PRESS STATEMENT DELIVERED BY THE DEPUTY DIRECTOR AND HEAD, SURVEILLANCE GHANA HEALTH SERVICE DR. FRANKLIN ASIEDU-BEKOE ON THE MENINGITIS SITUATION IN GHANA
Ladies and Gentlemen of the Press
Hon. Deputy Minister
Directors of Ministry of Health/ Ghana Health Service
Rep. from WHO
Distinguished Health Professionals
Good morning
We are grateful to have you here this morning to brief you on the meningitis situation in the country since we have just come back from the field. Meningitis is an inflammation of the meninges, the covering of the brain and spinal cord. It is most often caused by infection (viral, fungal or bacterial). Bacterial meningitis is caused by several bacterial pathogens but Neisseria meningitidis (Nm), Streptococcus pneumoniae and Haemophilus influenzae type B represent the triad causing over 80% of all cases of bacterial meningitis.
Outbreaks due to meningococcal meningitis remain a major public health challenge in the meningitis belt. The recurrent meningitis outbreaks in Ghana particularly in the northern regions, led to the conduct of a mass preventive immunization campaign in the country in 2012 to address the burden of Group A meningococcus. Group A meningococcus was accounting for an estimated 80–85% of all cases in the meningitis belt in the country, with epidemics occurring at intervals of 7–14 years. Following the successful conduct of the mass preventive campaign in the three northern regions, the proportion of meningococcus serogroup A has declined dramatically and the occurrence of meningitis outbreaks due to other Nm serogroups as well as other bacteria are rather a new concern. Additionally, outbreaks due to Streptococcus pneumoniae have also become more pronounced and a public health threat which demands effective preparedness and response strategies.
There have been seasonal reports of meningitis in Ghana normally during the dry periods of October to March. During these dry periods with relative low humidity and abundance of dust, individuals become susceptible to meningitis infection. Meningitis is somewhat endemic in the three northern regions of Ghana. Because meningitis is somewhat endemic in Ghana, reports of one case of meningitis does not constitute an outbreak though enhanced surveillance is required to prevent additional cases. Meningitis cases are actually monitored by what we call Alert and Epidemic Thresholds which are determined using the population of the locality.
The introduction of the Meningitis vaccine (MenAfriVac), climate change with subsequent extension of drought areas, increased mobility of the population and introduction of new strains of organisms into susceptible populations are accounting for the change in epidemiology of the meningitis and the way it is occurring and spreading.
Table 1: Meningitis Burden in Ghana, 2010-2015
Year Cases Deaths
2010 1164 128
2011 790 104
2012 956 90
2013 454 41
2014 477 39
2015 315 33
CURRENT SITUATION
An outbreak of pneumococcal meningitis occurred in December 2015 in Brohani and Seikwa communities in Tain district of Brong Ahafo region during which, initially 31 people were affected of which 9 died. The causative agent was confirmed as Streptococcus pneumoniae. Response measures were initiated and the outbreak abated. Following this, there have been increased reports of meningitis cases due to the same organism in Wenchi, Techiman North, Nkoranza South and Atebubu districts in the Brong Ahafo region. Bole district in the Northern region (16 cases with 4 deaths) has also recorded Streptococcus pneumoniae
Other districts have reported cases of meningitides serogroup W135 namely Techiman Municipal, Sene West in Brong Ahafo Region and Sawla-Tuna-Kalba in the Northern Region. These focal outbreaks bring to the fore the changing epidemiology of meningitis in the country vis-a-vis challenges gaps in preparedness and response of the health system to outbreaks. Ashanti Region has reported 7 cases which is not very different from the numbers recorded in 2015 (THIS IS AN IMPORTANT POINT). These reported cases are actually sporadic and are from 6 districts in the region including Ejisu Juabeng, Offinso Municipal, Offinso North, Asante Akim Central and Adansi South. I want to state that, currently there is no outbreak of meningitis in Ashanti Region, the organisms isolated in the reported cases are actually Neisseria meningitis type C, which is very different from Pneumococcal meningitis.
Table 2: Distribution of Meningitis cases, Brong Ahafo 2016
District Cases Deaths CFR (%)
Atebubu Municipal 6 1 16.7
Dormaa Municipal 4 0 0
Kintampo North 4 0 0
Nkoranza South 6 0 0
Sene West 11 0 0
Sunyani Municipal 1 1 100
Tain 39 12 30.8
Techiman Municipal 20 6 30
Techiman North 12 2 16.7
Wenchi 49 10 20.4
Grand Total 153 33 21.6
Bole has reported 16 cases with 4 deaths and the last reported cases were 4 days ago.
In total, there are 153 cases and 33 deaths, which may change with time. These figures are based on retrospective and new cases. There are cases in this total number which actually tested negative for meningitis and thus remain as suspected cases. We are addressing the challenge and want to assure Ghanaians that the Ministry of Health, Ghana Health Service and its partners will do all it takes to halt this outbreak with your support.
