Outbreaks in Africa  - January – June 2003 ( Including Severe Acute Respiratory infections (SARS)

by John Kiwanuka Ssemakula; June 12, 2003

There have been 11major outbreaks involving 5 diseases, over 17,000 cases and 1,556 deaths have been reported in Africa in the first 6 months of 2003. The most reported outbreak has been the SARS epidemic that took place in South East Asia and Canada. At the time of  compiling this data, 6583 cases with 461 deaths of SARS had been reported globally. None have been reported in Africa. The most extensive outbreak on the continent has been the meningitis epidemic in Burkina Faso which has received little or no media attention (See the Meningitis Belt). By May more than a thousand people had died of meningitis and more than seven thousand cases had been reported. Unlike SARS there is a vaccine against Meninigitis and drugs available, but they are too expensive.

Meningitis Belt

Meningococcal meningitis is a serious infection caused by the gram negative diplococcus Neisseria Meningitidis. It is found worldwide but special climactic conditions in the arid Sahel Savanna belt of Africa predispose to periodic large-scale epidemics. The region extending from Senegal in the West to Ethiopia in the East is designated the "African meningitis belt". The meningitis outbreaks are seasonal and tend to occur in the dry season.

Within the meningitis belt, outbreaks of meningitis occur in epidemic cycles that last between 8 to 15 years. The length of the epidemic cycles are not the same for all countries e.g. Niger and Nigeria: 8-9 years, Burkina Faso: 10-15 years, Sudan: 10 years. It appears that the number and intensity of epidemics has been increasing, with a decreasing interval time between epidemics. According to the WHO “Endemic bacterial meningitis is a major public health problem that is often neglected.” There is a need for increased national surveillance and monitoring programs in the affected countries. The factors responsible for the periodic outbreaks are not known, one school of thought is that it is related to the “herd immunity” of a population, particularly in the young.

This most recent outbreak is part of the continuing meningococcal meningitis pandemic, which began in 1996. By 2002 it had resulted in more than 300,000 cases reported to the WHO with the the most affected countriesbeing Nigeria, Burkina Faso, Mali, Niger and Sudan.

Wothout adequate surveillance and timely interventiuons it seems likely there will be more deadly outbreaks.