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Cerebrospinal Meningitis Public Health Advisory

Cerebrospinal Meningitis (CSM) occurs when there is an acute inflammation of the covering of the brain and the spinal cord. CSM is an epidemic-prone disease with cases reported all year round in Nigeria. However, weather conditions like the dry season that comes with dust, winds, cold nights, and frequent upper respiratory tract infections increase the risk of infection, especially with crowding and poor ventilation. The highest burden of CSM in Nigeria occurs in the “Meningitis Belt” which includes all 19 states in the Northern region, the Federal Capital Territory (FCT), and some southern states such as Bayelsa, Cross River, Delta, Ekiti, Ogun, Ondo, Osun). In 2022/2023, Nigeria recorded 2765 suspected and 303 confirmed cases with 190 deaths across 140 Local Government Areas (LGAs) in 30 States including the Federal Capital Territory.

The Federal Government of Nigeria through the Federal Ministry of Health and Social Welfare, and the Nigeria Centre for Disease Control and Prevention (NCDC) is working to prevent, detect, and respond to cases of CSM. The National CSM Technical Working Group (TWG, including representation from all relevant Ministries, Departments and Agencies [MDAs], and development partners) with its secretariat at the NCDC is responsible for monitoring disease trends to effect multi-sectoral preparedness and response. Despite significant progress in surveillance, diagnostic capacity, and vaccination over the last few years, CSM remains a priority disease and ever-present public health threat in Nigeria with annual outbreaks in high-burden states that present a challenge for people, health systems, economies, and communities.

The NCDC, in collaboration with MDAs and partners through the CSM TWG, has implemented the following to ensure enhanced coordination, collaboration, and communication for CSM response in Nigeria.

• At the beginning of the season, all State Governments and public health authorities were alerted to the heightened risk of a CSM outbreak and the need for resource mobilisation for preparedness and response activities.

• Routine meetings of the National multi-sectoral CSM TWG to coordinate prevention and preparedness activities.

• Regular communication with high burden states to ascertain status, progress, and challenges.

• Ongoing surveillance in all states through routine Integrated Disease Surveillance and Response (IDSR) and Event-Based Surveillance (EBS).

• Provision of offsite and onsite support to States and follow-up for daily reporting and progress with response activities.

• Preposition and distribution of case management and laboratory consumables to aid outbreak response.

• Risk communication to create public awareness of CSM prevention measures as well as signs and symptoms.

• Sample collection for laboratory diagnosis of suspected cases across the CSM network of laboratories to aid case management.

• Deployment of a Rapid Response Team (RRT) to Jigawa state to investigate report of rising cases and provide medical and laboratory commodities to aid the State's response.

• Deployment by the Bauchi State Ministry of Health RRT to investigate reports of CSM cases.

ABOUT CEREBROSPINAL MENINGITIS (CSM)

Meningitis is an inflammation of the meninges, a thin layer of the connective tissue that covers the brain and the spinal cord. This inflammation can be caused by infection with any of the following organisms - bacteria, viruses, parasites, or fungi. Injuries and certain drugs can also cause such inflammation.

Transmission is usually through:

• Direct person-to-person contact, including droplets from the nose and throat of infected persons.

• Close and prolonged contact with an infected individual.

CSM initially presents as fever, headache, nausea and vomiting, photophobia (pain on looking at bright lights), neck stiffness, and altered conscious levels. It may be more difficult to observe these signs in younger children, but irritability, poor feeding, and inactivity are common.

Although meningitis affects all ages, the most at-risk persons are:

• Young children, especially those under or not immunised.

• Individuals living in overcrowded households.

• Individuals who smoke.

• Individuals exposed due to poor ventilation and indoor air pollution (e.g., from cooking with wood, or charcoal).

• Those with poor hygienic practices (poor cough etiquette and hand washing for example).

• Contacts of infected persons with poor infection prevention and control measures.

• Health care workers who provide direct patient care, clean, and disinfect contaminated materials or handle biological specimens without using personal protective equipment and/or adhering to infection prevention control protocols.

HEALTH ADVICE TO THE PUBLIC

• Ensure you and your loved ones have received the appropriate vaccination required to protect against meningitis.

• Avoid close and prolonged contact with a confirmed case of CSM including relatives.

• Avoid overcrowding in households.

• Avoid smoking.

• Practice proper respiratory hygiene when coughing or sneezing.

• Discourage indoor air pollution, such as indoor cooking over open flames.

• Practice good personal and hand hygiene by frequently washing hands with soap under running water or using hand sanitisers when necessary.

• Always keep your environment clean.

• Visit the nearest health facility immediately if you notice any of the signs and symptoms associated with CSM mentioned earlier or call the State Ministry of Health hotline or 6232 (NCDC toll-free line).

• Avoid self-medication to prevent antimicrobial resistance and ensure proper diagnosis and early treatment.

ADVICE TO HEALTHCARE WORKERS

• Healthcare workers are advised always to practice standard infection prevention and control practices: i.e., wear gloves and other appropriate personal protective equipment while handling patients or providing care to an ill patient.

• Healthcare workers should maintain a high index of suspicion for CSM, i.e., be vigilant and consider a diagnosis of CSM when seeing patients presenting with suggestive symptoms including acute febrile illness at this time.

• Healthcare providers should report all suspected cases of CSM to their local government Disease Surveillance and Notification Officer for immediate access to healthcare. This is essential because early identification and treatment of cases are more effective and can save lives.

About NCDC

The Nigeria Centre for Disease Control and Prevention (NCDC) is the country's national public health institute, with the mandate to lead the preparedness, detection, and response to public health emergencies. The Bill for an Act to establish NCDC was signed into law in November 2018, by President Muhammadu Buhari. The mission of the NCDC is 'To protect the health of Nigerians through evidence-based prevention, integrated disease surveillance and response, using a One Health approach, guided by research and led by skilled workforce'.

Contact

NCDC Toll-free Number: 6232 | SMS: 08099555577 | WhatsApp: 07087110839 Twitter: @NCDCGov | Facebook: @NCDCgov | Instagram: @NCDCgov | NCDC Media Releases

Signed:

Dr Ifedayo Adetifa

Director General

Nigeria Centre for Disease Control and Prevention.