Southern Sudan has stocked up on meningitis drugs in the capital Juba and various states in a bid to minimise the impact of a possible outbreak during the dry season, a senior official said.

"We are better prepared than we were last year when we had an outbreak of meningitis and cholera," Monywiir Arop, under-secretary in the Southern Sudan health ministry, said. "We have developed a preparedness plan for the year."

Southern Sudan reported 12,000 meningitis cases in 2007, ranking second to Burkina Faso in numbers of cases out of 21 African countries in the so-called meningitis belt.

The high infection levels, Arop said, had compelled the health ministry, the UN World Health Organization (WHO), the UN Children’s Fund (UNICEF) and other organisations to stockpile  500,000 million vaccines in the event of an outbreak.

"The possibility of many households in Juba getting meningitis is very high because of unhygienic conditions, congestion and many returnees coming back to  South Sudan," Arop told IRIN.

Abdul Rahman Wurie, a WHO early warning epidemiologist, said Southern Sudan was vulnerable to various diseases because of the impact of climate change and flooding, the absence of an adequate health infrastructure, including trained personnel, and the return of large numbers of displaced people.
Dust storms, which are common during the January to April dry season, for example, lead to an increase in respiratory infections and help spread meningitis because the bacteria attach to dust particles.

The meningitis belt, according to WHO, stretches from Senegal in the west to Ethiopia in the east, with an estimated population of 300 million people. Meningitis epidemics occur in cycles. The disease, a potentially deadly infection of the thin lining that surrounds the brain and the spinal cord, can kill unless quickly treated although it can be controlled through vaccination.

"The region is prone to epidemic outbreaks ... last week, we experienced cholera in Yei [with] 194 cases, but that is now under control," Wurie said.

WHO, he added, had posted more epidemiologists to monitor Southern Sudan and was conducting training on enhanced meningitis surveillance; while the government of Southern Sudan had adopted an integrated disease surveillance and response strategy.

Upsurge in malaria

Apart from meningitis and cholera, the region also suffers from malaria. Last year, Wurie said, five states that were hit by raging floods, especially Upper Nile State, experienced an upsurge in malaria infection. Rift Valley fever was also identified in Upper Nile State.

To contain malaria, the government and its partners have procured 1.6 million mosquito nets for distribution this month in Jonglei, Unity, Western Equatorial, Upper Nile and Northern Bhar Al Ghazal states.

"Given the meagre resources, we can only manage to provide nets to the vulnerable population first - lactating mothers and their children," Arop said.

Southern Sudan emerged from more than two decades of conflict after the signing of the Comprehensive Peace Agreement with the north in January 2005.

The war devastated the region, displacing an estimated four million southerners. Since the accord, about two million southerners have returned home from displaced camps in other parts of Sudan or from refugee camps in neighbouring countries.

Epidemic levels of the bacterial infection meningitis have now reached two districts in Burkina Faso, Gaoua in the southwest, 30 km from the Ghana border, and Mandogara, just 20 km from the Cote d’Ivoire border, making it likely the epidemic in Burkina Faso is being boosted by infected people entering from neighbouring countries, experts warn.

“Now we are faced with a problem. If we vaccinate the populations in Burkina we may have to also vaccinate unexpected populations from across the borders, so we [may] be short of vaccines, or the protection will not be effective,” Jean Gabriel Wango, the secretary general of the Health Ministry told IRIN.

Souleymane Sanou, director general at the Ministry of Health, has estimated 5 million people are now at risk across 20 health districts in Burkina Faso.

The World Health Organization (WHO) warned in October 2007 that 80 million people out of roughly 350 million who live in 21 African countries stretching from Ethiopia in the east to Mauritania in the west might need to be vaccinated against the bacterium this year.

With 267 people in Burkina Faso contracting the illness in the first week of February, compared to 254 the previous week, the number of infected people has increased, but the number of deaths in the same period has lowered from 39 to 25.

According to Wango this is due to “better case management” and the patients being sent quickly to health centres.

“We are following with the greatest attention the evolution of the epidemic,'' Wango told IRIN. “We have taken into account WHO warnings about risks of resurgence of meningitis epidemics this season.”

WHO has been asked to approach the ministry of health on the Ivorian side to conduct a joint response, according to Wango.

The Burkina Faso government currently has a stock of 1.67 million vaccine doses which it is using to target the epidemics in Gaoua and Mandogara.

But to get hold of more, it must go through the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control, which was set up following a major outbreak in 1995, to help ensure the limited vaccines are used where they are most needed.

Between 1995 and 1997 a meningitis outbreak across the West Africa region killed 25,000 people and affected 250,000.

The meningitis bacterium, which usually reaches epidemic levels in the region between December and May, could be especially severe this year, health forecasters have warned, as the region is heading toward the peak of a 10- to 12-year cycle of meningitis crises.

Meningitis is an infection of the thin lining around the brain and spinal cord. Even when it is diagnosed early and adequate therapy is available, between 5 and 10 percent of patients die.

The end of the rainy season in Africa could trigger the worst meningitis epidemic to hit the continent in a decade, which the international community is poorly prepared to handle, the World Health Organization warned on 9 October.

At least 80 million people living in 21 countries from Ethiopia in East Africa to Mauritania in West Africa that make up a region often called Africa’s ‘meningitis belt’ might need to be injected with preventative vaccines this year, WHO said at an emergency meeting held in the Burkina Faso capital Ouagadougou.

