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close this bookCerebrospinal Meningitis Epidemics and Surveillance Systems in the Sudan, Ethiopia and Chad (Centre for Research on the Epidemiology of Disasters, 1990, 40 p.)
close this folderII. COUNTRY REPORTS
close this folderA. REPUBLIC OF THE SUDAN
View the document1. Background
Open this folder and view contents2. Referral and Surveillance Health Systems
View the document3. Meningitis Epidemics Control Plan
View the document4. 1988 Cerebrospinal Meningococcal Meningitis Epidemic in Khartoum
Open this folder and view contents5. Comments
View the document6. Data Collection

4. 1988 Cerebrospinal Meningococcal Meningitis Epidemic in Khartoum

At the beginning of 1988, the Sudan experienced a major CSM outbreak with a total number of 32016 reported cases and 2067 reported deaths. The Central and Khartoum regions, followed by Kordofan, Darfur and Eastern Region were the most affected areas. Khartoum is responsible for a third of the total number of cases. The epidemic began in the outskirts of Khartoum and rapidly spread in the three cities of Khartoum, Khartoum North and Omdurman.

MANAGEMENT OF THE EPIDEMIC

The first cases occurred in January 1988 but according to the data available in MOH only one case had been reported by the end of the month. At the beginning of February, the number increased sharply and 23 cases had been reported to the MOH by the end of the second week of the month.

On February 16, the emergency system was alerted and warning messages were sent to the other regions.

After that, data were collected daily and compiled weekly within the central epidemiology unit.

The data underestimated the real number of cases as shown in a survey1 conducted in the 3 major hospitals. According to this survey, a number of 106 cases had occurred on February 16.

1Christophe Paquet; Epide de Mngite Khartoum. Fier-mars 1988 Rapport d'Evaluation; Epicentre Paris

The weekly reported number of cases multiplied by three per week until a peak was reached around the sixth week of the epidemic when 1519 cases had reported in Khartoum region.

- Sensitivity and Serotype

On March 15, all of the 52 samples had been analysed in the central laboratory of Khartoum showing N. meningitidis Group A.

All of them were sensitive to Sulfadiazine, Crystalline Penicilline, Ampicilline and Chloramphenicol.

A survey conducted in May 1988 showed resistance to Sulfadiazine.1

1Report of cerebrospinal Meningitis Survey. Khartoum, Sudan. May 1988. MOH, Department of epidemiology. EMRO, NAMRU - 3

- Treatment

In 1988, the MOH did not distribute any recommended guidelines for the treatment of the cases. The most common drug regimen at the beginning of the epidemic consisted of a combination of Sulfonamides +

Crystalline Peni + ampicilline. Oily Chloramphenicol was not utilised.

Chimioprophylactic treatment of close contacts was not applied.

- General Measures

In the beginning of March, the schools were closed as well as the cinemas and the stadium.

Messages to inform the populations were broadcast on radio and TV and published in the newspapers.

- Immunizations

One million doses were used in Khartoum during the 1987 CSM vaccination campaign. It means that more than one fifth of the population was protected at the beginning of this epidemic.

During this 1988 epidemic, a mass vaccination campaign was organised.

The mass vaccination campaign with A polyvalent A & C meningococcal polysaccharide vaccine started on February 20, 1988 in Khartoum. 80 immunization centres were used:

- 14 mobile teams
- 18 centres equipped with pedojets
- 49 centres using classical syringes or one centre for 625001 persons

1the estimate population in Khartoum including displaced population is 5 millions

This structure relied on the 60 existing EPI centres of the capital city. The activities of the mobile teams were burdened by logistic constraints such as the lack of vehicles (1 vehicle for 14 teams).

The campaign began relatively early but slowly. By the beginning of March, 100.000 immunizations had been performed in Khartoum. During the following days 60 to 80,0000 persons were vaccinated each day.

A total of 3,4 million doses of vaccines had been used in Khartoum by the end of March.

In the areas where the displaced population was settled, the coverage was much lower than in the general population due to the logistic constraints: lack of mobility of the mobile teams and the absence of health infrastructure or EPI centres in these sectors.

All persons over two years old were vaccinated.

The population was informed of the immunization campaigns through the media.

No vaccination cards were distributed to the patients.

Vaccination campaigns were implemented in other regions and by the end of July 1988, 11.6 million doses distributed.

- Stocks of vaccines and drugs

On February 1, 1988 the Central Medical Store had in stock:

CSM Vaccines

862500

doses

Crystalline Penicilline

355200

vials

Ampicilline caps.

4508000

caps

Ampicilline inj.

452140

vials

Ampicilline syrup

94840

bott

Chloramphenicol cap.

149000

caps

Chloramphenicol inj.

19850

vials

Chloramphenicol syrup

28135

bott.

- International Assistance received:

Requests for international assistance were not sent before March 1. The number of reported cases during that week was 229 in Khartoum or almost 10 times more than the number of cases reported during the second week of February. Since the beginning of the epidemic 337 cases had been reported.

TABLE I: Assistance requested:

DATE

DESTINATION

TYPE

AMOUNT

1/3




15/3

MERIEUX

Technical collaboration

21/3

WHO

Antisera for serotype & sensensitivity tests

kg 1,5

22/3

UNICEF

Vaccines

5000000



Crystalline Peni




Chloramphenicol


30/3

MERIEUX

Vaccines

needs: 6 millions

TABLE II: Assistance received:

DATE

ORIGIN

TYPE

AMOUNT (doses)

2/3

EMRO

Vaccines

500000



Rifampicine

1000

11/3

EMRO

Diagnosis mat


15/3

EMRO

Vaccines

187500

15/3

MERIEUX

Vaccines

500000

17/3

Saudi Arabia

Vaccines

500000

February ?

UNICEF

Vaccines

500000