Managing an outbreak of cerebrospinal meningitis in Zamfara State, 6 th to 25 th May, 2017

Introduction : the 2016/2017 Cerebrospinal meningitis (CSM) outbreak in Nigeria was first reported on 13th December 2016 in Zamfara State. This outbreak was caused predominantly by Neisseria meningitis sero group C (NmC). As at the 3rd of May 2017, Zamfara State reported 6,400 suspected cases with 503 deaths and a case fatality rate (CFR) of 7.9%. There was a limited amount of NmC vaccine globally to conduct reactive vaccination. The state also has inadequate health-care workers (HCWs) especially doctors to conduct a lumbar puncture (LP) for diagnosis and treatment. The CSF collection rate was about 5.0% (343 samples were collected). Based on this, the National Cerebrospinal Meningitis Emergency Operations Centre (CSM EOC) deployed 28 health workers consisting of doctors, nurses and data managers to improve case management and active case search from 6th to 25th May, 2017. Methods : based on epidemiological data, five teams of health workers were constituted with each team having two doctors, two nurses and one data manager (five in a team) to provide services throughout the state. The medical personnel provided services to suspected CSM cases while the data managers ensured records were kept and the line list of cases were regularly updated and sent to the State CSM EOC through the Local Government Disease Surveillance Notification Officers. The State team lead was assisted by two supervisors to coordinate the response of the five teams. Checklists were developed to track the intervention in Zamfara State. Results : a total of 72 new suspected cases were managed. The cases were predominantly males accounting for 61.1% (44 cases). The age group 5 to 14 years accounted for 51.4% of cases. The mean age was 14.2 ± 11.3 years. A total of 59 LPs were attempted with 51 successful (86.4%). The LP rate was 70.8% during this period. Out of the 51 cerebrospinal fluids collected, 26 (51%) were positive with 26 (50%) being NmC. During this time, there were seven deaths recorded, out of the 103 cases managed (CFR - 6.8%). Conclusion : deploying response teams to states can lead to a rapid increase in LP rates supporting outbreak control in a context of paucity of vaccines.