Investigation of meningitis outbreak after the introduction of Pneumococcal and MenA conjugate vaccines in two districts of Northern Region, Ghana from October 2015 to March 2016

Abstract

Introduction: Despite the introduction of the Pneumococcal and Meningococcal conjugate vaccines (MenAfriVac) into the routine immunization programme in the Northern part of Ghana, Bole and Sawla-Tuna-Kalba (STK) districts experienced an outbreak of meningitis between October 2015 and March 2016. Cerebrospinal meningitis (CSM) is a major cause of morbidity and mortality. Globally meningitis mortality ranges between 2% and 30%, and 36% to 50% in Ghana. The northern part of Ghana lies within the African “meningitis belt” that extend from Senegal to Ethiopia making it prone to repeated meningitis outbreaks. Objective: This investigation was conducted to determine the cause of the outbreak in the two districts after the introduction of Pneumococcal and MenA Conjugate Vaccines. Methods: Field investigation conducted to determine the cause and appropriate control measures instituted to control meningitis outbreak in Bole and STK districts. Cases were detected using a standard surveillance case definition for meningitis. Case based forms were used to collect data on demographic and clinical characteristics of cases. Laboratory results were obtained from samples of specimen from suspected cases sent to the laboratory for standard microbiological investigation. Active case findings were conducted in the communities where cases were reported. Consulting room and in-patient registers in the district hospital and all health centres including community register were reviewed during the period. Results: Of the 39 confirmed cases, the highest percentage of cases were caused by Streptococcus pneumonia (54%) and Neisseria meningitides (38%) specifically serogroup W135. In two (2) cases more than one organism was found. Majority (61%) of the cases were males, also, 76% of the cases were less than 30 years. Seventy five percent (75%) of the cases were in the Bole district. Overall case fatality rate (CFR) for the two districts was 33%. Analysis by sex showed a higher fatality rate among males (37%) than females (23%). Conclusion: This investigation found that the outbreak was predominantly caused by two strains of meningitis causing organisms. Intensive surveillance, health education, sensitization of clinicians and proper case management helped to contain the outbreak. Logistic supplies especially specific laboratory reagents such as PCR needs urgent attention to help in timely characterization of disease-causing organisms and guiding the plan for vaccination activities using the isolated serogroup. Apart from mass vaccination campaigns targeting different causative agents, high PCV and Hib coverage in routine EPI should be maintained. The introduction of Pneumococcal and MenA conjugate vaccines was irrelevant in this outbreak since it was caused by different organisms. *Correspondence to: Bumawura Ewuntomah E Mahamah, Ghana Health Service, District Health Directorate, Bole, Ethiopia, Tel: +233 200545855/233244432656, E-mail: mzankawah@yahoo.co.uk