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Climate and Meningitis in Africa

We hear a lot about the impact of AIDS, tuberculosis and malaria in Africa. But if you’re keeping track, you may as well add bacterial meningitis to the list of nasty diseases that plague the continent.

Bacterial meningitis is an infection of the thin lining that surrounds the brain and the spinal cord, known as the meninges. The most common symptoms are stiff neck, high fever, headaches, and vomiting – but even when the disease is treated early, 5-10 percent of patients die within 48 hours. Those who survive often suffer long-term side effects including brain damage and hearing loss.meningitis-outbreak

While meningitis occurs all over the world, the highest disease burden is found in sub-Saharan Africa, in an area that stretches from the Gambia to Ethiopia, known as the Meningitis Belt. The disease is quite common throughout the area from February to May, but some years are worse than others: major epidemics striking up to 200,000 people have occurred in cycles of 8-12 years. In recent years, however, the epidemics seem to be occurring more frequently.

Though a number of factors (crowding, population displacement, herd immunity, etc.) influence the year-to-year prevalence of meningitis in Africa, the seasonality of the disease connects infection and climate in a way that can’t be denied. For instance, meningitis outbreaks only occur during the dry season, when temperatures fall at night and people huddle together for warmth. This is also the time in which the dry, dust-laden Harmattan winds blow from the north, damaging the mucous membranes of the respiratory system.

But while this much is understood, great deal more is still a mystery. Indeed, while the connections between climate and health can’t be denied, neither can they be entirely understood — at least not yet.

In pursuit of a more perfect understanding, researchers working to unravel the connections between climate and meningitis got together last week at the Mailman School of Public Health. The conference, called Epidemics and the Environment: The Meningitis Challenge in Africa, was presented in conjunction with the Center for International Earth Science Information Network and the International Research Institute for Climate and Society (IRI). It was opened by Mailman’s dean, Dr. Linda Fried, and chaired by Dr. Patrick Kinney, director of the Columbia Climate and Health Program. The conference was also incorporated into the IRI’s Summer Institute on Climate Information for Public Health.

Conference talks covered a range of issues. Dr. Tom Clark of Centers for DiseaseControl and Prevention introduced the Meningitis Vaccine Project, a partnership between the World Health Organization (WHO) and the Program for Appropriate Technology in Health that works to eliminate epidemic meningitis as a public health problem in Sub-Saharan Africa.

Dr. Eric Bertherat of the WHO outlined the efforts made by the Meningitis Environmental Risk Information Technologies Project to use existing knowledge to improve the understanding of the relationship between bacterial meningitis and environmental parameters. He also explored the potential to use this understanding to provide more timely warnings of the onset of meningitis epidemics and improve the efficacy of prevention and control.

This topic was later picked up by Dr. Madeleine Thomson of the IRI, who discussed ways that climate information might be able to improve meningitis control.

Dr. Patrick Kinney of Mailman, Dr. Sylwia Trzaska of the IRI and Dr. Yonas Asfaw from Ethiopia’s Federal Ministry of Health also joined in on the discussion. This group brought up possible mechanisms to illuminate the seasonality of carriage, rather than infection, and the potential benefits of further illuminating the relationship between climate and disease prevalence.

In the end, the conference served to raise as many questions as it answered, but it also served to underscore the need for climate and health experts to team up to combat meningitis in Africa – particularly since creeping desertification and dust storms may increase prevalence as our climate changes. It also served to highlight the fact that a way of predicting these meningitis epidemics would be enormously useful.

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14 years ago

Nice post, Cathy. Wanted to share a quote from Dr. Bertherat from a later interview, which I think really hits at why diseases such as meningitis are so devastating.

He said, “The other problem is that during an outbreak, all the activity of the health system [in affected districts] is blocked by all these meningitis patients arriving to the dispensaries.” The normal cases of malaria, tuberculosis, AIDS don’t go away. The health-care system gets completely overwhelmed.

