Containing pneumococcal meningitis outbreak in Ghana

Following the outbreak of meningitis in the Brong Ahafo region in Ghana, DRE-AM Ghana has taken the initiative to educate the public and create awareness about the disease. We were happy to interview Shadrach Dare, a Public Health Analyst, a registered nurse in Ghana and PhD student at the University of Glasgow.

1. What is meningitis?
Meningitis is an infection of the meninges, which is the covering around the brain and the spinal cord. It could be caused by bacteria or viruses. The basic clinical signs of meningitis are fever, headache, vomiting, stiff neck, photophobia (inability to tolerate light) and respiratory signs could include coughing and sneezing. In extreme cases, it could lead to brain damage or hearing loss.

2. How easy is it to pass on the disease?
The ease of spread of meningitis depends on the causative organism. Some bacteria like Neisseria meningitides spreads easily than others like the Streptococcus, which is the current strain identified in the BA outbreak. Heamophilus influenzae has also been identified to cause meningitis in the USA.

The organism causing meningitis does not survive for long outside the human body. Meningitis is spread from person to person, mostly through respiratory secretions like sneezing, coughing, kissing, sharing utensils, cutlery and personal possessions. People living in enclosed areas, boarding schools, university campuses, student accommodation are therefore at highest risk of getting the disease.

The bacteria normally resides in the human throat without causing any disease. However during the dry season, the throat becomes dry and compromised thus allowing these microorganisms to enter the blood stream to settle on the meninges, thus causing infection

3. How can people protect themselves from the disease?
Vaccination is perhaps the surest way to protect oneself from meningitis. But until that, it is advisable to wash your hands regularly, take sips of water in the dry weather in order to keep the throat moist, avoid overcrowded places which include keeping your room airy, and seek early treatment.
The public should also avoid the attitude of indiscriminate spitting. Cover your mouth when coughing, and your nose when sneezing. Items, like handkerchief, used to collect such respiratory secretions ought to be washed with soap and sun dried- Don’t share with anyone.

The use of shared utensils and cutlery, especially in public eating joints and also among family members, must be avoided in this period of an outbreak. Infected people could leave some saliva containing spores on the shared spoon, thus transmitting the infection. Family members should also avoid sharing toothbrushes, for the same reason above.

The last but not the least is kissing- Yes, kissing also involves the sharing of saliva and respiratory secretions so couple and partners, especially those in the epidemic regions, may have to cease kissing for a while.

4. Is there any treatment for meningitis?
Yes, there is treatment for meningitis and early seeking of treatment may guarantee survival. Effective treatment depends on the ability to identify the causative organism and administer the appropriate antibiotic. This means that people should go to the hospital or the clinic for treatment, rather than self medications with over the counter drugs, or visiting spiritual homes or herbalists, or using concoctions.

5. How should patients be handled?
Health care workers are advised to keep the normal infection prevention measures especially covering their mouth and nose with the face mask, handwashing and decontamination of used items. Patients could be kept in isolated wards, if available.

Contact with patients may have to be limited and family must be educated to bear with health workers. But for those who are permitted to visit clients may have to be provided with face masks as well and educated on infection prevention measures like handwashing and not share utensils.

The role of public education is as important as clinicians in the wards. And so I support and congratulate DRE-AM GHANA for this initiative to educate the public. There is no need to be shy or stigmatise, meningitis is just like any other infection which can be treated, it doesn’t mean the infected person has done anything the society may deem wrong. So lets keep up the education and encourage people to seek early treatment and also protect themselves.

6. What is the risk of the disease spreading to other regions of the country?
Once risk is mentioned, there is the temptation to quote figures but for the purpose of this interview, to educate the lay public, I will keep it simple.

In general terms, the pneumococcal bacteria cannot travel through space to other regions because it is spread by droplets- large particles which can only travel short distances. However if infected people should travel to visit families or seek treatment in other regions, then there is the likelihood of spread to other regions- first they could infect people they travel on the bus with, and infect their families as well. So yeah, there is the possibility of spread to other regions, however small.

7. How can we contain this expanding outbreak in the Brong Ahafo region? What needs to be improved?
Heeding to all the advice I have suggested earlier could help contain it. Involving all other stakeholders- like the education ministry is really important. To educate students and teachers to identify pupils who begin to show signs of the disease. Public health officials may have to consider closing down schools for a short period if that would help contain it, but of course that depends on if students in particular schools are being affected- based on the characteristics of infected people they are getting.

Churches within the region also have a role to educate their congregation on this disease and how to protect themselves. Media houses may have to provide platforms for such education to be intensified.
And finally, the ministry may have to consider procuring the vaccine for the pneumococcal vaccines for those in the epidemic zones, at least.

Source: DRE-AM Ghana

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