PAN expresses worry over meningitis, diphtheria outbreak

• Says episodic outbreaks reflect failure of immunization programme

The paediatric Association of Nigeria (PAN) has expressed dismay about the outbreak of vaccine-preventable diseases in some parts of the country and called for a review of the nation’s immunization programme.

In a Press Release signed by the Association’s National President, Prof. Ekanem Nsikak Ekure earlier today, the association said the “episodic outbreaks” reflect the failure of the country’s immunization program and its infection prevention and control activities in general.

The statement noted that Cerebrospinal meningitis is known to be endemic in the northern part of the country that falls within the meningitic belt of the Sahara, and pulses of outbreaks often occur at the peak of the dry season. It also observed that the country was the first ever to roll out the WHO-recommended vaccine which targets five strains of the bacteria known to cause cerebrospinal meningitis, the Meningococcus.

“The meningococcal outbreak in northern Nigeria is a reason to ask questions about the progress of the new meningococcal vaccine roll-out. Similarly, the diphtheria outbreak in Lagos raises questions about the immunization status of children admitted into schools. Children who are partly vaccinated or whose immune responses to primary immunization have waned, serve as reservoir from which outbreaks are launched.

“PAN notes that the current national immunization program only makes provision for primary diphtheria vaccination within the first fourteen weeks of life without official provisions for booster dosing yet. Although the WHO recommends three booster doses of diphtheria vaccine to be administered at 12-23 months, 4-7 years and 9-15 years, this is yet to be operational in the country,” the association further said.

While commending the concerned State Governments for their quick responses to the outbreaks PAN however urged government, at all levels, to consider developing blueprints for preparedness against disease outbreaks, not just preparedness for disasters and accidents.

“The disease outbreak preparedness should be incorporated into the annual budget. It should encompass specific public education, clinical and laboratory surveillance to confirm cases, multi-sectoral collaborations, facilities for quarantine and isolation, contact tracing, post-exposure prophylactic measures, and treatment of confirmed cases. This will improve the speed and quality of government response to disease outbreaks.

“The government also needs to invest more in vaccine procurement to create resources for introducing booster dosing. It is a scientific fact that the protection conferred on children following primary vaccination in early infancy wanes with time, thus predisposing them to natural infections, without booster dosing. It is attractive to make the booster dosing school-based since the school provides ready access to a catchment population.

“The schedule should be reviewed to include booster doses of diphtheria vaccines as recommended by the WHO. The school health program will be an effective tool of implementation of these innovations.

“Parents are encouraged to ensure their children are fully vaccinated and missed doses are promptly taken at the very next opportunity. Such vital information as the actual vaccination history should be disclosed during pre-admission medical screening so infection risks can be appropriately classified and precautionary measures applied by the school management. Community involvement is also important as a potent weapon against.

“Children should be taught basic personal hygiene, including cough hygiene as this is a sure way to slow down the spread of infective droplets. Overcrowding is a strong risk factor for the spread of diphtheria and cerebrospinal meningitis and this should be taken into cognizance when designing residential homes and school hostels and dormitories.

“The school health program needs to be re-invigorated, especially in the areas of policy review, implementation and utilization of standardised pre-entry medical fitness documentations as it concerns immunization status of students and proper linkage to health services. This step will play great roles in the prevention, early detection and in curtailing the spread of infections among school children,” the release further stated.