14 years ago

Hi Cathy,
This is just an interesting issue!
You may find further information on meningitis and climate and the MERIT initiative (Meningitis Environmental Risk Information Technologies) at the link below:

14 years ago

meningitis is obviously a huge problem (particularly in the African meningitis belt) and the link to climate is clearly an important one. what’s not clear from this post, at least, is just how important that link is, nor how important discovering what the link is could be.

the post describes scientists working to unravel the connection between climate and meningitis, but it’s also interesting to consider the value of that kind of information.

that is: predicting meningitis epidemics would be useful, but if we know that meningitis outbreaks are more frequent and more virulent during dry years, do we need to know the mechanism by which a dry climate translates into increased incidence? or is it enough to forecast, and prepare, for the impacts without understanding the precise mechanisms? what is the value of the imperfect information we currently have?

this is an interesting post, but it would be nice to know more about the use being made of the information we currently have with respect to the link between meningitis and climate.

Kalpana V.
Kalpana V.
14 years ago

Great post Cathy.
Some reports indicate that Meningococcal epidemics hit the African belt once every 8-12 years, and the year 1996 was particularly badly hit with huge causalities. It would be interesting to look at the possible causes (extreme weather/climate patterns) which led to it, perhaps links to ENSO too.
Here’s a conclusive paper on the climate-meningitis link in West Africa:

Michael Brown
14 years ago

May 1986, somewhere between Timbuktu and Bamako Mali where I was working on a major irrigation project (in Dire, Mali actualy), is when I got hit with meningitis. I had several billion identical jackhammers banging continuously in my mind’s eye as I crawled from bed to bathroom, unable to lift my chin. A horse vial of 5ccs of ampycillin (if memory serves correct) literally knocked it down in 15 minutes, whereas I was preparing myself to die minutes earlier. This was an absolutely astonishing turnaround, and none that left me in awe, akin to the sensation of just how biologically regular a cerebral malaria attck can be.

This meningitis attack I incurred was in the era of Live Aid, long before climate change was on everyone’s lips. But…the phenomenon even then was well known.

While there is no doubt that short term climate changes (which may or may not fit with predictable levels of inter-annual variability) may have public health consequences on meningitis morbidity in any given year, it has been known for decades that the meningitis belt will suffer each and every year to SOME extent. Yet, despite this knowledge, is there adequate preparation now for outbreaks even in the best of years, let alone the worst of years? I think not.

While this topic is of definite academic interest, in practice I fear that the extra layer of information would likely not lead to sustainable long-term solutions for preventing and treating meningitis on a major outbreak basis. And then too, causal linkage will likely remain problematic to prove for some time.

13 years ago

Nice post Cathy.
I’ve visited African countries. Most of them are leaving below than Porty line. Few more articles should be written on this issue.


13 years ago

It is so sad to hear about meningitis in Africa as it relates to the changes in climate. It is something different when it is something within the control of man (such as providing food, vaccinations, etc.) However, there’s little or nothing that we can do to control the climate to get the people the type of help they need now.


13 years ago

Very interesting article.. We all focus on AIDS and malaria in sub-saharan africa, but easily preventable diseases such as meningitis tend to be overlooked.
Thanks for writing on this issue!

13 years ago

Did you know that since January of last year that a total of 13,516 people have been infected with meningitis, and 931 have died. Nigeria has been the most adversely affected, with over half of the total cases and deaths occurring in the nation. The WHO reported Mar 27 that 1,100 had died and there were 25,000 suspected cases.[2] It is the worst outbreak in the region since 1996, and a third of the world’s emergency vaccine stockpile for the bacterial form has been consumed. The GAVI Alliance has been trying to secure more vaccines.

Thank you for the post Catherine,

13 years ago

AIDS, tuberculosis and malaria….now meningitis… so many trouble in africa…

13 years ago

And Africa will always have these problems … sadly enough!