) is responsible for the majority of laboratory confirmed cases (104/111; 93.7%). To organize the response to the outbreak, a global team of WHO and other partners, including MSF and UNICEF, has been sent to Niger. Even though there are many challenges in battle against meningitis in Niger, immunization, antibiotics administration and strong disease surveillance are recommended techniques to cope with the current meningitis outbreak in Niger.

Meningitis in Niger Republic amidst COVID-19: current issues and novel recommendations

“…Sadly, there is limited availability of ceftriaxone in most African meningitis belts. This could result in less-than-ideal treatment plans against meningitis 48 . Ceftriaxone has been recommended for meningococcal and pneumococcal meningitis epidemics 48 with a dose of 2 g/day for 14–28 days.…”

“…This could result in less-than-ideal treatment plans against meningitis 48 . Ceftriaxone has been recommended for meningococcal and pneumococcal meningitis epidemics 48 with a dose of 2 g/day for 14–28 days. However, it is best to perform a lumbar puncture first since antibiotics may make it more difficult for germs to grow in spinal fluid 48 .…”

“…Ceftriaxone has been recommended for meningococcal and pneumococcal meningitis epidemics 48 with a dose of 2 g/day for 14–28 days. However, it is best to perform a lumbar puncture first since antibiotics may make it more difficult for germs to grow in spinal fluid 48 . Other antibiotics that could be administered include penicillin G (20 million U/day for 14–28 days), doxycycline (100 mg orally or IV every 12 h for 14–28 days), or chloramphenicol (1 g every 6 h for 14–28 days) 3 , 4 , 46 , 49 .…”

“…Additional strengths are the ability to discuss the prevalent serotypes of N. meningitidis in Niger and other parts of the world. Although past studies and reviews have reported discussions in expert panels and meetings regarding laboratory capacity for meningococcal surveillance 7 , 31 , 33 – 45 , 47 , 48 , 50 , 53 – 55 . However, only a few of these studies and reviews incorporated COVID-19 and the military coup in Niger.…”