Wüstenschiff

Liverpool receives $1.5M to tackle disease in Africa
13.01.2011 - eurekalert

A University of Liverpool-led consortium has received $1.5million from the Bill & Melinda Gates Foundation to study a bacterium that causes serious disease and epidemics in sub-Saharan Africa. Streptococcus pneumoniae serotype1 is one of the most prevalent strains in sub-Sahara Africa. The funding will enable scientists to analyse the bacterium to determine why it is associated with invasive pneumococcal disease, why it spreads so quickly and why it has significant epidemic potential in some areas of Africa. Invasive pneumococcal disease causes life-threatening pneumonia, meningitis and sepsis and is a major cause of death and serious illness in Africa. There are more than 90 different serotypes of Streptococcus pneumoniae - the bacterium that causes pneumococcal disease - but only a small number are associated with invasive pneumococcal disease ... mehr

Gruß
Birgitt

Cheap new meningitis vaccine cuts cases in Africa

Burkina Faso, Mali and Niger had the lowest number of meningitis A cases in an epidemic season this year after the introduction of a cheap vaccine designed for Africa, World Health Organization (WHO) data showed Thursday. mehr...

Grüsse
Alexander

Immer diese amerikanischen Impfempfehlungen...Trau schau wem.
Meningokokken findet man bei 10% der Gesunden im Rachen .
Übertragung durch Tröpfchen- Also Abstand.
Ich habe alternativ Refampicin dabei- 2 Tabletten und man ist geschützt.
Quelle: DPGI
<Prophylaxe

Beratung und Überwachung der Kontaktperson (d.h., beim geringsten verdächtigen Symptom Arzt aufsuchen!),
Antibiotika-Prophylaxe bei Kontaktpersonen mit Refampicin (Alternativen: Ciprofloxacin, Ceftriaxon), Meningokokken-Stämme mit Refampicin- bzw. Ciprofloxacin-Resistenz kommen selten vor,
einen Impfstoff gegen B-Meningkokokken gibt es nicht,
es gibt einen Polysaccharid-Impfstoff gegen die Serogruppen A, C, Y, W-135, einen konjugierten Meningokokken-C-Impfstoff und neuerdings einen tetravalenten Konjugatimpfstoff (A, C, W135, Y),
systemische Meningokokken-Infektionen (Verdacht, Erkrankung, Tod) sind meldepflichtig.

Vor Reisen nach Afrika Impfung gegen Meningitis dringend angeraten

Wer nach Afrika reisen möchte - insbesondere in Länder des so genannten Meningitis-Gürtels, sollte sich unbedingt gegen Meningokokken-Meningitis impfen lassen. Dazu raten die Internisten vom Berufsverband Deutscher Internisten (BDI). „Meningokokken sind Bakterien der Art Neisseria meningitidis, die durch Tröpfcheninfektion von Mensch zu Mensch übertragen werden und schwere Erkrankungen wie Hirnhautentzündung (Meningitis) und Blutvergiftung (Sepsis) auslösen können", erklärt Prof. Thomas Löscher von der Abteilung für Infektions- und Tropenmedizin des Klinikums der Ludwig-Maximilians-Universität (LMU) München und Infektionsexperte des Berufsverbandes Deutscher Internisten (BDI).

Bereits über 600 Tote seit Beginn des Jahres mehr...

Grüsse
Alexander

MENINGITIS, MENINGOCOCCAL - FRANCE ex AFRICAN MENINGITIS BELT
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France ex African Meningitis Belt

Date: Thu 24 May 2012
Source: Eurosurveillance, Volume 17, Issue 21 [edited]
http://www.eurosurveillance.org/ViewArt ... leId=20181


W135 invasive meningococcal infections imported from Sub-Saharan Africa to France, January to April 2012
-----------------------------
Authors: Parent du Chatelet I, Barboza P, Taha MK.

