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Optimising Diagnostic Capacity for Cerebrospinal Meningitis through BLoTIMA Study

Cerebrospinal Meningitis (CSM) is one of the priority epidemic-prone diseases under the National Integrated Disease Surveillance and Response Strategy that is reported all year round in Nigeria. Despite its endemicity, CSM has predilection for dry season with peak between January and May. It is characterised by acute severe infection of the central nervous system causing inflammation of the meninges with associated morbidity and mortality. Highest burden occurs in the part of sub-Saharan Africa known as the “Meningitis Belt”. In Nigeria, the belt covers all the 19 northern states and the Federal Capital Territory (FCT).

In 2020, Nigeria recorded a total of 603 cases and 13 deaths reported from 138 Local Government Areas in 30 States of the Federation. Despite this burden, the problem of under-reporting due to low cerebrospinal fluid (CSF) collection rate still remains. This can be as low as less than 10% during outbreak. To address this, the Nigeria Centre for Disease Control (NCDC) with the support of relevant development partners is working with states to conduct a pilot study to specifically determine the prevalence of bacteraemia by quantitative polymerase chain reaction (qPCR) among suspected cases.

The study aims to develop approaches that can increase diagnostic yield of confirmed meningitis and to allow for easy detection of outbreaks with great rapidity to hasten reactive vaccination campaign. The specific objectives are to:

• Determine whether and by how much inclusion of blood testing in addition to CSF testing increases case ascertainment of meningococcal disease over case ascertainment by CSF testing alone

• Investigate if inclusion of blood testing will reduce the time between the onset of an outbreak and the activation of reactive vaccination campaign

• Evaluate the utility of dried blood and dried CSF specimen in Nigeria

To achieve the above objectives, the NCDC, with the support of partners, from April 12-16 2021 conducted a residential workshop for states’ actors on Blood Testing to Enhance Case Ascertainment during Meningococcal Meningitis Outbreaks in the African Meningitis Belt (BLoTIMA). A total of 27 personnel were trained (Clinicians, Biomedical Scientists, Laboratory Scientists and Disease Surveillance and Notification Officers (DSNOs)) in the five selected states- Sokoto, Zamfara, Katsina, Kebbi, and Niger.

The workshop provided an opportunity to strengthen the capacity of the states’ focal persons on CSM diagnosis using qPCR, CSM case management as well as data collection and management using Surveillance Outbreak Response Management and Analysis System (SORMAS) tool. This will promote early detection of CSMoutbreaks for appropriate public health responses.

We remain grateful to our partners- University College London, World Health Organisation and Public Health England for co-facilitating the training. The NCDC will continue to support the sub-national level to improve CSF