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Control of epidemic group A meningococcal meningitis in Nepal
Abstract:
During the first six months of 1983, an epidemic of serogroup A meningococcal meningitis occurred in the Kathmandu valley of Nepal, resulting in 875 cases and 95 deaths. The annual attack rate was 103 cases per 100,000 population, with a peak attack rate occurring in April. Epidemic meningococcal disease had not been recognized previously in Nepal. Early in 1984, a review of hospital-based data on pyogenic meningitis in Kathmandu showed three times as many cases per month compared with the same period the previous year, suggesting that a recurrent epidemic was unfolding. Beginning in February 1984, a vaccination campaign directed at a high-risk target population of people aged 1-24 years was launched; over 329,000 doses of bivalent A/C meningococcal vaccine were given, achieving approximately 64% coverage of the target population. A dramatic decline in the number of new meningitis cases occurred coincident with the initiation of the mass vaccination campaign. This experience demonstrates that it is possible, with appropriate surveillance efforts, to detect an evolving epidemic of meningococcal disease early in its course and to institute control measures in advance of the expected epidemic peak.
Insights
An epidemic of meningococcal meningitis in Nepal was detected early through surveillance. A vaccination campaign significantly reduced cases, demonstrating effective control of the disease outbreak.
Area of Science:
- Epidemiology
- Infectious Disease Control
- Public Health
Background:
- An epidemic of serogroup A meningococcal meningitis occurred in Nepal's Kathmandu valley in 1983, with 875 cases and 95 deaths.
- This marked the first recognized epidemic of meningococcal disease in Nepal, with an annual attack rate of 103 per 100,000.
- Early 1984 data indicated a recurrent epidemic, with monthly pyogenic meningitis cases tripling compared to the previous year.
Purpose of the Study:
- To report on the 1983-1984 meningococcal meningitis epidemic in Nepal.
- To evaluate the effectiveness of a mass vaccination campaign in controlling the epidemic.
Main Methods:
- Surveillance of meningococcal meningitis cases in Kathmandu valley.
- Review of hospital-based pyogenic meningitis data.
- Implementation of a mass vaccination campaign using bivalent A/C meningococcal vaccine for individuals aged 1-24 years.
Main Results:
- A dramatic decline in new meningitis cases was observed following the initiation of the vaccination campaign.
- The vaccination campaign achieved approximately 64% coverage of the target population (over 329,000 doses administered).
- The intervention demonstrated successful control of the unfolding epidemic.
Conclusions:
- Early detection of evolving meningococcal disease epidemics is possible with surveillance.
- Mass vaccination campaigns can effectively control meningococcal disease outbreaks.
- Proactive public health interventions are crucial for managing epidemic infectious diseases.