From January to April 2012, 16 cases of W135 invasive meningococcal infection were reported in France. Of these, 8 were linked to a recent travel history to Sub-Saharan Africa. These cases were reported in France concomitantly with the meningitis epidemic season in Sub-Saharan Africa. Considering the high number of travellers between France and West-African countries belonging to the so-called meningitis belt, the French recommendations for travellers stress the importance of vaccination before travelling to these countries.

In mid-February 2012, 2 W135 invasive meningococcal disease (IMD) cases were reported in 2 French regions (Pays de la Loire and Rhone-Alpes) in persons having recently returned from Senegal. The 1st case had arrived in France on [12 Feb 2012] and was hospitalised 3 days later. The 2nd case arrived on [19 Feb 2012] and was hospitalised on the same day. No connection could be established between the 2 cases but they had both visited the same region in Senegal (near Mbour) and they were both working with non-governmental organisations (NGOs).

In France, the annual mean incidence of IMD varies between 0.9 and 1.5 cases per 100 000 population. Cases are mainly due to serogroup B and C meningococci (65 percent and 27 percent respectively for the last 10 years). Serogroup W135 is rare in France; sporadic cases were reported in the 1990s (less than 5 cases per year) and they mainly belonged to the clonal complexes ST-11 and ST-22 (French National Reference Centre for Meningococci (NRCM), unpublished data). However, this serogroup underwent a clonal expansion in France and other European countries in 2000, during the 1st reported multinational outbreak of serogroup W135 _Neisseria meningitidis_ infections belonging to a particular clone of the ST-11 clonal complex. This outbreak started among pilgrims to Mecca and their contacts [1] and then affected Sub-Saharan countries (mainly Burkina Faso) [2,3]. Following a peak of incidence in 2002 with 42 reported cases, the incidence of W135 (ST-11) IMD cases decreased in France and the W135 cases were most frequently due to isolates belonging to the clonal complex ST-22 representing in 2011 less than 3 percent of the cases with known serogroup (14/542) (NRCM, unpublished data).

Investigation of W135 meningitis cases in 2012
----------------------
In 2012, the epidemic meningitis season, which coincides annually with the dry season between December and June, had already started in the so-called meningitis belt when the 2 W135 cases imported from Senegal were notified. Therefore we collected information regarding recent travel for all the W135 IMD cases that occurred in France since the beginning of the year [2012].

Between [1 Jan 2012 and 1 Apr 2012], a total number of 16 IMD cases were notified in France. This is an important increase if compared to the previous 5 years when only 4 to 8 W135 cases were reported each year during the 1st 5 months.

All 16 cases reported this year were laboratory-confirmed through isolation of _N. meningitidis_, positive PCR or detection of _N. meningitidis_ antigens. The median age of cases was 45 years (range: 2 months to 89 years) and the M:F ratio was 9:7. None of the 16 cases had been vaccinated with a tetravalent A/C/Y/ W135 meningococcal polysaccharide vaccine.

For 8 of the 16 cases, a link to Sub-Saharan Africa was identified: 2 had returned from Senegal in February [2012], one had arrived from Mali 4 days before the disease onset and one arrived from Senegal 15 days before the disease onset. The other 4 cases did not travel during their incubation period but a recent travel history was found for their close contacts: to Benin for one case, to Mali for 2 cases and to Senegal for one case with dates of return to France within the 3 weeks before the disease onset of the case. The purpose of travel was visiting friends and relatives for 6 cases or contacts and working for NGOs for two.

Considering an incubation period of 10 days, the dates of arrival in France and onset of the disease, 3 of the 8 cases could be considered as imported. The remaining 5 cases may have been infected by asymptomatic contacts carrying an imported strain. However, strains were not investigated among contacts.

Among the 8 cases, 4 cases presented with meningitis, 2 with pneumonia and septicaemia, one with arthritis, and one with pericarditis. No death was registered among the cases.

As of 24 May 2012, no other W135 IMD case has been notified since 1 April 2012.