Last year just 7 million doses of vaccines were available to the entire region because of funding shortfalls and a global deficit in the production of the cheaper vaccines usually used in Africa as European drug manufacturers have focused on producing newer, long-lasting but more expensive vaccines.

The meningitis virus, which usually reaches epidemic levels in the meningitis belt between December and May, could be especially severe this year as the region is heading toward the peak of a 10- to 12-year cycle of meningitis crises, health forecasters say.

“The number of cases has increased in the last two seasons and we are likely to have major epidemics in a context of vaccine shortages,” Dr Deo Nshimirimana, Director of the Communicable Disease Control Department at WHO Africa office told IRIN. “We need to educate everybody so that we can be prepared in case of an epidemic.”

An estimated total population of between 300 million and 400 million people live in the meningitis belt countries, the vast majority of them in isolated, rural areas, often far from roads or health centres. Between 1995 and 1997, the last time there was a major epidemic in the region, at least 25,000 people died and 250,000 people were infected.

From December to May last year 53,000 cases of meningitis were reported and an estimated 4,000 people died across the region.

The countries affected are mostly extremely poor and have desperately under-resourced health systems. In many of the countries, governments rely on foreign donors to prop up basic health infrastructure even when there is not a crisis.

WHO has asked donors to provide US$14 million to purchase 12 million doses of vaccine and injection materials, and to cover transport, storage and insurance costs. WHO also wants to strengthen surveillance and diagnosis capacities in the region, which includes several of the poorest countries in the world.

“The partners have been receptive to our appeal and to the stakes,” Nshimirimana said. “They have agreed to lobby at their headquarters.”

The 12 million doses – a minimum, according to WHO – will be pre-positioned for response in case of epidemics. Additionally, WHO wants to set up a security stock of 500,000 vaccine doses in each of the countries of the meningitis belt.

“I think this meeting is very important because the budgets of African countries mean left alone they cannot support the fight against meningitis,” Burkina Faso’s health minister Alain Yoda said at the opening of the WHO meeting. Burkina Faso, where nearly 26,000 cases of meningitis were recorded last year and 1,732 people died, needs six million doses, Yoda said.

Semi-arid Sahelian countries are hit each year by outbreaks of meningitis during the dry seasons between December and June when strong, dust-laden winds and cold nights make people more prone to respiratory infections. The meningitis bacteria is transmitted by sneezing or coughing.

Meningitis is an infection of the thin lining around the brain and spinal cord. Even when meningitis is diagnosed early and adequate therapy is available, between 5 and 10 percent of patients die, typically within 24 and 48 hours of experiencing the first symptoms. Many thousands of survivors live on with brain damage, hearing loss, or learning disabilities.

UN agencies and non-governmental organisations at the Ouagadougou meeting included the UN children’s fund, the European Commission Humanitarian Aid Office, USAID, Medecins Sans Frontiers, the World Bank and the US Centers for Disease Control and Prevention.

Measles is a preventable disease yet when it strikes in Nigeria it finds a ready pool of victims most of whom are children.

In June more than 50 children died while another 400 were hospitalised in Nigeria’s northeast Borno state following a measles outbreak.

The viral disease, transmitted both by air and by bodily fluids, was first reported on 19 June in the village of Njimtilo in the outskirts of the Borno state capital Maiduguri, and then quickly spread to five adjoining local areas including Konduga, Jere, Damboa, Bama and metropolitan Maiduguri.

Health officials have frequently blamed low immunisation rates for such outbreaks, as well as outbreaks of polio, diphtheria and tuberculosis. A 2005 World Health Organisation (WHO) survey found that 72 percent of measles cases in Nigeria occurred in children under five years old, three-quarters of whom had not been immunised.

Measles can strike as much as 90 percent of an un-immunised population.

Despite Nigeria’s oil wealth only 12.7 percent of children under five years old are fully immunised against childhood diseases. That rate is among the lowest rates anywhere in the world, according to WHO.

One reason for the low coverage, WHO says, is the decrepit health services sector which lacks funding and proper infrastructure and management.

Emeka Iwobi, a paediatric doctor based in Nigeria’s largest city, Lagos, told IRIN that poverty and ignorance also play a part. “Most of those who need [vaccines] are too poor to afford them or may not know they need them,”

Some 70 percent of the population of 140 million lives on less than US $1 a day, many in unhygienic conditions that favour the spread of disease.

Most people often lack access to basic medical care. Nigeria was 187th out of 191 countries in a WHO global ranking of performance of health systems, coming ahead of only DR Congo, Central African Republic, Myanmar and Sierra Leone.

The worst affected states in Nigeria are those in the Muslim north. Immunisation efforts in the region have suffered major setbacks because some radical Muslim preachers there are suspicious of Western medicine. The preachers have claimed that the polio vaccination programme was part of plot to reduce the Muslim population.

In 2004 authorities in the mostly Muslim state of Kano suspended polio vaccination for 10 months to conduct tests to determine if the vaccines contained sterilising agents or the AIDS virus, as critics had alleged.

In other parts of northern Nigeria communities systematically boycotted efforts to immunise their children.

“The polio boycott has had a ripple effect on immunisation efforts of other childhood diseases,” said a senior official of the National Programme on Immunisation who spoke on condition of anonymity.

“We can't make much progress unless we overcome the negative perception,” he said.