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Meningitis Outbreak in Jos: A Report of 29 Cases seen in Paediatrics Department of Jos University Teaching Hospital, Jos, Nigeria
Abstract
Background/Purpose: The sudden upsurge in cases of meningitis noted in our Emergency Paediatrics Unit was the stimulus for keeping track of the cases presented in this write up. Epidemics and sectarian crises is a well known phenomenon. We present our findings of meningitis outbreak in Jos North LGA coming after the major 2008 ethno-religious conflict to raise awareness for emergency preparedness for management of epidemics.
Methodology: We analyzed 29 children admitted and treated for meningococcal meningitis in the Emergency Paediatrics Unit (EPU) of the department of Paediatrics, Jos University Teaching Hospital (JUTH) situated in the north central part of Nigeria from March to June 2009. In addition, the admissions of meningitis into EPU from July 2006 to April 2010 were reviewed in order to demonstrate the upsurge in the number of cases. Meningitis was suspected in children who presented with history of fever, anorexia, vomiting, headache with or without seizures and evidence of meningeal irritation. Complete history and physical examination was carried on all patients Meningitis was confirmed by analysis of the cerebrospinal fluid (CSF) for elevated CSF protein, hypoglycorrhachia and identification of Nisseria meningitidis on culture. In addition, haematological and blood chemistry were evaluated. Patients were treated with a combination of intravenous peincillins and Chloramphenicol in line with current epidemiology of the sensitivity of organisms reported from our laboratory. They were monitored closely until well enough to go home. Sequelae observed after full course of treatment were carefully documented and followed up in the outpatient department.
Results: The review of admissions of meningitis cases from 2006 to 2009 demonstrated and upsurge of cases between January and April 2009. A total of 29 patients were admitted during the period of January to April 2009 alone. The children's age ranged from 5 months to 17 years with a mean (SD) of 7 (1.0) years with under-fives accounting for only 44% of the total. The male: female ratio was 2:1. The children hailed from 4 out 17 Local Government Areas of Plateau State with Jos North LGA contributing most of the cases (25/29). The major factors associated with the outbreak included low socio-economic status of parents (19/29, 65.5%), cohort overcrowding (16/29, 55.2%), the Hausa (12/29, 41.4%) and Yoruba (4/29, 13.8%) ethnic extractions. The most common co-morbidity was Acute Respiratory Infection ARI. Common presenting clinical features were fever (100%), nuchal rigidity (72%), vomiting (69%), and history of physical overcrowding (55%) and involvement of more than the index patient within a household (44.8%). Laboratory findings showed leukocytosis, elevated CSF protein in all but one patient, and hypoglycorrhachia.
Conclusions: The current outbreak of meningitis is essentially a Jos North LGA occurrence. The characteristics of this outbreak and the period of occurrence tend to suggest that the recent sectarian crises could have contributed in view of the relationship between the venue of crises and the place of domicile of majority of patients. The sites of community crises should be closely watched for outbreak of diseases.
Methodology: We analyzed 29 children admitted and treated for meningococcal meningitis in the Emergency Paediatrics Unit (EPU) of the department of Paediatrics, Jos University Teaching Hospital (JUTH) situated in the north central part of Nigeria from March to June 2009. In addition, the admissions of meningitis into EPU from July 2006 to April 2010 were reviewed in order to demonstrate the upsurge in the number of cases. Meningitis was suspected in children who presented with history of fever, anorexia, vomiting, headache with or without seizures and evidence of meningeal irritation. Complete history and physical examination was carried on all patients Meningitis was confirmed by analysis of the cerebrospinal fluid (CSF) for elevated CSF protein, hypoglycorrhachia and identification of Nisseria meningitidis on culture. In addition, haematological and blood chemistry were evaluated. Patients were treated with a combination of intravenous peincillins and Chloramphenicol in line with current epidemiology of the sensitivity of organisms reported from our laboratory. They were monitored closely until well enough to go home. Sequelae observed after full course of treatment were carefully documented and followed up in the outpatient department.
Results: The review of admissions of meningitis cases from 2006 to 2009 demonstrated and upsurge of cases between January and April 2009. A total of 29 patients were admitted during the period of January to April 2009 alone. The children's age ranged from 5 months to 17 years with a mean (SD) of 7 (1.0) years with under-fives accounting for only 44% of the total. The male: female ratio was 2:1. The children hailed from 4 out 17 Local Government Areas of Plateau State with Jos North LGA contributing most of the cases (25/29). The major factors associated with the outbreak included low socio-economic status of parents (19/29, 65.5%), cohort overcrowding (16/29, 55.2%), the Hausa (12/29, 41.4%) and Yoruba (4/29, 13.8%) ethnic extractions. The most common co-morbidity was Acute Respiratory Infection ARI. Common presenting clinical features were fever (100%), nuchal rigidity (72%), vomiting (69%), and history of physical overcrowding (55%) and involvement of more than the index patient within a household (44.8%). Laboratory findings showed leukocytosis, elevated CSF protein in all but one patient, and hypoglycorrhachia.
Conclusions: The current outbreak of meningitis is essentially a Jos North LGA occurrence. The characteristics of this outbreak and the period of occurrence tend to suggest that the recent sectarian crises could have contributed in view of the relationship between the venue of crises and the place of domicile of majority of patients. The sites of community crises should be closely watched for outbreak of diseases.
