Upsurge in meningitis cases in Jirapa district, 2017, Upper West - Ghana

Introduction: Meningitis is the inflammation of the meninges. In the first eight (8) epidemiological weeks of 2017, Jirapa District, Upper West Region, Ghana recorded 41 suspected cases with six deaths and this had exceeded the alert threshold of 5 suspected cases per 100,000 population per week. We therefore conducted an epidemiological investigation, assessed surveillance and epidemic response and helped implement control measures. Methods: We conducted a descriptive study in Jirapa District 21st to 25th March, 2017. We reviewed patient records from January to March with clinicians, response and surveillance assessment and searched for cases. The case definition was any person living in Jirapa District and reporting with or without fever of acute onset with neck stiffness, poor sucking (in infants), bulging fontanelles (in infants), altered consciousness, other signs of meningeal irritation/inflammation from 1st January to 25th March, 2017. Descriptive analysis was performed and expressed as frequencies and proportions with Microsoft Excel, 2016. Results: Sixty-one cases were recorded, of which 10 were confirmed with seven deaths (CFR=70%). Most were female 32 (53.33%) and majority, 21 (34.4%) below age 10 years. Streptococcus pneumoniae was the causative organism in all the 10 samples. Although the number of reported meningitis cases and the CFR were high, the epidemic threshold of 10 suspected cases per 100,000 population per week was not crossed. There was an active surveillance and effective rapid response team in the district conducted health education and contact tracing when the number of cases were increasing. Conclusion: Jirapa District saw an increase in the number of reported meningitis cases in 2017. An active surveillance system and effective rapid response team in the district prevented a potential outbreak. Communities were educated on risk factors, preventive measures to reduce spread and the need for early reporting

The effect of malaria prevention and control interventions on malaria morbidity among children under 5 years and pregnant women in Kintampo North Municipality, Ghana

Background: Malaria prevention and control interventions have been scaled-up in the last decade in Ghana. We analysed the malaria surveillance data to assess the trends and the association between some malaria prevention interventions and malaria incidence in Kintampo North Municipality (KNM). Methods: We extracted data on malaria indicators and interventions from the District Health Information Management System 2 database for 2012–2016. Proportions and cumulative incidence of malaria episodes were computed using STATA 14 software. We performed correlation analysis between malaria interventions and malaria morbidity. We used linear regression models to determine the association between Long-Lasting Insecticide-treated Nets (LLINS) distribution, Intermittent Preventive Treatment in Pregnancy (IPTp) and episodes of malaria in children <5 years old and pregnant women. Results: A total of 280,890 episodes of malaria were recorded in the KNM from 2012–2016. Of the total malaria episodes, 64,953 (23.1%) were children <5 years and 57.5% (161,486/280,890) were females. The incidence of malaria in KNM declined from 650/1,000 population in 2012 to 444/1,000 population in 2016. The proportion of confirmed malaria increased from 35.2% in 2012 to 80.7% in 2015, and subsequently declined to 77.5% in 2016. The malaria Case Fatality Rate decreased by 65% in 2012 to 0.04% (16/37646) in 2016. Long Lasting Nets distribution to children showed a weak negative linear relationship with malaria morbidity in children <5 years (R= –0.20). IPTp1, IPTp2 showed a weak negative linear relationship with malaria morbidity in pregnancy, IPTp3 showed a weak positive linear relationship while IPTp4 and IPTp5 showed a negative moderate linear relationship with malaria morbidity in pregnancy. A unit increase in LLINs distribution to pregnant women was significantly associated with a reduction in malaria in pregnancy episodes by 0.21 (R2 = 0.19, 95% CI: -0.3 ─ -0.7). The IPTp first dose (IPTp1) coverage declined from 75.5% in 2012 to 69.0% in 2014, but rose to 80.9% in 2016. IPTp5 (fifth dose) increased from 0.7% in 2014 to 4.8% in 2016. A percentage increase in the coverage of only IPTp4 was associated with a reduction of malaria in pregnancy by two episodes (R2 = 0.34, 95% CI = ─ 1.68 – (─0.78). Conclusion: Malaria morbidity trend declined in the municipality. Increase coverage in LLINs and IPTp were associated with declines in malaria episodes in children <5years old and pregnancy women. Coverage of IPTp4 and IPTp5 were relatively low. Health staff should intensify promotion of the use of malaria prevention interventions among pregnant women and children < 5 years old. Midwives should promote uptake of optimal IPTp doses through health education and community antenatal outreach services

Molecular Characterization of Circulating Yellow Fever Viruses from Outbreak in Ghana, 2021–2022

Yellow fever virus, transmitted by infected Aedes spp. mosquitoes, causes an acute viral hemorrhagic disease. During October 2021–February 2022, a yellow fever outbreak in some communities in Ghana resulted in 70 confirmed cases with 35 deaths (case-fatality rate 50%). The outbreak started in a predominantly unvaccinated nomadic community in the Savannah region, from which 65% of the cases came. The molecular amplification methods we used for diagnosis produced full-length DNA sequences from 3 confirmed cases. Phylogenetic analysis characterized the 3 sequences within West Africa genotype II; strains shared a close homology with sequences from Cote d’Ivoire and Senegal. We deployed more sensitive advanced molecular diagnostic techniques, which enabled earlier detection, helped control spread, and improved case management. We urge increased efforts from health authorities to vaccinate vulnerable groups in difficult-to-access areas and to educate the population about potential risks for yellow fever infections