Predicting Meningitis Risk in Africa

Transcription

1 International Conference on Secure and Sustainable Living: Social and Economic Benefits of Weather, Climate, and Water Services Predicting Meningitis Risk in Africa M. K. Konde, M.H. Djingarey, Thomson M.C, F.Ake, W. Perea, F.M. LaForce, D. Rogers Presentator: M. K. Konde MD, MPH, PHD Director of WHO-Multi Disease Surveillance Centre Ouagadougou, Burkina Faso Madrid March 2007

2 Content Background Objective of the Programme Conceptual framework Ecosystem & Factors related to Epidemic meningitis in the African belt What is ongoing What benefits from Meteorological & Hydrobiological Ways forward 2

3 Background During African countries faced a huge meningitis outbreak with more tan cases & deaths The WHO- (MDSC) in Ouagadougou Burkina with the support of Meningitis Vaccine Project (MVP) funded by Gates foundation has conducted a retrospective study for about 20 years in the African meningitis belt since One of the main outcomes was a risk approach determining health district towards the epidemic meningitis Benefits from weather, Climate and water services is important for health sector 3

4 Integrated Disease Surveillance and Response Strategy (IDSR) After the meningitis outbreak epidemic in Africa IDSR was adopted during the 48th WHO/AFRO Regional Committee meeting in 1998, Harare Vision: By 2008, all WHO/AFRO Member States would assess their national surveillance systems and would be capable of providing timely data in order to better: predict, detect and respond to epidemics, contribute to the reduction of the priority communicables diseases burden 4

5 Priority communicable diseases targeted by MDSC Environmental prone disease Onchocerciasis Meningitis Malaria Cholera and other diarrhoeal diseases Yellow Fever and other VHF Avian Flu Disease more link to Behaviour HIV/AIDS/STDs Tuberculosis 5

6 African Meningitis Belt Average annual rates per 100, Meningitis belt Kilometers N

7 Objective of the Programme WHO-MDSC in close collaboration with WMO-ACMAD and some institutions and partners propose to develop an early warning system for meningitis that utilizes GIS capabilities combined with weather and climate forecasts for the meningitis belt in West Africa. 7

8 Conceptual Framework A lot know factors but some unknown!!!! Environment Socio-Economic Factors (Poverty, crowding, Social patterns, Agricultural practi Climate (Temperature, Humidity, Dust, ) Host / Population Susceptible, loss of Immunity, Inter current Infections, Carriage Mobility, Hadj in Mecca Germ/Bacterium Nm A & New Strains W135, X ST 5, ST 7 8

9 Modelling Epidemic Risk Topography Humidity Dust Population density 9 (Molesworth et al. Emerg Infect Dis 2003;9:1287)

10 Strategic Questions orienting Decision Making through evidence base What are the drivers of Epidemics Meningitis? What starts an Epidemic? What is the role of environment and climate in the occurrence of Epidemic Meningitis? Are there means to forecast them for better decision making and epidemic response? 10

11 Ecosystem & Factors related to Meningitis Epidemic in the African Meningitis Belt 11

12 High Disease Burden 12

13 Every Year Epidemic response 13

14 Dust concentration 14

15 Temperature maximum, minimum Humidity relative, absolute 15

16 Rainfall 16

17 Agricultural practices Travel Social gatherings 17

18 Season and Meningococcal Epidemics 210 Cases (Greenwood et al. Lancet 1979; 73:557-62) Absolute humidity RAIN RAIN RAIN 0 40 Mean max temp (Greenwood WHO et Multi al. Lancet Disease 1979; Surveillance 73:557-62) Centre 18 HARMATTAN HARMATTAN HARMATTAN

19 What impact of Global warning on the climate & Heath? Kilimandjaro Snow! 19

20 What is ongoing 20

21 GIS - ARGOS as a tools for epidemic meningitis control Automated data collection (ARGOS) permits rapid mapping and dissemination of data (Experience from Niger) GIS - Healthmapper (WHO Global Atlas, MDSC GIS) 21

22 GIS/ARGOS as a tools for epidemic meningitis research Isabelle Jeanne CERMES, Niamey, Niger & Madeleine Thomson IRI, New York, USA 22

23 Epidemic (95-96 & 96-97) or non-epidemic years (97-98 & 98-99) Dust peak each year Time lag between dust peaks and meningitis incidence curve slope 23

24 Onchocerciasis Surveillance Results observed from Senegal Mali Niger Guinée Burkina faso Togo Benin Sierra Leone LEGEND > 0.5/1000 Bad Results = 0.5/1000 Mid Results < 0.5/1000 Good Results 24 Côte D Ivoire Ghana

25 CASES OF CEREBROSPINAL MENINGITIS IN BURKINA FASO BY WEEK FROM YEAR 1996 TO 2001 AS REPORTED TO AFRO (Source : M OH) 7000 Number of reported new cases Year 1996 Year 1997 Year 1998 Year 1999 Year 2000 Year Weeks 25

26 26 Comparative Weekly Meningitis Attack Rates, Burkina Faso and Niger, BF incid NE incid

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33 Carriage study Epidemic Meningitis W135 (CDC, WHO, MoH Burkina) Districts Dedougou (non-epidemic) & Yako (epidemic) Burkina Faso, mai % 25.0% 20.0% 15.0% 10.0% 5.0% % TOTAL Dedougou TOTAL Yako N meningitidis W135 N meningitidis A, C, W135, XYZW135

34 Repartition of etiological agents of meningitis identified from the countries under surveillance during the 2004 epidemic season Pneumo 31% Nmsps 3% Nm.W135 8% Hib 7% Nm.A 51% 35

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36 Etiological agents notified by country Week 1 to 26 en 2006 (N=1675 dont 361 NmX) 13% 6% 2% Strain Bank in MDSC for the Meningitis Belt 4% 51% 22% 2% Meningo A Pneumo Meningo W135 Hib Meningo X Other germs Other meningo 37

37 MDSC feedback bulletins 38

38 What benefits from Meteorological & Hydrobiological opportunities and information 39

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42 Ways Forward Advances in GIS capability and the availability of key social, economic and health data at the district level combined with forecast and analysis data derived from global model products will provide frequently updated risk maps for the meningitis belt. The similar tool can be used to provide risk assessment for other disease like Avian Flu epidemics, Malaria Assess Vaccine impact (Meningitis Vaccine Project- MVP) 43

43 Socio-Economic Study impact of the Epidemic Meningitis in the 2 countries (Burkina, Niger) in the meningitis belt on the: Health sector Agricultural sector Transport and tourism Trade Hadj to mecca 44

44 Data collection & Analysis Data Scale in space Scale in time Tools Epidemiological Districts Weekly data IDSR line list Microbiological Health centers/ Dictricts Weekly collection Lab line Molecular surveilance (PCR) Meteo maps (Dust, Temp, Humidity) MDSC & WHO Collaborative centers (Oslo NIPH, Marseille PHARO, CDC) Monitoring during epidemic season Pixel : 5 km Weekly Meteo Field tool 45

45 New Initiative WHO-MVP Stop meningitis epidemics in Africa By New Men A conjugate vaccine (0.40 USD) 46

46 47 Thanks for your attention!