All 8 'possibly import-related' W135 IMD cases were caused by the same strain, characterised at the NRCM in Paris by multilocus sequence typing, PorA variable regions (VR1 and VR2), penA and fetA genes. The antigenic formula was W135:2a:P1-5,2, the genetic typing showed porA VR1=5, VR2=2, fetA=F1-1, penA=1, and the strains were ST-11.

Conclusions
---------
The increase of serogroup W135 meningococcal disease incidence in France in early 2012 was concomitant to the meningitis epidemic season in Sub-Saharan Africa. From [1 Jan 2012 to 15 Apr 2012], almost 15 000 meningitis cases have been reported in West Africa to the World Health Organization. In some countries (e.g. Burkina Faso, Cote d'Ivoire, Ghana, Mali, Niger) the serogroup W135 was predominant among cases for which _N. meningitidis_ has been identified whereas serogroup A was predominant in other countries like Chad [4]. Serogroup W135 has increased in Niger in 2010 [5]. No laboratory results were available from Senegal.

The French NRCM typed 8 isolates from Cote d'Ivoire. These bacteria were isolated in February 2012 in 3 different districts of the country. All the isolates from France and Cote d'Ivoire shared the same tested markers (porA VR1=5, VR2=2, fetA=F1-1, penA=1, ST-11) (unpublished data). Eight other cases of W135 cases were also isolated in France during the same period but they reported no travel history during the previous 3 months. All these isolates also showed different markers (unpublished data).

Further investigations are required including typing isolates from other countries within the meningitis belt and comparing results with isolates from the previous years in order to help understanding this recent re-emergence of W135/ST-11 isolates. A long-lasting establishment of this serogroup in sub-Saharan African countries may prompt re-considering the vaccination strategies in the belt upon the introduction of the conjugate vaccine against serogroup A [6].

In the meantime, specific surveillance should be enhanced in Europe and recommendations for travellers who have contacts with population in high-incidence countries should be updated taking into account that non-pilgrimage-related travel is rarely associated with transmission and that the purposes of travel described above for the cases themselves or their asymptomatic contacts were visits to family members and friends or work for NGOs [7]. Since there are frequent travellers between France and West-African countries belonging to the meningitis belt, the French recommendations for travellers insist on the importance of vaccination with a quadrivalent A/C/Y/ W135 vaccine (preferably a conjugate vaccine) when travelling to these countries [8].

[For References, see the URL for this article above.]

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[2] African Meningitis Belt
Date: Thu 24 May 2012
Source: WHO Global Alert and Response (GAR) [edited]
http://www.who.int/csr/don/2012_05_24/en/index.html


From [1 Jan 2012 to 17 Apr 2012] (epidemiologic week 17), outbreaks of meningococcal disease have been reported in 42 districts in 10 of the 14 countries of the African Meningitis Belt [with enhanced surveillance for meningococcal disease, which includes Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, Cote d'Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Mali, Niger, Nigeria, Sudan and Togo]. These outbreaks have been detected as part of the enhanced surveillance.

The 10 countries (Benin, Burkina Faso, Chad, Central African Republic, Cote d'Ivoire, Gambia, Ghana, Mali, Nigeria and Sudan) reported a total of 11 647 meningitis cases including 960 deaths resulting in a case fatality ratio of 8.2 percent. The outbreaks were mainly caused by the W135 serogroup of _Neisseria meningitidis_ (Nm) bacteria.

In response to the outbreaks, the Ministries of Health implemented a series of preventive and control measures which included enhancement of surveillance, case management, sensitization of the population, strengthening of cross border collaboration and provision of vaccines through the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG).

The ICG released a total of 11 000 vials of antibiotic (Ceftriaxone) and 1 665 673 doses of vaccines to 6 countries [Table: Benin, Burkina Faso, Cote d'Ivoire, and Ghana, where Nm serogroup W135 is said to have caused the epidemic; and Chad and Sudan, where Nm serogroup A is said to have caused the epidemic] most affected by the epidemic, upon requests. The vaccines released include 919 023 doses of polysaccharide ACW/ACYW vaccine, 746 650 doses of meningitis A conjugate vaccine and 81 418 doses of polysaccharide AC vaccine.

