2023-04-23 09:12:49
Au Togoon February 15, 2023, the Ministry of Health officially declared an outbreak of pneumococcal meningitis in the South Oti District, Savannah regionin the north of the country, a region bordering the Ghana and the Benign.
From December 19, 2022 to April 2, 2023, a total of 141 suspected cases of meningitis with 12 deaths (CFR 8.5%) were reported in Oti Sud district, corresponding to an attack rate of 112 per 100,000 inhabitants.
A total of 118 cerebrospinal fluid (CSF) samples were collected from suspected cases, 22 of which were confirmed by polymerase chain reaction (PCR) and culture for Streptococcus pneumoniae at the national reference laboratory (81 samples were negative and the results of 15 samples are pending).
The most affected age group is that of 10-19 years (47%; n = 66), followed by the age group ≥30 years with 20% (n = 28) of cases, and the age group 20-29 years old with 15% (n = 22) of cases. There is no difference in the distribution of cases by sex, with 71 (53%) cases reported in men.
Comments:
Togo introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in 2014, which is currently given in three doses at the first, second and third month of life. PCV13 administrative coverage in the Savanes region is 100% for the third dose, but vaccination history is not available for individual cases, and it is not known whether the serotype(s) involved is (are) covered by the vaccine. Additionally, the most affected age groups were born before the introduction of PCV13 in 2014 and may not have received the vaccine.
Togo is part of the African meningitis belt and records meningitis cases and deaths every year. Although the country has gained some experience in managing outbreaks of meningococcal meningitis in recent years, the current outbreak of S. pneumoniae is unusual because the country has never managed a pneumococcal meningitis outbreak in the past, and national capacities are limited.
To date, no imported cases have been reported in neighboring countries. However, several factors are likely to increase the risk of spread, including the country’s location in the African meningitis belt; the epidemic season, which generally extends from January to June; constraints related to the provision of vaccination services, which do not allow optimal vaccination coverage to protect the population; the fact that the main age groups affected by the epidemic are not protected by routine vaccination against S. pneumoniae, introduced in Togo in 2014; the security crisis in the Sahel, affecting the Savannah region, hampering public health interventions and causing population movements; the precarious economic conditions in the country, particularly in the Savannah region; and suboptimal surveillance capacity for early case detection, diagnosis and treatment in Oti Sud district.
Neighboring countries are also in the African meningitis belt, and the Oti Sud district borders Ghana and Benin, making it possible for the disease to spread to other countries in the region.
Given the situation described above, WHO assesses the overall risk posed by this outbreak to be high at the national level, moderate at the regional level and low at the global level.
Source: World Health Organization (WHO)
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