PRESS STATEMENT DELIVERED BY DIRECTOR-GENERAL OF GHANA HEALTH SERVICE DR. EBENEZER APPIAH DENKYIRA ON THE MENINGITIS SITUATION IN GHANA, 15th FEBRUARY, 2016
Ladies and Gentlemen of the Press
Directors of Ministry of Health/ Ghana Health Service
Rep. from WHO
Distinguished Health Professionals
We are grateful to have you here today to brief you on the meningitis situation in the country. This is the second in the series and hope to intersperse this with weekly Press Releases.
Meningitis is an inflammation of the meninges, the covering of the brain and spinal cord. It is most often caused by infection (viral, fungal or bacterial). Bacterial meningitis is caused by several bacterial pathogens but Neisseria meningitidis (Nm), Streptococcus pneumoniae and Haemophilus influenzae type B represent the triad causing over 80% of all cases of bacterial meningitis.
Outbreaks due to meningococcal meningitis remain a major public health challenge in the meningitis belt. The recurrent meningitis outbreaks in Ghana particularly in the northern regions, led to the conduct of a mass preventive immunization campaign in the country recently to address the burden of Group A meningococcus. Following the successful conduct of the mass preventive campaign in the three northern regions, the proportion of meningococcus serogroup A has declined dramatically and the occurrence of meningitis outbreaks due to other Nm serogroups as well as other bacteria are rather a new concern. Additionally, outbreaks due to Streptococcus pneumoniae have also become more pronounced and a public health threat which demands effective preparedness and response strategies.
There have been seasonal reports of meningitis in Ghana normally during the dry periods of October to March the ensuing year. During these dry periods with relative low humidity and abundance of dust, individuals become susceptible to meningitis infection. Meningitis is endemic in the three northern regions of Ghana and hence the monitor being used requires three (3) and ten (10) cases respectively within one week, per population of 100,000 to declare alert or epidemic situations respectively. We are using an enhanced surveillance system to monitor what we call Alert and Epidemic Thresholds which are determined using the population of the locality.
An outbreak of meningitis occurred in December 2015 in Brohani and Seikwa communities in Tain district of Brong Ahafo region during which, initially 31 people were affected of which 9 died. The causative agent was confirmed as Streptococcus pneumoniae. Response measures were initiated and the outbreak abated. Following this, there have been increased reports of meningitis cases due to Streptococcus pneumoniae in Wenchi, Techiman North, Nkoranza South and Atebubu districts in the Brong-Ahafo region and Bole district in the Northern region. There have also been reported cases of Neisseria meningitis in sporadic districts across the country.
As at 13th February, 2016, cumulatively, 548 suspected meningitis cases including 93 deaths have been reported across the country (death rate of 16.9%). All regions have reported cases except Central Region. Brong-Ahafo Region is still the most active region reporting cases. Eighteen (18) districts from Brong-Ahafo Region have so far reported cases. Significantly among them, are Tain, Wenchi, Techiman Municipal, Nkoranza South and Jaman North. Tain and Jaman North districts even crossed the Epidemic Threshold.
For the other regions, there have been no or marginal changes in the number of reported cases particularly deaths over the period.
Distribution of Suspected Meningitis cases, Ghana, 10th February, 2016
SUMMARY SPECIFIC ACTIONS TAKEN SO FAR BY THE MINISTRY IN RESPONSE TO THE OUTBREAK INCLUDE THE FOLLOWING:
We have undertaken field investigations into these high reported cases and the predominant causative agent has been identified to be pneumococcus. This can be treated with antibiotics; and effective antibiotics are being used to manage the cases. A few districts have detected isolated cases of meningococcus and we are monitoring all of them very closely.
Funding has been provided together with antibiotics (Ceftriaxone), laboratory test kits and logistics to the regions and districts affected.
Senior health officials have visited the regions, districts and communities to investigate, assess preparedness and response actions on the ground and provide moral and technical support.
Intensive public awareness has started and is ongoing. We are using varied social mobilization strategies including the radio stations, gong-gong beating, traditional and religious leaders, information centres (Public Address systems) to mobilize the communities for positive response.
Surveillance on meningitis has been enhanced and health workers are sensitized on the outbreak.
District and Regional Epidemic management committees have been activated and are functional.
Team of health workers go to the affected communities to trace and follow up contacts and manage them as appropriate.
All regions and districts have been alerted to look for cases for prompt and appropriate management
Donation of antibiotics by private sector and distributed to all regions for use and stockpiling
Visit by Hon Minister of Health and the WHO Country Representative and other technical officers to Techiman, Wenchi, Offinso and Bole districts to interact health officials and other key stakeholders including DCEs, MPs on measures to control the situation.
We have streamlined our communication to minimize the confusion in the announcement of statistics with the current situation.
We have done briefing and provided update to the parliamentary select committee on health and the entire house of parliament.
The following activities have been undertaken and some are currently ongoing.
Antibiotics (7,500 vials) have been distributed to all 10 regions, Brong-Ahafo Region received 2,250 vials.
Provision of additional funding to all 10 regions, but with emphasis on Brong-Ahafo and the three northern regions
Noguchi Memorial Institute of Medical Research (NMIMR) is the lead institution conducting test for meningitis. They are being supported by Kumasi Centre for Collaborative Research (KCCR), all regional and district hospital laboratories.
Medical Research Council (MRC) Unit, a WHO Collaborating laboratory based in Gambia is in the country for 10 days to provide laboratory reagents and assist on-site training of staff and diagnosis.
A team from Centers for Disease Prevention and Control (CDC) US, Atlanta are in Ghana. They are to replace the PCR machine stationed in Tamale, provide additional laboratory reagents and assist in the training of laboratory and epidemiology health officials.
Health Advisory on Meningitis has been distributed to all health workers through Regional Directors
Meningitis Q&A has distributed to the media including social media
UNICEF and other Development partners are supporting the development and printing of posters and facts sheets
All District Epidemic Management Committees and other stakeholders are involved in on-going media campaign
There are weekly National Technical Coordinating Committees meetings involving Ghana Education Service, World Health Organization, CDC and UNICEF
Weekly Conference call involving GHS, WHO-Ghana, WHO-AFRO, WHO-Geneva and CDC
Suspected Meningitis: Any person who has
Fever or Headache AND any one of the following
Bulging anterior fontanelle (for children under one year)
OR a sudden unexplained death
What the ordinary person should do:
Avoid overcrowding ( particularly avoid infected persons sneezing, coughing )
Drink a lot of water
Improved ventilation (opening of windows in your rooms)
Report to the nearest health facility if you have fever, headache and neck pain
With increasing awareness, we expect increasing reported cases due to improved reporting and high index of suspicion on the side of clinicians. Currently a lumbar puncture is done for every suspected case. The weather continues to be harsh and makes it easy for the occurrence of sporadic cases, but with enhanced surveillance cases would be detected early and managed with available appropriate antibiotics for favorable health outcomes.
The orientation of community volunteers to report all alerts and unexplained deaths would further ensure better reporting.
There is increasing reported cases of meningitis across the country. The harsh weather condition is a constant threat for more reported cases. The whole country is on high alert to report any suspected cases. The national health system is working with development partners to control the situation.
We wish to take the opportunity to single out a few, including our partners that have contributed and supported the fight against the disease till now:
The Government of Ghana
Ministry of Health and Ghana Health Service at all levels
Noguchi Memorial Institute for Medical Research
The World Health Organization
Centres for Disease Control and Prevention (CDC)
Private Pharmaceutical companies
Traditional and religious leaders
The Media who have always been our Partners for Health