The ICG is working with manufacturers and partners to ensure the stockpiles of the appropriate vaccines are maintained in sufficient quantities, for responding effectively to epidemics in the future. ICG partners include WHO, International Federation of Red Cross and Red Crescent Societies (IFRC), United Nations Children Fund (UNICEF), and Medecins Sans Frontieres (MSF).

The emergency stockpile was established with the support of Global Alliance for Vaccines and Immunization (GAVI). The vaccination campaigns were conducted with the support of MSF, UNICEF, IFRC, the European Community Humanitarian Aid Office (ECHO), and the United Nations through its Central Emergency Response Fund (CERF).

WHO continues to monitor the epidemiological situation closely, in collaboration with partners and Ministries of Health in the affected countries.

[For Table, see the URL for this article above.]

--
Communicated by:
ProMed-mail Rapporteur Marianne Hopp
<promed@promedmail.org>

[The sub-Saharan region of Africa is plagued yearly by large epidemics of meningococcal meningitis. This region, known as the "African Meningitis Belt," stretches from the east to the west coast of Africa, and includes Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, Cote d'Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Mali, Niger, Nigeria, Sudan and Togo (http://www.cdc.gov/ncidod/eid/vol9no10/03-0170.htm). The meningitis outbreaks occur in the dry season (December to June), and every 8-12 years large outbreaks occur (http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx). Attack rates during these cyclic epidemics of meningitis range from 100 to 800 per 100 000 population, but individual communities have reported rates as high as 1000 per 100 000 (World Health Organization: Meningococcal meningitis fact sheet: http://www.emro.who.int/sudan/pdf/FactS ... ngitis.pdf).

The following is extracted from the moderator's comments in ProMED-mail post Meningitis, meningococcal - Nigeria: (YO), susp. 20110524.1581:

"Epidemic thresholds are used to confirm the emergence of an epidemic in order to step up control measures, that is, mass vaccination and appropriate case management. For definitions of epidemic thresholds, see http://www.who.int/disasters/repo/6618.doc.

"To control an outbreak, WHO recommends mass vaccination with the appropriate meningococcal vaccine in every involved district in an attempt to induce herd immunity, whereby transmission is blocked when a critical percentage of the population has been vaccinated (see http://www.who.int/mediacentre/factsheets/fs141/en/). In 2009, meningococcal serogroups A and W135 were involved in outbreaks in Nigeria (see ProMED mail post Meningitis, meningococcal - Nigeria (03)20090509.1731). These serogroups cause meningitis that is potentially vaccine-preventable. However, in 2010, a new strain (serogroup X) of meningococcal meningitis emerged in Burkina Faso that led to huge outbreaks in that country, with 46 percent (6/13) of the regions in the country being at epidemic level. Serogroup X is one of those for which no vaccine exists. Niger, which borders the Yobe State of Nigeria, also experienced cases due to serogroup X in 2010 and experienced an epidemic of meningitis due to this strain in 2006 (see ProMED-mail post Meningitis, meningococcal - Africa (02): WHO meningitis region. 20100426.1343)."

There are at least 13 serogroups of _Neisseria meningitidis_ based on the antigenic specificity of their capsular polysaccharides; disease is most commonly due to serogroups A, B, C, Y, and W135. Capsular polysaccharide or protein conjugate vaccines are available to immunize against disease caused by serogroups A, C, W-135, and Y. Meningococcal polysaccharide vaccines will only protect against meningitis due to the meningococcal polysaccharide serogroups that the vaccine contains.

The meningococcal protein conjugate polysaccharide vaccines induce a T-cell-dependent response, resulting in an improved immune response in infants, provide long-lasting immunity, and prevent nasopharyngeal carriage of _N. meningitidis_, thus reducing transmission of this microorganism person-to-person (see http://www.nfid.org/pdf/publications/me ... alepid.pdf). A preventive strategy based on conjugate vaccines could have a significantly larger and more enduring impact on attempts to control the yearly recurrences of this disease in Africa that causes considerable morbidity and mortality, especially among children (see http://www.jidc.org/index.php/journal/a ... 745499/102).

