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An outbreak of meningococcal meningitis in Gauteng, Spring 1996
T M Balfour1, M E Edginton, H Koornhof
1Department of Community Health, University of the Witwatersrand, Johannesburg.
Objective:
To describe a Neisseria meningitidis outbreak in Gauteng during the period 1 July to 31 December 1996.
Design:
A descriptive study.
Setting:
Patients with meningococcal meningitis in Gauteng who had been diagnosed by laboratory means, or notified during the period 1 July to 31 December 1996.
Main Outcome Measures:
Data including age, sex, date of admission to hospital, N. meningitidis serogroup and outcome were collected from Gauteng notification lists, South African Institute of Medical Research (SAIMR) records, a linelist compiled by the Gauteng Health Department, and hospital records.
Results:
A total of 201 patients was studied; of this number 87 (43%) had been notified. Seventy per cent of cases were below 30 years of age and 78% were male. More than half (54%) of the cases were from the West Rand. The case fatality rate for 70 cases of known outcome was 14%. Serotyping of 85 isolates showed that a majority (76%) were serogroup A, with 57% being serogroup A clone I-1. Serogroup A clone III-1 accounted for 14% of the typed isolates. All isolates were sensitive to penicillin with minimum inhibitory concentrations of < 0.05 microgram/ml.
Conclusion:
In 1996 Gauteng experienced an epidemic of serogroup A meningococcal meningitis. The serotype that caused the majority of cases had been recorded in South Africa before, but serogroup A clone III-1, responsible for epidemics spreading across two continents, was recorded in South Africa for the first time. Notification of cases by health workers was inadequate in this epidemic.
Insights
Gauteng experienced a meningococcal meningitis epidemic in 1996, primarily caused by serogroup A. A new serogroup A clone, previously seen internationally, emerged, highlighting inadequate case notification.
Area of Science:
- Epidemiology
- Microbiology
- Public Health
Background:
- Gauteng, South Africa, experienced a significant outbreak of meningococcal meningitis in the latter half of 1996.
- Neisseria meningitidis outbreaks pose a substantial public health challenge, particularly in densely populated areas.
Purpose of the Study:
- To characterize the Neisseria meningitidis outbreak in Gauteng between July and December 1996.
- To identify the predominant serogroups and serotypes involved and assess the outbreak's epidemiological features.
Main Methods:
- A descriptive epidemiological study was conducted.
- Data were collected from laboratory-confirmed and notified cases of meningococcal meningitis in Gauteng.
- Information gathered included patient demographics, serogroup, serotype, and outcomes, utilizing notification lists, SAIMR records, and hospital data.
Main Results:
- A total of 201 patients were studied, with 43% notified. The majority of cases (70%) were under 30 years old, and 78% were male.
- Serogroup A was predominant (76% of isolates), with serotype A clone I-1 accounting for 57%. Serogroup A clone III-1, known for international spread, was identified for the first time in South Africa.
- The case fatality rate was 14% among 70 cases with known outcomes. All isolates were sensitive to penicillin.
Conclusions:
- The 1996 Gauteng outbreak was characterized by serogroup A Neisseria meningitidis.
- The emergence of serogroup A clone III-1 in South Africa is a significant finding, with implications for regional and international disease surveillance.
- Inadequate reporting of cases by healthcare workers was identified as a critical issue during this epidemic.