Several countries in West Africa are facing a major meningitis epidemic; hundreds of MSF /Ministry of Health teams are mobilized to treat and to vaccinate. In Nigeria, Niger and Chad, MSF is working with the health authorities to carry out vaccination campaigns for a total target population of around 8 million people. Meningitis epidemics are a well-known scourge in the countries of West Africa, which form part of the “meningitis belt”. But this year, the epidemic has reached a large scope. According to the official national figures, more than 1600 people infected with the disease have died since the beginning of the year in the two most affected countries, Nigeria and Niger. The epidemic trend is still on the rise in some places. The number of cases is now declining in the areas that were first affected and where vaccination campaigns have been carried out. But new areas are just crossing the epidemic level.

The worst epidemic in years.
In Nigeria, this is the worst meningitis epidemic the country has experienced since 1996. MSF is working in close partnership with the Ministry of Health in nine states (see the map). “There are numerous epidemic hotspots all across northern Nigeria”, describes Dounia Dekhili one of the MSF Emergency Coordinators in the field, “the situation evolves rapidly, but the number of deaths remains relatively low”. More than 37 000 cases of meningitis have been recorded by the joint MSF and Ministry of Health teams who are visiting health facilities to review patients and organize drugs supplies when necessary and collect data. On average, meningitis kills half of the infected people if not treated and one out of ten if treated. But it appears that during this epidemic, the bacteria are more sensible to treatment and 97% of the patients survive.

Niger is relatively less affected but the epidemic is spreading in some southern areas. MSF teams working with the Ministry of Health are treating patients suffering from meningitis and are vaccinating in the Dosso, Maradi and Zinder regions. A total of 4,591 meningitis cases and 161 deaths have been registered in these areas so far.

Massive vaccination
“The initial plan was very different that what we’re facing right now” explains Ramón Arrieta, head of the MSF emergency intervention in Dosso region, “the epidemic has spread to others zones so we have had to adapt our activities to the changing situation and vaccinate in new areas”. The means are huge. For example, in Zinder region only, 8’000 ice packs need to be frozen each night to be used by the 65 vaccination teams of 5 people each. One team can vaccinate up to 1500 people per day. The target population is aged from 2 to 30 years.

In total, more than 2,7 millions people have already been immunized (1,1 million in Nigeria and 1,6 million in Niger) and additional campaigns for around 5,5 million people are on going or planned in Nigeria, Niger and Chad. Usually, in one area, the number of meningitis cases drop two weeks after the vaccination campaign.

Intervention in Niger   

Medecins Sans Frontieres teams are working in close partnership with the Ministry of health to contain the spread of the epidemic and treat the affected people in 3 regions (Maradi, Zinder, Dosso) in southern Niger. The MSF team helps the staff of the health structures with the case definition and patient treatment. Training is provided, kits for simple meningitis cases are donated to health structures and kits for complicated meningitis cases are donated to hospitals.
In parallel with the treatment strategy is a mass vaccination campaign carried out with health ministry workers. So far, 1,6 million people have been vaccinated by MSF/Ministry of Health in Niger. In total, if all the campaigns are carried out, more than 2,9 millions people would be vaccinate during the meningitis epidemic by MSF/MOH in Niger.

Maradi region.

In several districts of the region of Maradi, the number of meningitis patients has been above the epidemic threshold for weeks. 1,871 people suffering from meningitis have been reported by the Ministry of Health in the region since the beginning of the year, among whom 60 have died. Three doctors are supervising the treatment of sick patients in health structures.
MSF teams have already vaccinated 663,595 people in collaboration with the Ministry of Health, in the districts of Maradi city, Madarounfa, and Tessaoua.
MSF teams have started to vaccinate in Aguié district, still in Maradi region, where there have been more and more patients with meningitis. The current estimated target population for the vaccination is about  900,000 people between 2 and 30 years old.

Dosso region

Four doctors are currently working on case management; they visit the five hospitals at district level and plan supervision visits according to the mortality and cases reported by the health centres.
MSF has started a three weeks vaccination campaign on the 26th March in Dosso and Doutchi districts. So far, around 275.000 people has been vaccinated. Vaccination is about to start in Boboye district that has entered in the epidemic threshold. The target population of vaccination campaign in Dosso region is the approximately 600,000 people.

Zinder region
MSF is supporting the health structures for the treatment of the meningitis patients in 6 districts of Zinder region.1'770 patients have been treated. 38 have died.
A mass vaccination campaign carried out by 65 MSF vaccination teams with health ministry workers, in good cooperation with the health department of Zinder. After Matameye district and Zinder town, MSF has started to vaccinate in the districts of Mirriah (target population of 300 000), Magaria (target population of 380 000) and Tanout (target population of 190 000). So far, 700.000 persons have been vaccinated. In total, 1,4 million people should be vaccinated against meningitis at the end of this campaign in Zinder region.

Intervention in Nigeria
In the last ten weeks, Medecins Sans Frontieres teams have been working in close partnership with the Ministry of health to contain the spread of the epidemic and treat the affected people in nine states.
Forty six surveillance teams have so far recorded 37,385 cases, along with 1210deaths among the population of 38 million people.
In parallel with the treatment strategy is a mass vaccination campaign carried out by 182 MSF teams with health ministry workers. So far, more than 1,1 million people have been immunized in the most  affected states of Jigawa, Katsina and Sokoto. A second round of vaccination has started in Bauchi, Gombe, Jigawa, Kaduna, Katsina, Kebbi, Sokoto and Zamfara states.
In total, if all the campaigns currently planned are carried out, more than 5,2 millions people would be vaccinated during the meningitis epidemic by MSF/MOH in Nigeria.