There is no polysaccharide vaccine for disease caused by serogroup B. Because serogroup B polysaccharide resembles the human neural cell adhesion molecule, the serogroup B capsular polysaccharide is poorly immunogenic. A new protein-based, 4 component meningococcal serogroup B (4CMenB) vaccine has been developed that is hoped will be a broad-spectrum B vaccine (Cohn AC, Messonnier ME. Inching Toward a Serogroup B Meningococcal Vaccine for Infants. JAMA 2012;307(6):614-615.; and Stephens DS. Comment. Prevention of serogroup B meningococcal disease. Lancet 2012;379(9816):592-594).

A map of the African bacterial meningitis belt can be found at http://www.medic8.com/images/map4-9.gif. The HealthMap/ProMED-mail interactive map of this region is available at http://healthmap.org/r/1vef. - Mod.ML]

MENINGITIS, MENINGOCOCCAL - CHAD: (ENNEDI) VACCINE REACTION, REQUEST FOR INFORMATION
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Date: Mon 21 Jan 2013
Source: Medicalxpress [edited]
http://medicalxpress.com/news/2013-01-c ... -chad.html


"During the last phase of the vaccination campaign organised at Gouro (near the Libyan border) on 11 to 15 Dec 2012, unusual reactions were noted," Health Minister Mamouth Nahor NGawara told AFP.

The health ministry sent the children to 2 hospitals in the capital NDjamena and then flew 7 of them to Tunisia "for further exams and more specialised care," N'Gawara added, saying that "their state of health is not worrying." Some of the children began to moan shortly after receiving their meningitis shot and then went into convulsions, said a former lawmaker from Gouro, Ahmat Saleh Bodoumi. International experts have been in the country since 9 Jan 2013 to investigate, the health ministry said in a statement.

Meningitis outbreaks are frequent in the poor, landlocked Sahel country. "During the past 15 years, Chad has recorded more than 50 000 cases of meningitis with more than 5000 deaths," N'Gawara said.

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Communicated by:
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[Numerous cases of meningococcal meningitis are reported in the sub-Saharan African region known as the "meningitis belt" each year during the hot, dry season, between December and June
(http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx). A map of the African bacterial meningitis belt can be found at http://www.medic8.com/images/map4-9.gif. Chad is located in the middle of this "meningitis belt." Epidemics of meningitis in the African "meningitis belt" are mostly associated with the meningococcus. Mass immunization programs with meningococcal polysaccharide vaccine are recommended as a control measure in meningococcal outbreaks. Therefore, the adverse reactions, namely "seizures" in this case, after a "meningitis shot" reported above presumably occurred after receipt of a meningococcal polysaccharide vaccine, although this is not specified as such in the news release.

There are 2 kinds of meningococcal vaccine: 1) Meningococcal conjugate vaccine (MCV) and 2) Meningococcal polysaccharide vaccine (MPSV). Adverse events after meningococcal vaccination consist primarily of local reactions, such as redness or pain, at the site of administration in as many as half the people who get meningococcal vaccines, and occur more commonly after MCV than after MPSV (http://www.cdc.gov/vaccines/vac-gen/sid ... htm#mening). A small percentage of people who receive the vaccine develop a low-grade fever.

A more serious condition, Guillain Barre syndrome (GBS) occurring up to one month after vaccine administration has been reported after administration of quadrivalent MCV. As of 15 Feb 2008, the Vaccine Adverse Event Reporting System (VAERS) has received 26 confirmed case reports of GBS within 6 weeks of receipt of the quadrivalent MCV Menactra out of more than 15 million doses of this vaccine being given.

