Meningococcal disease – Togo
Since 1 January 2017, 201 suspected cases of meningitis with 17 deaths were reported by 19 health districts. In week 2, the district of Akebou which is part of the Plateau Region issued an alert after four cases of meningitis were reported. In week 4, the epidemic threshold was reached with nine cases and an attack rate of 12.4 per 100 000 inhabitants. From 2 January to 12 February 2017, 48 suspected meningitis cases with three deaths were reported (case fatality rate of 6.3%). Of these, 14 specimens were confirmed as Neisseria meningitidis serogroup W by PCR.
The Plateau Region, together with the other three regions in the country benefited from the mass vaccination campaign with MenAfriVac in December 2014.
Togo is part of the African meningitis belt and documents cases and deaths due to meningitis every year. In 2016, the country recorded an epidemic in the northern part caused by Neisseria meningitidis serogroup W. A total of 1975 cases and 127 deaths were reported in 2016.
Public health response
In response to the outbreak, the following measures are being implemented:
- 56 000 doses of meningitis vaccines have been requested from the International Coordinating Group (ICG) for the planned vaccination campaign.
- WHO Field Mission was deployed in the field to strengthen outbreak management.
- Strengthening of meningitis surveillance at the district level.
- Training of clinicians at the district level on case management.
- Conducting cross-border meetings with Ghana and Benin.
WHO risk assessment
The largest burden of meningococcal disease occurs in the African meningitis belt. Although the successful roll-out of MenA conjugate vaccine has resulted in the decreasing trend of meningitis A, other meningococcal serogroups are shown to have caused epidemics. This report of the Neisseria meningitidis W outbreak in Togo calls for a close monitoring of the changing epidemiology of meningococcal disease. There is a need to ensure that global stocks of vaccines are available, laboratory and epidemiologic surveillance systems are strengthened and outbreak response strategies in the countries are on hand.
The epidemic response consists of prompt, appropriate case management involving reactive mass vaccination of populations, and strengthening of meningitis surveillance.