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Published on: May 19, 2020
Atmospheric Dust, Early Cases, and Localized Meningitis Epidemics in the African Meningitis Belt: An Analysis Using
Maxime Woringer1, Nadège Martiny2, Souleymane Porgho3
11 École Normale Supérieure (ENS) , Paris, France.
Background:
Bacterial meningitis causes a high burden of disease in the African meningitis belt, with regular seasonal hyperendemicity and sporadic short, but intense, localized epidemics during the late dry season occurring at a small spatial scale [i.e., below the district level, in individual health centers (HCs)]. In addition, epidemic waves with larger geographic extent occur every 7-10 y. Although atmospheric dust load is thought to be an essential factor for hyperendemicity, its role for localized epidemics remains hypothetic.
Objectives:
Our goal was to evaluate the association of localized meningitis epidemics in HC catchment areas with the dust load and the occurrence of cases in the same population early in the dry season.
Methods:
We compiled weekly reported cases of suspected bacterial meningitis at the HC resolution for 14 districts of Burkina Faso for the period 2004-2014. Using logistic regression, we evaluated the association of epidemic HC-weeks with atmospheric dust [approximated by the aerosol optical thickness (AOT) satellite product] and with the observation of early meningitis cases during October-December.
Results:
Although AOT was strongly associated with epidemic HC-weeks in crude analyses across all HC-weeks during the meningitis season [odds ratio (OR) [Formula: see text]; 95% CI: 4.90, 9.50], the association was no longer apparent when controlling for calendar week (OR [Formula: see text]; 95% CI: 0.60, 1.50). The number of early meningitis cases reported during October-December was associated with epidemic HC-weeks in the same HC catchment area during January-May of the following year (OR for each additional early case [Formula: see text]; 95% CI: 1.06, 1.21).
Conclusions:
Spatial variations of atmospheric dust load do not seem to be a factor in the occurrence of localized meningitis epidemics, and the factor triggering them remains to be identified. The pathophysiological mechanism linking early cases to localized epidemics is not understood, but their occurrence and number of early cases could be an indicator for epidemic risk. https://doi.org/10.1289/EHP2752.
Insights
Localized bacterial meningitis epidemics in Africa are not linked to atmospheric dust. Early season meningitis cases, however, may predict future localized epidemics, suggesting a potential early warning indicator.
Area of Science:
- Epidemiology
- Environmental Health
- Infectious Disease Dynamics
Background:
- Bacterial meningitis poses a significant health burden in the African meningitis belt, characterized by seasonal hyperendemicity and localized epidemics.
- While atmospheric dust is linked to hyperendemicity, its role in triggering localized epidemics remains unclear.
- Epidemics occur at small spatial scales (health center catchment areas) and larger waves every 7-10 years.
Purpose of the Study:
- To investigate the association between localized meningitis epidemics and atmospheric dust load.
- To evaluate the correlation between early season meningitis cases and subsequent epidemic occurrence within health center catchment areas.
Main Methods:
- Weekly suspected bacterial meningitis cases were collected at the health center (HC) resolution in Burkina Faso (2004-2014).
- Logistic regression analysis was used to assess the association of epidemic HC-weeks with atmospheric dust (aerosol optical thickness - AOT) and early season case counts (October-December).
Main Results:
- Atmospheric dust load (AOT) showed a strong association with epidemic HC-weeks in crude analyses, but this link disappeared when controlling for calendar week.
- The number of early meningitis cases reported between October and December was significantly associated with epidemic HC-weeks in the following January-May period (OR per additional early case: 1.13; 95% CI: 1.06, 1.21).
Conclusions:
- Spatial variations in atmospheric dust load do not appear to be a trigger for localized meningitis epidemics.
- The number of early season cases may serve as a predictive indicator for localized epidemic risk, though the underlying mechanism requires further investigation.
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