More lives at risk
The agency is warning that lives in other countries in the meningitis belt could be at risk if more vaccines are not made available to contain the disease, UNICEF said. Nigeria was the worst hit with 1 701 deaths followed by Burkina Faso with 389. Despite vaccines being released from global stocks to tackle the outbreak in the region, Nigeria needed a further 2.5 million doses and Niger another 300 000, UNICEF said. Chad's health minister declared a meningitis epidemic last week and went on national radio to assure people the government would start a vaccination program. Health officials have launched such a programme for two- to 30-year-olds in Niger with vaccines provided by the World Health Organisation.
Spread through sneezes, coughs
Meningitis spreads mainly through kisses, sneezes, coughs, and in close living quarters, especially when people share cups, forks, and spoons. The largest recorded meningitis outbreak in the African high-risk zone where, like polio, the disease is endemic, occurred in 1996-1997 when an estimated 100 000 people were infected in Nigeria and 50 000 in Niger. Up to 20% of people who survive infection with bacterial meningitis suffer brain damage, hearing loss or learning disability.
What is meningitis?
Essentially, meningitis is an infection of the fluid that cushions the spinal cord and the brain (it is named for the meninges, the membranes which surround and enclose the central nervous system). There are in fact two kinds of meningitis: viral and bacterial. The viral sort is generally not too severe and will clear up without anything more than treatment of the symptoms. It's bacterial meningitis that can result in disability (such as hearing loss or brain damage) or even death. It's important to realise that this is a very serious disease which has a death rate, everywhere in the world, irrespective of the quality of medical care, of between 6% and 10%, says Dr Pete Vincent of Netcare Travel Clinics. When doctors see a patient who has bacterial meningitis, the first thing they'll do is find out (by taking some of the spinal fluid) what kind of bacteria is causing this particular case the more they know about the bacteria involved, the better they can tailor the treatment.
The most common bacterium involved is Neisseria meningitides, but it can be caused by Streptococcus pneumoniae as well. (There's another bacterium, Haemophilus influenzae, which usually causes meningitis, but most children are now vaccinated against it.) Eighteen out of every hundred people you encounter have Neisseria meningitides living in their nasal passages, and you can be infected by it if you come into contact with their nasal secretions (maybe through kissing or coughing). The bacteria are contagious (you have to have physical contact with the bodily fluids) rather than infectious (where the bacteria spread through air). This begs the question: if so many people have the bacteria, how come meningitis is not much more common? Well, the development of bacterial meningitis does not automatically follow an infection. Infection is more likely to progress to become meningitis when certain risk factors are present:
* A pre-existing infection of the upper respiratory tract (so during the 'meningitis season' in South Africa, it might be an idea to keep a child with a cough or cold at home until the infection has cleared up)
* Active and passive smoking (parents who smoke put their children at greater risk a huge incentive to give up!)
* Crowded conditions, especially when people experience these conditions for the first time so be on the alert when your child first starts at nursery school, for example, or a teenager heads for boarding school or a university residence
* Existing physical depletion, such as reduced immune function.
What are the signs and symptoms of meningitis?
The noticeable thing about bacterial meningitis is how quickly it develops, says Vincent. Symptoms appear and get worse within hours, or at most one to two days. Symptoms could include:
* A really bad headache
* Joint and muscle pain
* In young children, irritability is often a feature
* Light hurts the patient's eyes
* The neck is stiff
* There's a fever
* The patient may get a rash known as a petechial rash (red/purple blotches which don't go white under pressure)
* Seizures occur in 40% of children with meningitis, typically during the first few days.
Small children may not get the fever, headache and neck stiffness the baby may instead be irritable and fussy, lethargic and not feeding.