Ministry General Meningitis Plan
The MOH anticipates meningitis outbreaks particularly during the dry periods of the year. In this regard, there is a plan on surveillance, case management, laboratory and public education.
  • Health Alert was sent to health facilities in respect of a reminder of the meningitis season.
  • Line listing of suspected cases and monitoring of alert and epidemic thresholds
  • Provision of laboratory reagents (Pastorex; already supplied to regions)
  • Orientation of health staff ( including case definitions)
  • Public education at health facilities and communities on meningitis.
  • Stock pile of drugs including antibiotics, IVFs etc
  • Making vaccines readily available
  • Support the various districts with funding
For this outbreak, like earlier ones in Ashanti Region in 2008 and 2011, the index of suspicion in Brong Ahafo Region was low. This is due to the not too common incidence of the disease in the region. As a result, a number of the cases were missed and treated as malaria particularly at the peripheral clinics. Also the population in Brong Ahafo is less immune to the circulation pathogens unlike the northern regions, and thus easily become infected.
INTERVENTIONS have been implemented at district, regional and national levels.
District and Regions
  • Meetings of Regional and District Epidemic management Committees, involving MPs, DCEs, Coordinating Directors, Regional Ministers and other key stakeholders
  • Public Education (Radio announcements, Community durbars and meetings etc)
  • Orientation of Community Based surveillance Volunteers
  • Training of health staff on case management and case definitions
  • Treatment of cases at all health facilities FREE of charge
  • Active case search in all communities and health facilities using case definitions
  • Laboratory testing of all samples to get the causative organism
National level
On instructions of the Minister of Health, the Deputy Minister of Health, Director-General of the Ghana Health Service and the Director of Public Health spent a working week (11 – 15 January) visiting the meningitis prone three northern regions and Brong Ahafo Region. They had discussions with Epidemic management committees and staff durbars to address existing concerns, assess the situation and report back.
The Hon Minister of Health was fully briefed and joined the exit meeting of senior health officials of B/A region by telephone, where he announced that he has authorized the release of GH 150,000 and 1,500 vials of medication to the affected areas to address the outbreak. The funds and medication have been received by the regions and duly distributed to support the districts including Bole for their control activities. In addition, the MOH has provided intra-venous fluids, gloves and other logistics to support regional activities in the outbreak control. The Hon Minister has also directed NHIA to give priority in the payment of Insurance claims submitted by health facilities managing cases of meningitis
Following this, a team led by myself, Head of Surveillance, other epidemiologists and laboratory experts were in Brong Ahafo region and Northern to;
  • Estimate the magnitude of the outbreak
  • Understand the regions response
  • Assess the possibility of spread and make recommendations
The findings and recommendations of my team are to be shared with the Deputy Minister of Health, Incident Commander of Public Health emergencies and the Minister of Health to advocate for more resources to totally put an end to the outbreak.
Involvement of Technical partners
The World Health Organization (WHO) has been involved in the measures to control this outbreak. We are actually having a Technical meeting right after this Press briefing to review the national response and the findings of the national team, a meeting to be hosted by WHO.
WHO has provided a number of laboratory equipment’s including the Test kits for the diagnosis of meningitis and we would be receiving more consignments from the AFRO Head office, through the initiative of the Deputy of Health They have actually been a lead agency in our preparedness and response to meningitis outbreak.
The Centers for Disease Prevention and Control (CDC) Atlanta has also provided primers for the confirmatory testing of samples. They are further going to support us in serotyping the causative organisms in this outbreak.
Expectation
With increasing awareness, we expect increasing reported cases due to improved reporting and high index of suspicion on the side of clinicians. Currently a lumbar puncture is done for any suspected case. The weather is harsh and makes it ideal for the occurrence of sporadic cases, but with enhanced surveillance cases would be detected early and managed with available appropriate antibiotics for favorable health outcomes.
The orientation of community volunteers to report all alerts and unexplained deaths would further ensure better reporting.
CONCLUSION
Reported meningitis cases in Seven districts in BAR and two in NR
Highest case loads are in Wenchi, Tain, Techiman Municipal and Techiman North
Cases in Bole district have reduced markedly
Districts in BAR and Northern Region are on high alert
National and Regional response has been good in the area of community and facility surveillance; case management; ACSM; but challenged by inadequate laboratory support.
MUST KNOW:
  1. Suspected Meningitis: Any person who has
  2. Fever or Headache AND any one of the following
  3. Neck pains
  4. Neck stiffness
  5. Convulsions
  6. Confusion
  7. Bulging anterior fontanelle (for children under one year)
OR a sudden unexplained death
What the ordinary person should do:
  • Avoid overcrowding ( particularly avoid infected persons sneezing, coughing )
  • Drink a lot of water
  • Improved ventilation (opening of windows in your rooms)
  • Report to the nearest health facility if you have fever, headache and neck pain

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