Juba, 28 November 2018 – To establish optimal in-country capacities to detect, investigate, test, confirm and respond to meningitis cases in South Sudan, the Ministry of Health (MoH)  with support from WHO conducted a training of trainers workshop involving over 60 Expanded Program on Immunization (EPI) managers, state surveillance officers, and state laboratory focal points from 26 to 28 November 2018 in Juba.

The objective of the training was to enhance their knowledge and skills on meningitis surveillance; treatment, care and vaccination; sample collection, processing, transportation, rapid diagnostic testing; microbiological culturing and antimicrobial susceptibility testing, and the use of molecular techniques to confirm meningitis.

Meningitis is an inflammation of the meninges, the covering of the brain and spinal cord. Those infected by the disease can die within 24 to 48 hours if not detected and managed after symptoms have developed and the disease may cause brain damage, learning and other disabilities among those patients who survive.  

Epidemic meningitis commonly occurs in the African meningitis belt during the dry months of the year. Prior to the introduction of preventive campaigns using the conjugate MenAfriVac A vaccine in 2010, Neisseria Meningitidis serogroup A accounted for most of the epidemic meningitis cases. This trend has now changed with Streptococcus pneumoniae, Neisseria meningitidis serogroup C, W135, and X are the common causes of epidemic meningitis in the African meningitis belt.

South Sudan lies in the African meningitis belt, alongside twenty- five other countries in sub-Saharan Africa. The belt stretches from Senegal in West Africa to Ethiopia in East Africa. These countries are prone to meningitis epidemics that have taken a devastating toll on younger populations for over a century.

The country has experienced meningococcal meningitis outbreaks in 2006, 2007, 2009, and 2013. In 2007, South Sudan was only second to Burkina Faso with over 12 000 cases and 600 deaths among the countries in the African meningitis belt that reported outbreaks.

The most recent major outbreak in South Sudan occurred in 2013 in Malakal County. During the outbreak, Neisseria meningitidis serogroup A was confirmed with at least 196 cases including 13 deaths (case fatality rate of 6.6%). As part of the response, an estimated 123 520 people, covering 80 percent of the target population of people between two and 30 years of age were vaccinated during the mass reactive campaign.

In his opening remarks, Dr Lul Deng Lojok, the Director General at the National Public Health Laboratory noted that the Ministry of Health has adopted a comprehensive strategy that includes enhanced surveillance, case management, and vaccination to mitigate the risk of future outbreaks in South Sudan. 

Hence in March 2016, South Sudan launched the first round MenAfrivac preventive immunization campaigns targeting individuals one to 29 years of age in Central Equatoria, Eastern Equatoria, Warrap, Western Bahr el Ghazal, Northern Bahr el Ghazal, and Lakes states. During the campaign, out of the 4 372 695 individuals aged 1-29 years that were targeted, a total of 4 023 659 individuals (92%) were reached with MenAfriVac vaccine. However, due to insecurity, the coverage during the second round is less than 70% and 11 counties have not been reached.

Comprehensive meningitis preparedness and response planning is critical for steady progress towards meningitis control and elimination, said Dr Wamala Joseph, WHO Country Preparedness and IHR Officer who represented Dr Olushayo Olu, the WHO Representative for South Sudan. The training is part of the concerted efforts of the Ministry of Health, WHO and partners to defeat meningitis by 2030.

“We appreciate the technical support from the WHO Inter-country Support Team for West Africa (IST/WA); the WHO Regional Office for Africa, Brazzaville; and the support from our partners especially the Global Alliance for Vaccines and Immunizations (GAVI) and the Medical Research Council (MRC),” says Dr Wamala.

In order to eliminate meningitis by 2030, the World Health Organization (WHO) recommends prevention and epidemic control; diagnosis and treatment; disease surveillance; advocacy and information; and aftercare support for survivors.