Etiology and risk factors for meningitis during an outbreak in Batié Health District, Burkina Faso, January-March 2016

Abstract

Introduction: On 16 March 2016, Batié Health District notified the Burkina Faso Ministry of Health Surveillance unit of 12 suspected cases of meningitis. During the same period, Batié´s neighboring districts in Côte d'Ivoire and Ghana were experiencing a meningitis epidemic. We investigated to establish the etiology and risk factors for the disease and to recommend prevention and control measures. Methods: We conducted unmatched case control study. A case was any person living in Batié with fever (temp. ≥ 38.5°C) and any of the following: neck stiffness, neurological disorder, bulging fontanelle, convulsion during January to April 2016 with cerebrospinal fluid (CSF) positive to PCR. Controls were non sick household members, neighbors or friends to the cases. We analyzed the investigation and laboratory records. We included all confirmed cases and two neighborhood controls per case. We used a standard questionnaire to collect data. We analyzed data by Epi info 7 and calculated odds ratio (ORs),adjusted odds ratios (AOR) and 95% confidence interval. We proceeded to univariate, bivariate, multivariate and logistic regression analysis. Results: We interviewed 93 participants including 31 meningitis cases and 62 controls. The median age of cases was 8 years old [2 months-55 years] and 6.5 years old [5 months-51 years] for controls. Streptococcus pneumoniae 16(51.61%), Neisseria meningitidis W 14(45.16%) and Haemophilus influenzae b 1(3.23%) were the identified germs. The independent risk factors identified were travel to meningitis affected areas (Adjusted odd ratio(AOR)=12[2.3-60],p=0.0029); >5 persons sharing bedroom (AOR=5.7[1.5-22],p=0.012) and rhinopharyngitis (AOR=26[1.8-380],p=0.017). Conclusion: Streptococcus pneumoniae and Neisseria meningitidis W caused the outbreak in Batié. The risk factors were overcrowding, travel to affected areas, and rhinopharyngitis. We recommended reactive vaccination against Neisseria meningitidis W, limited travel to affected areas and ventilation of rooms.