Meningitis outbreak kills thousands in Northern Nigeria as the MRC Unit The Gambia leads effort to save lives and improve case management across Northern Nigeria

The first case of this meningococcal meningitis outbreak epidemic was reported on 16 December 2016 in Zamfara State, Northern Nigeria. Nigeria is known to be within the African meningitis belt; 26 of its’ 36 states lie within the belt. The States, most affected by this epidemic outbreak are; Zamfara, Sokoto, Katsina, Kebbi, Yobe, Borno, Niger, Nassarawa and Plateau with over 14,280 suspected cases and 1145 deaths reported in this epidemic as of 24th May 2017 and still counting.

Building local capacity in rapid PCR meningitis diagnosis at the NCDC laboratory in Gaduwa, Abuja

Building local capacity in rapid PCR meningitis diagnosis at the NCDC laboratory in Gaduwa, Abuja

Zamfara is the epicentre of the epidemic affecting 45 local government areas and Neisseria meningitides serogroup C is the most common cause of meningitis amongst those affected states. Zamfara State remains the most affected state, alone accounting for 56% of the national total reported suspected cases. Neisseria meningitides serogroup C was the commonest cause of the epidemic. As of 25th May 2017, there have been excess of 7135 reported cases in Zamfara State with the young (5–14years old) most afflicted accounting for 47.8% of all reported cases.

On 21 April 2017, the Nigeria Center for Disease Control (NCDC) and the World Health Organization Regional Office for Africa (WHO/AFRO) invited Professor Martin Antonio and his team at the MRC Unit The Gambia (MRCG) to lead a ‘Regional Outbreak Alert and Response’ Team to curb the on-going epidemic in Nigeria. The MRCG team was tasked to improve case management, surveillance and laboratory capacity. The MRCG team arrived in Abuja, the Nigeria’s capital, on 25 April 2017 with 50 boxes of laboratory reagents in cold boxes and laboratory consumables to help with rapid identification of the pathogen causing the meningitis outbreak to control efforts.

Ebenezer Foster-Nyarko (MRCG Clinical Microbiologist) with Nigerian Microbiologists, identifying the epidemic pathogen (Neisseria meningitides serogroup C)

Ebenezer Foster-Nyarko (MRCG Clinical Microbiologist) with Nigerian Microbiologists, identifying the epidemic pathogen (Neisseria meningitides serogroup C)

The MRCG team drove for six and half hours from Abuja to Gusau, Zamfara State through Zaria State passing in front of Ahmadu Bello University, where 50 years earlier, Professor Sir Brian Greenwood, former MRCG Director (1980-1995) and Professor Hilton Whittle former Deputy MRCG Director (1980-1995) developed the ‘meningitis latex test’, used today for diagnosis of bacterial meningitis. Sir Brian also conducted the first meningococcal polysaccharide vaccine trials in Zaria in the 1970’s.

Early detection is key to the control of meningitis epidemic by reactive vaccination. However, laboratory capacity in the affected areas Local Government Areas (LGA) is poor so MRCG deployed a mobile laboratory into the most affected LGA in close collaboration with NCDC. Within few days of arrival, the MRCG team for the first time since the epidemic in Nigeria, confirmed a positive pathogen by culture (Neisseria meningitides serogroup C) and performed antimicrobial susceptibility testing. The MRC team is also building local capacity in rapid diagnosis using sensitive Polymerase Chain Reaction (PCR) at the NCDC laboratory in Abuja.

MRCG team was led by Professor Martin Antonio includes Catherine Okoi (Molecular Microbiologist), Ebenezer Foster-Nyarko (Clinical Microbiologist), Archibald Worwui (Senior Data Manager) and former MRCG staff, Dr Bernard Ebruke (Consultant Paediatrician). The team is supported in Fajara by Dr Brenda Kwambana-Adams, Jacinta Okeakpu, Queen Bola-Lawal, Isatou Cham and Fatima Davis.