Fighting meningitis in Africa: Climate information the missing link

In the developed world, a single fatality or even case of meningitis is cause for alarm. The death of a ten-year-old a few months ago in the US state of Pennsylvania prompted over 20 news articles.

In the developed world, a single fatality or even case of meningitis is cause for alarm. The death of a ten-year-old a few months ago in the US state of Pennsylvania prompted over 20 news articles.

This is because meningitis is one of the world’s more frightening diseases.
Although relatively rare, its tendency to target children and a close symptomatic resemblance to a nasty bout of flu intensifies public fear and even a sense of futility. That’s in the developed world.

In 1996-97, devastating epidemics of meningococcal meningitis killed 25 000 and affected 250 000 people in Africa’s Meningitis Belt (from Senegal to Ethiopia); many survivors suffered disabilitiesincluding brain-damage and amputations.

Such epidemics - and there have been several since – are influenced by factors such as new bacterial strains, rates of contagion, immune status, social behaviour, population movements, living conditions and . . . the climate.

Earlier last year, the Intergovernmental Panel on Climate Change (IPCC) stated in its Working Group II Report: Projected climate change-related exposures are likely to affect the altered spatial distribution of some infectious disease vectors.

Experts consider sub-Saharan Africa to be one of the most vulnerable regions to these alterations and scientists have already recorded outbreaks south of the Belt on a consistent basis. When tackling meningitis in Africa, one of the most pressing issues has been the lack of an effective vaccine.

While vaccines exist and inoculation programmes have been carried out, each dose costs around $28 and those treated received the disappointing protection span of just six months.

This however, may be about to change.
Trials of a new vaccine, developed by the Serum Institute of India, promise lifetime protection against the most contagious strain of meningitis. More promising still is the projected price tag - 40 cents a shot.

If trials continue as expected, the Meningitis Vaccination Project - a partnership between the World Health Organization (WHO) and the Seattle-based non-profit group Program for Appropriate Technology in Health or (PATH) - will start mobilizing this new weapon against the disease in 2008 with the aim of protecting 350 million people over the next ten years.

All this sounds very encouraging except that health programmes throughout the region will still face the usual evils of meagre funding, lack of staff as well as the costly and complicated challenges of distribution and demographics.

This is where accurate user-friendly climate information can play such a critical role.
The bacteria which cause meningitis epidemics are transmitted from person-to-person through droplets of respiratory or throat secretions, often triggered by coughing or sneezing.

Yet carriage of the bacteria in the nose or throat is common and often benign; only becoming pathogenic when it invades the bloodstream. Research suggests that outbreaks in the Belt are exacerbated by the onset of hot, dry, dusty conditions which cause minute abrasions in the throat and mucous membrane allowing the bacteria to enter the bloodstream.

Reasonably accurate predictions of when and where these conditions will occur already exist but investigations carried out by the newly formed Health and Climate Foundation (HCF) indicate that climate-related information is not yet reaching health workers in a format that they can understand and use.

The Consultative Meningitis Environmental Risk Meeting in Geneva (26-28 September 2007) at the John Knox Center was aimed at tackling this issue. Instigated by HCF, the meeting was attended by around 30 leading experts to examine ways of improving how climate information - which is often technical and complex - could be properly communicated to the health sector and hence effectively employed at the front line during meningitis immunisation programmes.

Until this happens all the satellites and super-computers employed to observe and predict the climate will matter little for the thousands of lives at risk from meningitis throughout Africa in
the future.

Dr David Rogers is President of the Health and Climate Foundation and Dr Madeleine Thomson is Vice-President.

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