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Epidemiology and aetiology of the 2023 meningitis outbreak among children in Iraq
Zana B Najmadden1, Karzan R Sidiq2, Dana K Sabir2
1Research Centre, University of Halabja, Kurdistan Region, Iraq.
Background:
Meningitis is still a major public health challenge globally. Both the viral and bacterial forms of the disease have been reported worldwide. In 2023, around 200 children with suspected meningitis were admitted to hospital in Halabja Governorate, Iraq. No outbreak of meningitis had been reported previously in that region.
Aims:
To investigate the aetiology and epidemiology of meningitis among children in Halabja Governorate, Iraq, and expedite clinical management and prevention.
Methodology:
Blood and cerebrospinal fluid specimens were collected from 197 children admitted to Halabja Paediatric and Maternity Teaching Hospital from 1 March to 1 July 2023 and analysed. The sample t-test was used to compare the haematological, serological and biochemical characteristics of the samples.
Results:
The majority (76.6%) of the children were aged 2-9 years and 54% were males. The clinical manifestations of the disease were fever (100.0%), headache (89.0%), vomiting (85.7%), and photophobia (72.4%); none of the children had convulsions. The mean values for both neutrophil count and C-reactive protein were statistically significantly raised (P < 0.05) and the red blood cells, white blood cells and neutrophil counts, and lactate dehydrogenase values were statistically significantly raised (P < 0.05). The causative organism was enterovirus (98.5%), with sporadic cases of streptococcal meningitis (1.5%). All the patients recovered fully.
Conclusion:
The rapid diagnosis of the disease was crucial to the therapeutic and prevention control measures for the outbreak. Although it is still unclear how and where this outbreak started, contaminated drinking water and transmission among children in nurseries and schools are suspected. Further investigations are recommended to determine the source of the enterovirus and identify the virus species and serotypes.
Insights
A 2023 meningitis outbreak in Iraq primarily affected young children, with enterovirus identified as the main cause. Prompt diagnosis and treatment led to full recovery for all patients, highlighting the need for further source investigation.
Area of Science:
- Epidemiology
- Infectious Diseases
- Pediatrics
Background:
- Meningitis remains a significant global public health concern, affecting both viral and bacterial forms worldwide.
- In 2023, Halabja Governorate, Iraq, experienced an unprecedented meningitis outbreak, admitting approximately 200 children to the hospital.
- This event marked the first reported meningitis outbreak in the region.
Purpose of the Study:
- To investigate the specific causes (aetiology) and patterns (epidemiology) of meningitis in children within Halabja Governorate.
- To guide and expedite effective clinical management and prevention strategies for the ongoing outbreak.
Main Methods:
- Collected and analyzed blood and cerebrospinal fluid samples from 197 pediatric patients between March 1 and July 1, 2023.
- Utilized sample t-tests to compare hematological, serological, and biochemical characteristics of patient samples.
- Focused on children admitted to Halabja Paediatric and Maternity Teaching Hospital.
Main Results:
- The majority of affected children (76.6%) were between 2-9 years old, with males constituting 54%.
- Common clinical signs included fever (100%), headache (89%), vomiting (85.7%), and photophobia (72.4%); convulsions were absent.
- Enterovirus was identified as the causative agent in 98.5% of cases, with a small percentage (1.5%) attributed to streptococcal meningitis. Statistically significant elevations in neutrophil count, C-reactive protein, red blood cells, white blood cells, and lactate dehydrogenase were observed (P < 0.05).
Conclusions:
- Rapid diagnosis was critical for managing the outbreak and implementing control measures.
- Suspected sources of the enterovirus outbreak include contaminated drinking water and person-to-person transmission among children in educational settings.
- Further research is recommended to pinpoint the enterovirus source and identify specific viral species and serotypes.
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