International Reports of Meningitis

Updated: April 18, 2007

This year, as in past years, outbreaks of bacterial (meningococcal) meningitis are expected to occur in epidemic form in various countries. Sporadic meningococcal meningitis occurs throughout the world, including Canada. Temperate regions usually experience epidemics in the winter-spring period while tropical regions see increased disease activity during the dry season . The largest and most frequently recurring outbreaks have been in the semi-arid area of sub-Saharan Africa, designated as the A Meningitis Belt. This area extends from Senegal in the west to Ethiopia in the east; epidemics occur between December and June.

When meningococcal meningitis infection is diagnosed and treated early, antibiotics are effective in arresting the illness and reducing mortality rates. Both prophylactic antibiotics and vaccines are used to prevent transmission and curtail outbreaks.

There are 13 recognized serogroups (also referred to as strains) of the causative bacterium, Neisseria meningitidis. Groups A, B and C are the strains most commonly implicated in disease outbreaks. Vaccines have been developed for only four of the 13 strains. Meningococcal vaccines that are currently approved for use in Canada include a quadrivalent vaccine containing strains A, C, Y and W-135; a bivalent vaccine containing strains A and C; and three monovalent vaccines containing strain C only. There is no available vaccine for serogroup B. F or international travellers, the quadrivalent vaccine is generally recommended.

Serogroups B and C are the most frequent causes of sporadic cases and outbreaks of meningococcal disease in Europe and the Americas. Serogroup A still predominates in Africa and Asia. Serogroup Y is relatively uncommon; however, recent reports of endemic occurrences of serogroup Y meningococcal disease in the United States suggest that the virus is gaining importance. Serogroup W135 is increasingly associated with outbreaks of considerable size. In 2000 and 2001 several hundred pilgrims attending the Hajj in Mecca, Saudia Arabia were infected with N. meningitidis W135, importing the disease to their home countries upon return. Additionally, in 2002, W135 emerged in Burkina Faso, striking 13,000 people and killing 1,500.

For additional information on meningococcal meningitis including its prevention and treatment, visit the following Web pages from the Public Health Agency of Canada:

• Disease Information Backgrounder on Meningitis ;
• Committee to Advise on Tropical Medicine and Travel (CATMAT) Statement on Meningococcal Vaccination for Travellers

The Public Health Agency of Canada is aware of the following epidemic and outbreak meningitis activity as reported by the international sources indicated. This list is not necessarily complete. Travellers who visit areas where meningitis epidemics occur regularly should be aware that outbreaks can occur at any time. Travellers to these areas are advised to consult with their personal physician or a travel medicine clinic to determine their need for vaccination.

Country and Source of information	Date	Meningitis incidence
Burkina Faso -update [WHO]	17 April, 2007	From 1 January to 8 April 2007, the Ministry of Health of Burkina Faso reported 22 255 suspected cases including 1490 deaths (case-fatality rate, 7%). Thirty-four districts are currently over the epidemic threshold. Cerebrospinal fluid specimens from all affected areas have tested positive for Neisseria meningitidis serogroup A by latex test and/or culture.
Burkina Faso [WHO]	19 March, 2007	From 1 January to 11 March 2007, the Ministry of Health reported 7 333 suspected cases including 583 deaths (8%CFR) in the country. Twenty two district are currently above the epidemic threshold, including three district in Ouagadougou. Cerebrospinal fluid specimens from all affected areas have tested positive for Neisseria meningitidis serogroup A.
Sudan [WHO]	15 March 2007	From 1 January to 11 March 2007, the Ministry of Health of the Government of Southern Sudan reported 6 946 suspected cases of meningococcal disease including 430 deaths (6.19%CFR) in 9 out of 10 states of Southern Sudan. Due to delayed and irregular reporting these figures should be considered provisional. Cerebrospinal fluid specimens collected from 8 affected states between January 1 and February 10 have tested positive for Neisseria meningitidis serogroup A.
Democratic Republic of the Congo [WHO]	2 February, 2007	From 1 January to 31 January 2007, the Ministry of Health has reported 53 suspected cases including 6 deaths (11.3%CFR) in Adi health zone, Province Orientale, in the north-eastern part of the country, bordering Uganda. Two cerebrospinal fluid specimens have tested positive for Neisseria meningitidis serogroup A.
Uganda [WHO]	24 January, 2007	From 1 January to 21 January 2007, the Ministry of Health has reported 241 suspected cases including 16 deaths (6.6%CFR) in Arua/ Maracha-Terego, Koboko, and Yumbe districts, an area bordering South Sudan and the Democratic Republic of the Congo. The population in the affected districts consists of both refugees and nationals living in rural, densely populated settlements. Three cerebrospinal fluid specimens have tested positive for Neisseria meningitidis serogroup A.
Meningococcal disease in the African Meningitis Belt, epidemic season 2006 [WHO]	21 March 2006	For the WHO summary of meningitis activity in Africa during 2006 please click on the following link: http://www.who.int/
**CFR = Case Fatality Ratio