Dr Nimako: What to know about Meningitis & Yellow Fever - The Ghana Experience
Health news in Ghana over the past 2 weeks has been dominated by the outbreak of meningitis in the Brong-Ahafo Region and Yellow fever in the Northern Region. Both diseases are of high public health importance and we all need to understand them well, in order to be able to better protect ourselves and to allay unnecessary fear and panic.
Here is a briefing about the two diseases.
Meningitis simply means inflammation of the membranes covering the brain and spinal cord (the meninges). This inflammation is usually due to bacterial or viral infections, but may also result from parasitic infections and non-infectious agents like irritation from blood and cancer cells.
In the context of an outbreak, meningitis refers to a bacterial infection of the meninges.
There are many types of bacterial infections that can cause meningitis outbreaks: Neisseria meningitides, which is highly infectious is the major cause of outbreaks, but in adolescents Pneumococcus, which is not as infectious, is a common culprit, like we are seeing in the current outbreak. The term Cerebrospinal meningitis (CSM) is a term reserved for meningitis caused by Neisseria meningitides.
Meningitis is mainly transmitted through the inhalation of respiratory droplets (from e.g. sneezing or coughing) from an infected individual (NB: infected individuals do not necessarily show symptoms; some are silent carriers).
The classic triad of symptoms is fever, severe headache and neck stiffness. Other symptoms are nausea, vomiting and photophobia (intolerance of bright light). Seizures, irritability, confusion and coma may also occur. Complications like kidney failure and bleeding disorders may occur in severe cases. Survivors of severe disease may end up with permanent disability like blindness, hearing impairment and mental retardation.
Diagnosis is through the laboratory analysis of a sample of spinal fluid tapped from the lower back, a procedure referred to as a lumbar puncture.
Bacterial meningitis is fatal without treatment. A delay in initiating treatment worsens the prognosis. Treatment involves the administration of appropriate antibiotics and supportive therapy as necessary.
Vaccination is a potent way to prevent severe infections. The immunization schedule of children in Ghana include vaccination against some of the organisms that cause meningitis. Immunization drives are also organized periodically for vulnerable populations to ensure they are protected, as happened in 2012 in Northern Ghana. There are also vaccines that are deployed during outbreaks with particular strains of Neisseria meningitides to protect individuals in the outbreak zone; this current outbreak is not one such.
Prevention also involves avoiding crowded places, hand hygiene (washing hands regularly and using hand sanitizers) and covering the nose and mouth when coughing or sneezing.
Outbreaks of diseases may occur from time to time, but once we are aware of how to protect ourselves, such outbreaks should not cause much havoc. The ministry of health and its agencies are doing their best to contain the situation; let’s do our bit to stay safe.
Yellow fever is a viral infection of humans. It derives its name from the yellowing of skin and eyes (jaundice) that occurs late in the disease, when it causes liver damage.
It is transmitted through the bite of an infected female Aedes aegypti mosquito (in most cases), which is different from the Anopheles mosquito that causes Malaria.
In Ghana and other African countries, yellow fever typically occurs in epidemic form.
The outbreaks usually occur in urban settlements near forest areas, since the organism maintains its life in forest primates like monkeys. When an infected primate is bitten by a mosquito and that same mosquito bites man, an outbreak can occur, with the virus spreading from person to person through the bite of the female Aedes aegypti mosquito. This mosquito– unlike the malaria-causing Anopheles mosquito which bites at night– bites in the mornings and early evenings.
The initial (acute) symptoms are fever, chills, muscle aches, headaches, loss of appetite, nausea and vomiting. These symptoms are common to many other infections and this non-specificity in symptomatology makes disease difficult to diagnose in the early stages. This acute phase typically lasts a few days (about 4 days) and resolves spontaneously without complications. This is the case for most of the infections.
About 15 percent of cases will progress to a toxic phase where the virus affects the liver, causing liver damage and resultant jaundice and bleeding- from any orifice. This results in multiple organ failure in about 20% of such severe cases, eventually leading to death.
Treatment is purely supportive- that is, medical personnel manage the symptoms as they arise and allow the infection time to “blow over”. Such supportive therapy may include antipyretics for fever, fluids for dehydration, analgesics for bodily pains and blood transfusions as necessary. There is no cure and prevention is thus very important.
“Vaccination is the most important preventive measure against yellow fever. The vaccine is safe, affordable and highly effective, and a single dose of yellow fever vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease and a booster dose of yellow fever vaccine is not needed.” (WHO, March, 2014). The earliest age for vaccination is 9 months.
Survivors of the infection also have lifelong protection from the disease.
Preventing mosquito bites, by wearing protective clothing when outdoors in forest regions, using mosquito repellants and sleeping in insecticide-treated mosquito nets is also important in preventing infection in the non-vaccinated population.
By: K.T. Nimako (MB ChB)
Dr. Kojo Nimako is a private medical practitioner with an interest in public health, and Citi FM’s Chief Medical Correspondent. He is also the editor of healthbloggh.com and the Executive Director of Helping Hand Medical Outreach, an NGO focused on health education.
Follow on Twitter: @KTNimako
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