Meningitis Outbreak Caused by Vaccine-Preventable Bacterial Pathogens - Northern Ghana, 2016

Abstract

Bacterial meningitis is a severe, acute infection of the fluid surrounding the brain and spinal cord that can rapidly lead to death. Even with recommended antibiotic treatment, up to 25% of infected persons in Africa might experience neurologic sequelae (1). Three regions in northern Ghana (Upper East, Northern, and Upper West), located in the sub-Saharan "meningitis belt" that extends from Senegal to Ethiopia, experienced periodic outbreaks of meningitis before introduction of serogroup A meningococcal conjugate vaccine (MenAfriVac) in 2012 (2,3). During December 9, 2015-February 16, 2016, a total of 432 suspected meningitis cases were reported to health authorities in these three regions. The Ghana Ministry of Health, with assistance from CDC and other partners, tested cerebrospinal fluid (CSF) specimens from 286 patients. In the first 4 weeks of the outbreak, a high percentage of cases were caused by Streptococcus pneumoniae; followed by an increase in cases caused by Neisseria meningitidis, predominantly serogroup W. These data facilitated Ghana's request to the International Coordinating Group* for meningococcal polysaccharide ACW vaccine, which was delivered to persons in the most affected districts. Rapid identification of the etiologic agent causing meningitis outbreaks is critical to inform targeted public health and clinical interventions, including vaccination, clinical management, and contact precautions.

FIGURE 1

Suspected meningitis cases (N = 1,006), by date of admission and region and dates of vaccination campaigns with meningococcal polysaccharide ACW vaccine — Northern Ghana, December 2015–April 2016 * Neisseria meningitidis serogroups A, C, and W.

FIGURE 2

Laboratory-confirmed meningitis cases (N = 127),^,† by date of admission and pathogen — Northern Ghana, December 9, 2015–February 16, 2016 * Among 432 suspected cases, 286 of which were laboratory tested, and 133 of which were confirmed. ^† Two confirmed Haemophilus influenzae cases and four cases with multiple pathogens excluded from figure.