In some children, having a fever can bring on a seizure. Febrile seizures can occur when a child has a fever from any cause, be it an infection or a febrile reaction to a vaccination. Febrile seizures usually last a minute or 2. They are most common with fevers reaching 102 deg F (38.9 deg C) or higher but can also occur at lower temperatures or when a fever is going back down. About 2-5 percent of young children will have at least one febrile seizure. Most febrile seizures occur in children between the ages of 6 months and 5 years. Such events have been reported to occur at a very low level following vaccines, most notably following measles, mumps and rubella vaccine (MMR) and the whole cell pertussis, diphtheria, tetanus, (DTP) vaccine, which is no longer used in the United States.

Only one report of a seizure-like reaction after administration of a meningococcal vaccine could be found on a brief survey on the Internet (http://www.phac-aspc.gc.ca/publicat/ccd ... 1b-eng.php). In this report, the "seizure" occurred soon after receipt of meningococcal quadrivalent polysaccharide vaccine and was attributed to a "pseudoseizure conversion reaction."

Chad is a poor, landlocked country in central Africa. It is bordered by Libya to the north, Sudan to the east, the Central African Republic to the south, Cameroon and Nigeria to the south west, and Niger to the west. N'Djamena is the national capital of Chad. Gouro is a subprefecture in the Ennedi region (one of the 22 regions of Chad), located northeastern Chad (http://en.wikipedia.org/wiki/File:Chad_ ... 008-02.svg).

The HealthMap/ProMED-mail interactive map of Chad is available at http://healthmap.org/r/017X. - Mod.ML]

[The description of the event following the receipt of vaccine in the above newswire as "moan shortly after receiving their meningitis shot and then went into convulsions" is curious. As mentioned above, febrile seizures have been reported following receipt of vaccine, but the time frame tends to be within hours to 2 weeks following vaccination. More frequently, immediate type reactions to exposure to antigens tend to be allergic reactions, with the more serious presentation being an anaphylactic event. Other possibilities that might explain what occurred include the possibility of a contaminant introduced into the vaccine vial (locally or at the manufacturer) or the use of a different adjuvant or higher than usual concentration of adjuvant, which has been associated with an increased incidence of local as well as febrile reactions.

Of note, according to a WHO report, Chad and other African countries have recently been incorporating a new meningococcal A conjugate vaccine as part of their meningitis vaccination program activities. (available at: http://www.who.int/mediacentre/factsheets/fs141/en/)

ProMED-mail would greatly appreciate more information from knowledgeable sources on results of the investigations into the above mentioned vaccine associated adverse events, including information on the timeline from receipt of vaccine to event, as well as a description of the events that occurred and the numbers of affected children, ages of affected children and geographic locations of the events (all affected children were from same or different health facilities). In addition, more information on the actual vaccine used in the vaccination program (?conjugated) would be greatly appreciated. - Mod.MPP]

MENINGITIS, MENINGOCOCCAL - CHAD: (ENNEDI), VACCINE REACTION, NOT, OFFICIAL REPORT
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In this report:

[1] Chad - Ministry of Health statement: results of investigation

[2] Subscriber observations



******

[1] Chad - Ministry of Health statement: results of investigation

Date: 21 Jan 2013
Source: Ministry of Health Statement 21 Jan 2013 [edited]
http://www.meningvax.org/files/2ndstate ... an2013.pdf


2nd Statement - Ministry of Public Health - Chad - 21 Jan 2013
Republic of Chad
State Office
Ministry of Public Health
2nd Statement from the Government

2nd Statement
The independent international experts in charge of the in-depth investigation into the unusual reactions recorded during the vaccination campaign against meningitis between [11 and 15 Dec 2012] at Gouro (West-Ennedi) presented their preliminary findings on Friday [18 Jan 2013] at SEM. Their investigation was based on 4 axes:
- Analysis of available documents;
- Analysis of the organization of the vaccination campaign and vaccine quality;
- Interviews of the different parties involved;
- Medical examination of the 36 cases in the 2 hospitals in N'Djamena.

As a result from the different analyses, discussions among the team, and after meetings or contacting those implicated (or not implicated), in the event, the experts have come to the preliminary conclusions below:

Expert Findings:
The vaccination campaign organized in Gouro was conducted under normal conditions by staff who are experienced in implementing mass campaigns and routine vaccination programs.

