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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 folderC. Republic of Chad
View the document1. Background
Open this folder and view contents2. Referral and Epidemiological Surveillance Systems
View the document3. Emergency Mechanisms in Chad
View the document4. Meningitis Epidemic Plan
View the document5. 1988 Meningitis Epidemic in N'Djamena
Open this folder and view contents6. Comments
View the document7. Data Collected

5. 1988 Meningitis Epidemic in N'Djamena

The epidemic started in N'Djamena in February 1988. The Central Hospital is the major hospital of N'Djamena and it received almost all the patients of the city. The patients went essentially to the emergency ward of this hospital. It is probably because of the role of the Central Hospital, that the delay between the occurrence of the first cases and the time the epidemic had been declared was so short.

In January 1988, 21 cases had been reported. At the end of the second week of February the number increased drastically. All the cases were coming from N'Djamena city and surrounding villages north of the city. On February 22, the alarm was given by the Emergency Ward of the Central Hospital.

On February 27, the CASU met for the first time. That day, 116 cases and 13 deaths had been reported in N'Djamena since the beginning of the month and 96 for the last week of February. During this first meeting the following measures were taken:

a. Evaluation of Resources:

Stocks on February 27 were:

- vaccines1: 0
- chloramphenicol (vials): 663

1all the stocks available in MOH have already been given to the Central Hospital and utilized.

Human Resources:

- 27 Medical Doctors in the Central Hospital

b. Evaluation of needs, resources and requests made to the present donor agencies according to actions to be taken (see table in annex 6)

c. Formulation of recommendations:

- creation of a Crisis Committee to coordinate and follow-up the situation. This committee met every day.

- treatment standardization based on oily Chloramphenicol (OCEAC protocol)

- vaccination of high risk groups in N'Djamena: school children, military, health personnel and prisonners.

- decentralisation of treatment facilities: opening of three additonnal treatment centres disseminated in different parts of the city

- information messages to the population: message broadcast on radio on February 29. The information content concerned the disease and the opening of the additionnal centres for treatment

- prohibition of mass meetings: this measure was impossible to apply effectively.

Two of these measures require further comments:

- Decentralisation of treatment facilities

This measure was taken in order to avoid saturation of the Central Hospital capacities. On March 1, the three centres were operational. Actually few patients went to these peripheral centres. The major reason was the lack of facilities offered in the centres. These centres were open during normal day time working hours, and provided ambulatory treatment only. No doctor attended these temporary health centres. The population realised quickly that the severe cases were referred to the hospital and hence, preferred to go directly there.

- Vaccination campaign

This first vaccination campaign was targetted on high risk groups in the entire city of N'Djamena. The campaign started on February 5 and it took 11 days to vaccinate 119500 high risk persons and 37000 non targetted persons.

Due to the panic, this targetted campaign led to some acts of violence from the population against the vaccinators.

After this campaign, the number of cases dropped to 50 per day but soon this number increased up to 100 cases per day.

- On March 2.2, the CASU met for the second time. At this time, 1344 cases and 95 deaths had been reported since January (1245 for the last 30 days). Only 11% of the cases had been treated in a peripheral centre.

The conclusions of the committee were the following:

- the measures to prohibit mass meetings need to be reinforced

- tents need to be added at the hospital

- mass campaign vaccination is too expensive and the situation will be reevaluated one week later


- On March 30, the CASU met again. Facing the failure of the first vaccination campaign and of the other measures taken, the situation and needs were reevaluated. In N'Djamena, 2115 cases and 175 deaths had been reported.

Needs and donors were identified as shown in annex 7.

- A mass vaccination was decided and planned with the assistance of Bioforce.

- 35 medical doctors were working in N'Djamena Central Hospital.

ORGANISATION OF THE MASS VACCINATION CAMPAIGN.

The team from Bioforce arrived on April 3 and organised the campaign.

Number of centres:

13 scattered throughout the city


1 at the airport

Coordination:

Medicine Preventive

Supervisor:

one in each “arrondissement” (5)

Vaccines stockage:

in EPI


in Farcha (cattle breeding station)

Target population:

all the persons more than 1 year old and not


yet vaccinated

Resources and needs:

attached in annex 7

Information:

radio broadcasted message


megaphone

The vaccination campaign started on April 8 and ended on April 14. In 7 days, 262738 people were vaccinated.

Since the beginning of the epidemic, 419238 vaccines had been distributed in N'Djamena.

A survey performed by Bioforce a few days after the end of the vaccination campaign, estimated that 95 % of the population was covered.

The number of cases dropped immediately following this campaign. On April 15, 57 cases were reported, and 27 on April 30.

During the third week of May, 16 cases were reported.

Between January 1 and May 31, 4572 CSM cases and 433 deaths were reported in N'Djamena. Amongst these cases, 379 cases (8,39%) only have been treated in the peripheral centres.

TABLE IV: SUMMARY OF ASSISTANCE RECEIVED DURING THE EPIDEMIC

TYPE

QUANTITY

ORIGIN (date reception)

Chloramphenicol (vials)

5000

WVI


5000

Swiss Cooperation


40000

FAC


10000

EEC


1000

UNICEF


23000

USAID

Extencilline (vials)

10000

USAID

Corticosteroids (vials)

2000

Swiss Cooperation

Ampicilline (vials)

5000

UNICEF

Ringer sol.

1000

Swiss Cooperation

Medical gowns

1000

USAID

Gauzes (boxes)

18

USAID

Syringes-needles

10000

UNICEF

Tents

20

ICRC

Vaccines

300000

FAC


250000

EEC


100000

WHO


80000

KOWEIT


2000000

SAUDI ARABIA (May)

Fridges

30

SAUDI ARABIA (May)

Iceboxes

124

SAUDI ARABIA (May)

Shelters


Swiss Cooperation

Soap/desinfectants


Swiss Cooperation

Cars:




donation

6

SAUDI ARABIA (May)


loan


UNICEF



SECADEV



Swiss Cooperation



FAC



EEC

Fuel


UNICEF



FAC

Refreshments vacc. camp.


FAC

Repairing of Generator


OXFAM