Meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord known as the meninges.
The inflammation is usually caused by an infection of the fluid surrounding the brain and spinal cord. Meningitis is also referred to as spinal meningitis. Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the meninges (brain membrane). It can cause severe brain damage and is fatal in 50% of cases if untreated.
Different bacteria can cause meningitis but it is Neisseria Meningitidis that has the potential to cause large epidemics. Neisseria meningitids infects only humans. The bacteria are carried in the throat, sometimes with no symptoms, and are transmitted from person to person through droplets of respiratory or throat secretions as a result of prolonged, close contact.
Meningitis can also be caused by viruses, physical injuries, cancer or certain drugs. The severity of the illness and its treatment depends on the cause. Thus, it is important to know the specific cause of meningitis. Symptoms can be the same for both the viral and bacterial causes. The incubation period can be very short, 3-4 days, or long, 2-10 days. Change of mental status, nausea and vomiting, sensitivity to light (photophobia), severe headache and stiff neck are common symptoms of meningitis.
Meningitis has swept across 26 countries in sub Saharan Africa for a century. The countries are found along the equatorial areas, which are referred to as the meningitis belt. Since 2010, a Sero group A Conjugate Vaccine has been introduced through mass campaigns to countries of the meningitis belt resulting in the disappearance of meningitis outbreaks. Twenty-one countries of the meningitis belt were victorious in the campaign.
As Eritrea is located in the meningitis belt there is a great risk of the spread of the disease. For this reason, the Ministry of Health (MoH) is planning a big mass campaign aimed at eliminating the disease. In the year 2018 – 2019 the MoH carried out a successful campaign against rubella and measles for children aged one to 15 years, and the campaign was rated as having a 97.8% success. Eritrea was given an award by the World Health Organization (WHO) for the success and for the administration of the vaccine, its wide distribution and sustainability.
In this year’s campaign the MoH is planning to achieve more in the elimination of meningitis. Afeabet, Foro, Wea, Adiquala, Mai Mine, Molki, Barentu,Teseney and Keren are sites where meningitis was detected. Meningitis can be treated easily if identified early; but the ultimate solution to control the disease is vaccination. Vaccines are an attractive investment for essential health packages and are often more cost effective than other health interventions.
The main goal of the meningitis vaccination is to make an overall reduction of morbidity and mortality due to meningococcal meningitis serotypes by conducting large age group vaccination campaigns. In order to make this plan successful specific objectives have been designed for the action plan. The main objectives include conducting Men A vaccination campaign among large age group (1-29 years) at national level and achieve vaccination coverage of over 95% of the target age group; strengthening meningitis surveillance and laboratory testing in the country to have confirmed serotypes and documented results for a follow-up and taking appropriate actions; and reducing the resistance and spread of the disease.
In order to launch the campaign efficiently selection of target groups is made. A wide-age range vaccination campaign will be carried out nationwide targeting 70% of the total population of the country.
Based on geographical distribution of the people and topographical setup of the country, the campaign is planned to be conducted in two phases within one month difference in between. Phase one is targeting three Zones: Northern Red Sea, Southern Red Sea and Maekel. The implementation dates will be from 1st to 15th November 2019. Phase two of the campaign will also be targeting three Zobas: Anseba, Debub, and Gash-Barka. The implementation date will be from 1st to15th December 2019. A total of 70 % of the current population is expected to be vaccinated.
According to WHO, the MoH makes an elimination strategy for the control of epidemic meningitis and it is based on three key pillars. The first pillar is surveillance. Ensuring that an enhanced surveillance is in place is important to detect the first cases, identify the pathogen as well as the serogroup of the meningococcus that is responsible for the infection can serve as a trigger to launch a rapid response operation. Standardized case definitions can be used to recognize early cases. These should then be confirmed by laboratory tests. Standard reporting mechanisms are needed in order to analyze the incoming data and determine the extent and evolution of an outbreak.
The second pillar focuses on reducing the impact of the diseases on patients by providing prompt, appropriate, accessible and affordable treatment and care. Ensuring sufficient stocks are available in the health centres well in advance of the need requires careful planning and anticipation of areas likely to be most at risk of outbreaks.
In order to limit the magnitude of the epidemic, large scale vaccination of the population is required, which is the third pillar. Vaccination campaigns on large scale require extensive coordination involving procurement, distribution and logistics, public information and post-vaccination follow-up.
According to the MoH, vaccination will be given in all zones and subzones, and 4000 health professionals are expected to participate in the campaign. The task forces, which will be the main actors of the campaign, are being recruited in all the 63 sub-zones. The task forces include regional administrators, sub-zonal administrators, school administrators, police departments, representatives of the NUESY and NUEW, and all community clinical staff.