The conditions of hospitalization, in particular the medical care at the psychological level, and the dialogue between the community and the health staff were insufficient.

The crises are triggered by noise, visits by foreigners, and the occurrence of crises among other patients.

Apart from these agitated periods, the children lead normal lives.

The patients are aged between 8 and 25 years, and with 77 percent of them being girls, i.e. 27 out of a total of 35.

A child that had not been vaccinated complains of similar symptoms.

All the different medical examinations performed on the patients were normal. The neurological examination on patients at the request of the experts also concluded that all was normal.

The same MenAfriVac vaccine lot 127M1033, used in Gouro, was used in the entire Ennedi region.

The expert reports from WHO on the vaccine lot at the level of the manufacturer Serum Institute of India (SII) showed no manufacturing defect.

The MenAfriVac vaccine, prequalified by WHO in 2010, has been subjected to all the required tests before being used. To date, more than 100 million people have been vaccinated in 10 countries (Burkina Faso, Mali, Niger, Cameroon, Nigeria, Ghana, Sudan, Senegal, Chad, and Benin). The vaccine will be further introduced in 16 African countries. Since the introduction of the vaccine, no case of meningitis "A" has been recorded in vaccinated individuals.

Expert Recommendations:
- Ensure the progressive but rapid return of the children to their families and a medical follow-up;
- Maintain a dialogue with the families and vaccination stakeholders and partners.
- Reinforce the medical structure at the local level through the addition of a doctor and a qualified nurse for a better health follow up in the populations and routine immunization activities.
- Reinforce the ability of the health staff in crisis communication and the management of rumors.

The experts wish to specifically state that analysis of the epidemiological, medical, clinical, and diagnostic tests data has not been able to establish a causal link between the clinical manifestations observed in the patients and the MenAfriVac vaccine.

The symptoms observed in patients are similar to those described in the literature under several names:
- Collective hysteria
- Collective obsessive behavior
- Mass psychogenic phenomenon

The independent experts thank the population and the authorities in Chad for their confidence. They request that the authorities be diligent in the implementation of the recommendations that will facilitate a return to a peaceful situation that will be to the benefit of the vaccination programs.

The full preliminary report has been submitted to the governmental authorities and will be finalized by the Health Service in Tunisia, where 7 of the 35 patients from N'Djamena were evacuated.

The Ministry of Public Health has worked in collaboration with the experts whilst guaranteeing the complete independence of the investigation. The Ministry welcomes the experts' conclusions in reassuring the patients, their families, and the general public of the health status of the evacuated patients from Gouro, the quality of the MenAfriVac vaccine, and the overall importance of vaccination.

N'Djamena, 21 Jan 2013
The Minister of Public Health
Dr Mamouth Nahor N'Gawara

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******
[2] Subscriber observations
Date: Wed 23 Jan 2013
From: Juan Bellido <bellido_jua@gva.es> [edited]


Subject: PRO/EDR> Meningitis, meningococcal - Chad: (EN) vaccine reaction, RFI

"The description of the event following the receipt of vaccine in the above newswire as 'moan shortly after receiving their meningitis shot and then went into convulsions' is curious."

This does not seem like an allergic reaction. It could be a convulsive syncope, not because of the content of the meningococcal vaccine but from the mere vaccination (as a result of the puncture, or because of fear of being stuck by the needle, who knows?). It sometimes happens, especially in adolescent girls. There is some risk of injury from falling when they suddenly lose consciousness.

--
Dr. Juan B Bellido-Blasco
Seccion de Epidemiologia
Centro de Salud Publica de Castellon
Avenida del Mar, 12
12003-Castellon (Spain)

[The above report in [1] contains the detailed findings of the thorough investigation of this event by a team of experts. All aspects of the vaccination activities, the vaccine and the procedures used were investigated and were found to be correct and appropriate. The conclusion that this event was an event involving mass hysteria was drawn on solid grounds after all other possibilities were eliminated. ProMED-mail has posted reports on outbreaks of mass hysteria in the past (see the list of "see alsos" below).

