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Epidemic Meningococcal Meningitis, Cameroon

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Epidemic Meningococcal Meningitis, Cameroon LETTERS infections. Although we did not Dianna M. Blau, 7. Hajjeh RA, Relman D, Cieslak PR, Sofair conduct a case–control study, these Amy M. Denison, AN, Passaro D, Flood J, et al. Surveil- lance for unexplained deaths and critical fi ndings also support the results of Julu Bhatnagar, illnesses due to possibly infectious causes, other studies that previously reported Marlene DeLeon-Carnes, United States, 1995–1998. Emerg In- the demographic characteristics of Clifton Drew, fect Dis. 2002;8:145–53. doi:10.3201/ patients with pandemic infl uenza Christopher Paddock, eid0802.010165 8. Nolte KB, Lathrop SL, Nashelsky MB, infections and the risk factors for Wun-Ju Shieh, Sherif R. Zaki, Nine JS, Gallaher MM, Umland ET, et severe or fatal pandemic infl uenza and Infectious Diseases al. “Med-X”: a medical examiner sur- infections (3,4), especially with Pathology Branch Working veillance model for bioterrorism and in- respect to obesity (5). Group1 fectious disease mortality. Hum Pathol. 2007;38:718–25. doi:10.1016/j.humpath. Evaluation of tissues collected Author affi liation: Centers for Disease 2007.02.003 during autopsy from patients with Control and Prevention, Atlanta, GA, USA 9. Nolte KB, Fischer M, Reagan S, Lyn- a suspected infectious process can fi eld R. Guidelines to implement medi- DOI: http://dx.doi.org/10.3201/eid1711.110429 provide an etiologic diagnosis that cal examiner/coroner-based surveillance for fatal infectious diseases and bioter- was not available from routine References rorism (“Med-X”). Am J Forensic Med premortem and postmortem testing. Pathol. 2010;31:308–12. doi:10.1097/ Other etiologic agents detected in 1. Shieh WJ, Blau DM, Denison AM, De- PAF.0b013e3181c187b5 this study included reportable disease leon-Carnes M, Adem P, Bhatnagar J, et agents (e.g., Rickettsia rickettsii, al. 2009 Pandemic infl uenza A (H1N1): Address for correspondence: Dianna M. Blau, pathology and pathogenesis of 100 fatal Centers for Disease Control and Prevention, Legionella pneumophila, dengue cases in the United States. Am J Pathol. virus), vaccine-preventable diseases 2010;177:166–75. doi:10.2353/ajpath. 1600 Clifton Rd NE, Mailstop G32, Atlanta, GA (e.g., pneumococcal, meningococcal 2010.100115 30333, USA; email: [email protected] diseases), and zoonotic agents 2. Denison AM, Blau DM, Jost HA, Jones T, Rollin D, Gao R, et al. Diagnosis of in- (Leptospira and Capnocytophaga fl uenza from respiratory autopsy tissues: spp.). These fi ndings underscore the detection of virus by real-time reverse need for autopsies for diagnosing transcription-PCR in 222 cases. J Mol fatal infectious diseases (6). They Diagn. 2011;13:123–8. doi:10.1016/j. jmoldx.2010.09.004 also confi rm the need for coordinated 3. Centers for Disease Control and Preven- surveillance programs that identify tion. Intensive-care patients with severe Epidemic deaths potentially attributable to novel infl uenza A (H1N1) virus infec- infectious causes, including the tion—Michigan, June 2009. MMWR Meningococcal Morb Mortal Wkly Rep. 2009;58:749–52. unexplained deaths program (7) and 4. Jain S, Kamimoto L, Bramley AM, Meningitis, medical examiner infectious diseases Schmitz AM, Benoit SR, Louie J, et al. Cameroon death surveillance program (8). Hospitalized patients with 2009 H1N1 Partnerships of medical examiners infl uenza in the United States, April–June 2009. N Engl J Med. 2009;361:1935–44. To the Editor: In 2010, the and pathologists with local, state, and doi:10.1056/NEJMoa0906695 city of Ngaoundéré in Cameroon federal public health departments are 5. Louie JK, Acosta M, Samuel MC, Schech- experienced its fi rst reported epidemic crucial for detecting and monitoring ter R, Vugia DJ, Harriman K, et al. A novel of meningococcal meningitis. pandemic diseases and for assessing risk factor for a novel virus: obesity and 2009 pandemic infl uenza A (H1N1). Clin Ngaoundéré, with an estimated the scope and magnitude of infectious Infect Dis. 2011;52:301–12. doi:10.1093/ population of 180,000, is the main city agents that continuously affect human cid/ciq152 in the Adamaoua region in northern populations (9). These infections often 6. Hanzlick R. Medical examiners, coroners, Cameroon. The 2 northernmost regions result in sudden or unexplained death; and public health: a review and update. Arch Pathol Lab Med. 2006;130:1274–82. of Cameroon, North and Far North, thus, a standardized approach to death are considered to belong to the African investigations is recommended. meningitis belt (1) and are periodically affected by meningococcal meningitis Acknowledgments 1Infectious Diseases Pathology Branch outbreaks. However, the Adamaoua We thank the state and local public Working Group members were Patty Adem, region had been spared because of its health departments, the state and local Jeanine Bartlett, Brigid Batten, Reema altitude, latitude, and low population public health laboratories, and all the Dedania, Amy Green, Pat Greer, Tara density