Serogroup Shift: Neisseria meningitis Out-break Investigation in Kano, Nigeria, 2017

Background: Neisseria meningitis is among the 10 top causes of death worldwide. Forecasting sero-group shift in Neisseria meningitis outbreak in most states in Nigeria was conducated without a proven explanatory model. We characterized the outbreak in Kano State; assessed their level of preparedness for the outbreak; and the relevant knowledge and practice of health workers in affected local government areas. Methods: We interviewed line-listed cases; emergency response committee members; and health care workers in affected districts. Cerebrospinal Fluid samples were collected from cases for laboratory confirmation. Data were analyzed using descriptive statistics, spot map and chi-square at 5% level of significance. Results: A total of 295 cases were line listed with a Case Fatality Rate of 8%. Children aged 5-14 years had the highest number (34.9%) of cases. Outbreak lasted from epidemiologic week 1 to 20, affecting 34 of 44 districts with varied attack rates, ranging from 0.3 per 100,000 population in Dambatta to 14.4 per 100,000 population in Fagge. ‘Latex particle agglutination test' was ‘sero-group C' positive for 17 of 51 samples collected. Mass vaccination was delayed until the 16th week of the outbreak. Most (62.5%) health workers had good knowledge concerning meningitis. However, only a few (27.1%) practice droplet precaution. There was no statistically significant association between level of knowledge of Health Workers and the practice of droplet precaution (OR: 1.99; 95% CI: 0.96-4.11; p-value: 0.06). Conclusion: The 2017 Neisseria meningitis outbreak affected most districts in Kano and majority of the cases were children. Regular evaluation of the national vaccine program and further research on the impact of mass vaccination on sero-group selection and meningococcal carriage are recommended.