The description of the involved individuals gave an age range old enough to be influenced by events they were seeing, and the composition of the involved group was 77 percent female. The fact that all involved individuals were at the same location, combined with the observation that the same lot of vaccine was used elsewhere without adverse events, and the inclusion of one affected individual who had not received the vaccine all strongly support the conclusion that the event was most likely a mass hysteria event.

(Borrowing from a prior ProMED posting, Undiagnosed illness - Bangladesh (02):
mass hysteria 20070720.2327:)'In a prior ProMED-mail posting from 2002, when there was a multistate outbreak of rash illness (see Unexplained rash illness - USA (multistate) (06) 20020605.4409), a reporter in a New York Times article, Margaret Talbot, had the following background material: "Well-documented outbreaks of mass psychogenic illness do occur. Between 1973 and 1993, there were 70 reports of mass hysteria in medical journals; most took place in self-contained communities, like schools, barracks, and factories. Symptoms spread by "line of sight" -- people get sick as they see other people getting sick -- which is quite different from what happens with a viral illness. Adolescents and preadolescents are particularly susceptible, and girls are more likely to fall ill than boys. Girls' heightened susceptibility to mass psychogenic illness need not be seen as due to their more "hysterical" nature, but to their propensity to talk among themselves about their health. Additionally, women are more likely to seek medical attention, and presumably, therefore, to take note of their own symptoms, than men.'

There was a previous report of a mass hysteria event following vaccination with tetanus-diphtheria toxoid in Jordan in 2001. (see Kharabsheh S, Al-Otoum H, Clements J, Abbas A, Khuri-Bulos N, Belbesi A, Gaafar T, Dellepiane N. Mass psychogenic illness following tetanus-diphtheria toxoid vaccination in Jordan. Bull World Health Organ. 2001;79(8):764-70. Epub 2001 Oct 24. Available at: http://www.who.int/docstore/bulletin/pd ... 64-770.pdf.)

Abstract: "In September 1998, more than 800 young people in Jordan believed they had suffered from the side effects of tetanus-diphtheria toxoid vaccine administered at school; 122 of them were admitted to hospital. For the vast majority, their symptoms did not result from the vaccine but arose from mass psychogenic illness.

The role played by the media, the children's parents, and the medical profession in the escalation of this mass reaction appeared, at 1st sight, to be unusual and even unique to the circumstances in Jordan at the time. A review of the literature showed, however, that this mass reaction was similar in many ways to previous outbreaks, even though the underlying causes varied. There are about 200 published accounts of mass responses to situations involving suspected poisoning or other events. Because such mass reactions are relatively rare and the triggers so diverse, individuals faced with responding to them are unlikely to have prior experience in how to handle them and are unlikely to take bold steps to prevent their escalation. Indeed, they may be unaware that such events have been recorded before. The lessons learned from this incident in Jordan may help other immunization programme managers to handle crisis situations elsewhere."

For the HealthMap/ProMED-mail map of Chad, see http://healthmap.org/r/1CnT. - Mod.MPP]

Nigeria bekommt sein Meningitisproblem in den Griff und investiert nun 39 Millionen

Niger Government says it has spent N39 million to combat the outbreak of Cerebrospinal Meningitis (CSM) in the state. The State Commissioner for Health, Dr Mustapha Jibril, told newsmen on Friday in Mina that the state recorded 33 deaths out of its 123 CSM cases.

Jubril said that a total of 4,100 tablets of Ciprofloxacin were distributed to contacts of suspected cases in the affected areas, including health workers. According to the commissioner, represented by the Director of Public Health, Dr Muhammed Usman, 12 local government areas were affected by the epidemic.

The Guardian: Niger spends N39m to combat meningitis outbreak

Auch wenn hier von Niger die Rede ist, bezieht sich diese Meldung auf den Niger State in Nigeria. Das geht in der Presse manchmal unter.

Grüsse
Alexander