in comparison with the North pathologists and medical examiners who Jones, Lindy Liu, Jeltley Montague, Mitesh and Far North regions. Fewer than 10 submitted specimens to the Infectious Patel, Dominique Rollin, Chalanda Smith, sporadic cases have been reported in Diseases Pathology Branch. and Libby White. the Adamaoua region every year. 2070 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 11, November 2011 LETTERS During February–April 2010, where the mean annual rainfall for the a lumbar puncture performed at the a total of 126 cases of meningitis past 30 years was 1,460 mm (Agency Ngaoundéré Regional Hospital or at (70 cases/100,000 inhabitants) were for Aerial Navigation Safety in Africa the Norwegian hospital. With the help reported in the Adamaoua region. Of and Madagascar, unpub. data). This of the laboratory, an increasing number the 126 cases, 34 were confi rmed by value should exclude Ngaoundéré of cases of meningitis in Cameroon identifi cation of Neisseria meningitidis from the African meningitis belt, for are confi rmed cases (4). Second, serogroup A in cerebrospinal fl uid which the southern limit of annual the etiologic agent was serogroup A (CSF) samples, 46 cases were apparent rainfall was classically considered to meningococcus, a serogroup that had meningitis in which the patients had be the 1,100-mm isohyet (Figure). not been identifi ed in north Cameroon turbid CSF, and 46 were clinical cases This epidemic at the border of since 2006 (5) but that had been diagnosed in an epidemic context. The the African meningitis belt raises the isolated previously (6) and in south male:female ratio of the patients was question of the belt limitation and its Cameroon (7). 2.7:1. The mean age of patients was 19 potential expansion southward. These years, and median was 17 years. topics should be addressed through Acknowledgments CSF specimens from 34 patients active and standardized surveillance We thank the provinces’ authorities were sent to the Centre Pasteur du in countries such as Cameroon, which and the health districts’ staff for their Cameroun in Garoua for testing. are not entirely included in the belt collaboration and Pascal Boisier for Laboratory procedures included (2,3). assistance in preparing the manuscript. assessing CSF turbidity, Gram This meningitis epidemic has 2 staining, searching for soluble other noteworthy characteristics. First, This work was supported by the capsular antigens by using the 80 (63%) of 126 suspected cases had French Ministry of Foreign Affairs. Pastorex latex agglutination kit (Bio- Rad, Hercules, CA, USA), and testing by the dipstick rapid diagnostic test for N. meningitidis serogroups A, C, W135, and Y (provided by the Centre de Recherche Médicale et Sanitaire, Niamey, Niger). All 34 specimens were positive for serogroup A by agglutination, rapid test, or both. CSF specimens were cultured on blood agar and chocolate agar supplemented with PolyViteX (bioMérieux, Marcy-l’Etoile, France) and incubated at 37°C in an atmosphere of 5% CO2. Susceptibility to antimicrobial drugs was tested according to the recommendations of the Antibiogram Committee of the French Society for Microbiology (www.sfm.asso.fr). An isolate of N. meningitidis was sent to the World Health Organization Collaborating Centre for Reference and Research on Meningococci in Oslo, Norway, for molecular analyses, as described (www.neisseria.org). The result was that the isolate, a N. meningitidis serogroup A clone of sequence type 7, was susceptible to β-lactams and Figure. Northern regions of Cameroon with mean annual rainfall. Maroua is at the 800 mm chloramphenicol but resistant to isohyet line, Garoua at 1,006 mm, and Ngaoundéré at 1,460 mm. Estimate for Maroua is by the Agency for Aerial Navigation Safety in Africa and Madagascar; recorded rainfall trimethoprim/sulfamethoxazole. for Garoua and Ngaoundéré are by the Agency for Aerial Navigation Safety in Africa and This epidemic occurred in an area Madagascar. Eq. Guinea, Equatorial Guinea. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 11, November 2011 2071 LETTERS D. Massenet, Foodborne- in February 2010, which support D. Vohod, H. Hamadicko, extension of S. sonnei into India. The and D.A. Caugant associated Shigella outbreak isolates were characterized Author affi liations: Centre Pasteur du sonnei, India, by antimicrobial drug resistance Cameroun, Annexe de Garoua, Cameroon 2009 and 2010 and plasmid and pulsed-fi eld gel (D. Massenet); Hôpital Régional de electrophoresis profi les. Ngaoundéré, Ngaoundéré, Cameroon (D. To the Editor: Infection with On February 1, 2009, >300 Vohod); Délégation Régionale de la Santé Shigella spp. is a major cause of persons (age range 2–70 years) Publique, Ngaoundéré (H. Hamadicko); foodborne diseases, which have attended a marriage party at and Norwegian Institute of Public Health, increased considerably during the past Thiruvananthapuram, Kerala, where Oslo, Norway (D.A. Caugant) decades, but only a small fraction of they were served local food made of cases are reported (1). S. dysenteriae rice, lentils, milk, and water.
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