3rd April, 2017
By Bilkis Ogunnubi
At least 282 people aged between 5and 14 have lost their lives in Nigeria due to the outbreak of meningitis, mostly in the North Western States of Sokoto, Zamfara, Kebbi, Katsina, Niger and the Federal capital, Abuja. With close to 2,000 suspected cases across the country, the current outbreak is purported to be the worst in the history of the country since 2009 when at least 156 people died.
Meningitis is an inflammation (swelling) of the protective membranes covering the brain and spinal cord known as the meninges. This inflammation is usually caused by bacterial or viral infection of the fluid surrounding the brain and spinal cord. Meningitis can also result from injury, cancer, or certain drugs. Bacterial meningitis is spread from person to person. The bacteria are spread by exchanging respiratory and throat secretions (saliva or spit) during close or lengthy contact, in form of kissing or coughing, especially if living in the same household.
On the other hand, if you have close contact with a person who has viral meningitis, you may become infected with the virus that made the person sick, but you are probably not likely to develop meningitis from the illness. This is because only a small number of people who get infected with the viruses that cause meningitis will actually develop meningitis.
Other rare forms of meningitis are as results of fungi, parasites or amoebic infections. Fungal meningitis is rare and usually caused by fungus spreading through blood to the spinal cord. Although anyone can get fungal meningitis, people with weakened immune systems, like those with an HIV infection or cancer, are at increased risk. Also, various parasites can cause meningitis or can affect the brain or nervous system in other ways. Primary amebic meningoencephalitis (PAM) is a very rare form of parasitic meningitis that causes a brain infection that is usually fatal. PAM is caused by the microscopic ameba (a single-celled living organism) Naegleria fowleri when water containing the ameba enters the body through the nose.
The first symptoms of meningitis are usually fever, vomiting, headache and generally feeling unwell, but as time goes on, the victim presents with symptoms peculiar to the disease. These are limb pain, pale skin, and cold hands and feet which often appear earlier than the rash that can be all over the body. Other specific symptoms include, neck stiffness, dislike of bright lights, confusion and seizures.
To diagnose meningitis blood culture is necessary, that is blood sample from the patient is tested for bacterial meningitis. Computerized tomography (CT) or magnetic resonance (MR) scans of the head can also be done. This may show swelling or inflammation. X-rays or CT scans of the chest or sinuses may also show infection in other areas that may be associated with meningitis.
However, for a definitive diagnosis of meningitis, a spinal tap to collect cerebrospinal fluid (CSF) is needed. In people with meningitis, the CSF often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein. CSF analysis also help in identifying which bacterium caused the meningitis. But if viral meningitis is suspected, a DNA-based test, known as a polymerase chain reaction (PCR) amplification or a test to check for antibodies against certain viruses to determine the specific cause and determine proper treatment is needed.
Also, if an individual is ill and develops rashes or spots, the tumbler test can be used. In this case, a clear glass tumbler is placed firmly against the rash. If the rashes can be seen clearly through the glass, then urgent medical help should be sought.
In treating meningitis, it is important to know the specific cause of meningitis because the treatment differs depending on the cause and the age of the individual involved. Most people with viral meningitis usually start getting better within 3 days of feeling sick, and they recover within 2 weeks. With mild cases of viral meningitis, only home treatment may be needed including drinking extra fluids and taking medicine for pain and fever.
On the other hand, in treating bacterial or severe viral meningitis, treatment in a hospital may be required. In this case, medicines such as antibiotics, corticosteroids, and medicines to reduce fever are prescribed. And despite the availability of effective anti-microbial therapy, bacterial meningitis results in substantial morbidity and mortality, particularly in children. Although, most healthy adults who have recovered from meningitis don’t need follow-up care, but babies and children always need follow up care after recovery; therefore, they need to be checked for long term complications such as hearing loss, memory or concentration problems and learning difficulties which can be temporary or permanent among others.
Although Nigeria has witnessed outbreaks of meningitis in the past, but the current one is caused by new strain of Cerebro Spinal Meningitis, purportedly imported from Niger Republic. Therefore, new vaccines are required in its prevention. Hence, preventive measures should as a matter of urgency be put in place to combat the spread.
Meanwhile, the Federal Ministry of Health has deployed epidemiologists to the affected States to minimize the impact of the disease among the people but the States that are free from the illness should take precautions. Since meningitis is spread by contact with the infected individual, overcrowding should be avoided. It is important that windows are left open to avoid stuffiness.
And because children are more susceptible to meningitis, suspected cases of unusual fever should be reported at a health facility. Immunizing children against the disease which remains the main method of preventing the disease should be prioritized by all parents. It is of utmost importance that these five groups of people considered at risk should get a meningitis vaccine: college freshmen who live in dorms and haven’t been vaccinated, adolescents who are 11 to 12 years old, new high school students who haven’t been vaccinated, people traveling to countries or areas where meningococcal disease is common, children who are ages 2 or older and who have a compromised immune system.
Ogunnubi is of the Ministry of Information & Strategy, Alausa, Ikeja, Lagos