Two Clusters of Meningococcal Meningitis in Bunyangabu District, Uganda: October, 2017

Background: On 13 November 2017, the Uganda Ministry of Health through the Public Health Emergency Operations Centre was notified of an unknown illness that caused sudden deaths of 3 children in Bunyangabu District. The case-patients presented with fever, convulsions, loss of consciousness and neck stiffness. We investigated to establish the cause, scope of outbreak and recommend preventive measures. Methods: We defined a suspected case as onset of fever, neck stiffness and any of the following: convulsions, loss of consciousness, headache, vomiting, nausea in a resident of Kabonero or Kateebwa sub-counties, Bunyangabu District from 1 September to 30 November 2017. We reviewed medical records and conducted active case finding in affected communities. We analyzed case data by person, place and time and assessed vaccination status of the case-patients. A cerebro spinal fluid (CSF) sample from one case-patient for laboratory analysis was collected and tested using standard gram staining procedure. Results: Between 1 September and 30 October 2017, 5 cases with 3 deaths (case fatality rate = 60%) occurred in Bunyangabu District. The mean age of case-patients was 4 years. Two sub-counties of Kabonero and Kateebwa were affected. Of the 5 case-patients, one (20%) had laboratory confirmation of meningococcal meningitis. One (20%) had proof of full vaccination with Pneumococcal Conjugate Vaccine, one (20%) was partially vaccinated and three (60%) had not received any vaccination. Conclusion: These were two unrelated clusters of meningococcal meningitis outbreak caused by Neisseria meningitides. We recommended that the Ministry of Health extends vaccination to susceptible sub-populations in districts outside the meningitis belt.