Idrissa Abdoul-Aziz, Atti Salifou, Wasaulua Roger Kiamvu, Kazadi Serge, Sani Ousmane, Tassiou Elhadji Ibrahim, Guindo Ousmane, Tonamou Georges, Ciglenecki Iza, Coldiron Matthew E
Epicentre, Maradi, Niger.
Ministry of Public Health, Magaria, Niger.
PLoS One. 2025 May 22;20(5):e0323223. doi: 10.1371/journal.pone.0323223. eCollection 2025.
The management of post-meningitis sequelae is a priority in the WHO Roadmap to Defeat Meningitis by 2030. Nonetheless, the prevalence of sequelae in the African Meningitis Belt is not well described, making the development of post-meningitis care programmes difficult. We conducted a home-based follow-up study of cases notified during an epidemic due to Neisseria meningitidis serogroup C (NmC) in 2022 in the Dungass and Magaria Districts of Niger, to describe the prevalence of sequelae several months after the epidemic.
Standard WHO case definitions were used during the epidemic. District linelists were completed with the results of PCR testing of patients who had undergone lumbar puncture. These lists included the village of origin of the notified cases. Accompanied by community outreach workers, the study's nurse-investigators sought out case-patients in their homes to assess the presence of sequelae. A standardised questionnaire was administered, and a focused physical examination was carried out.
A total of 1001 suspected cases and 50 deaths (CFR 5.0%) were reported in the two districts. A total of 469 CSF samples (47%) were analysed at the national reference laboratory, of which 220 were PCR positive (47%). NmC was the predominant causative organism (87% of confirmed cases). 82 cases were excluded due to distance. 570 of the 919 cases sought out were eventually found and included. Of these 570 cases, 49 had died (CFR 8.6%). Among surviving cases, the prevalence of sequelae was 12%, and among survivors of confirmed NmC meningitis, 18%. The most common sequelae were hearing loss (6%), paralysis (3%) and epilepsy (2%).
Case fatality during the epidemic appears to have been higher than reported in routine surveillance. The prevalence of severe sequelae is high, and clinical description of sequelae could help future epidemic management.
在世界卫生组织《到2030年战胜脑膜炎路线图》中，脑膜炎后遗症的管理是一项优先事项。尽管如此，非洲脑膜炎带后遗症的患病率尚无详尽描述，这使得脑膜炎后遗症护理项目的开展困难重重。我们对2022年在尼日尔的敦加斯和马加里亚地区因C群脑膜炎奈瑟菌（NmC）引发的疫情期间报告的病例进行了一项基于家庭的随访研究，以描述疫情结束数月后后遗症的患病率。
疫情期间采用了世界卫生组织的标准病例定义。通过对接受腰椎穿刺患者的PCR检测结果完善地区病例清单。这些清单包括报告病例的原籍村庄。在社区外展工作者的陪同下，该研究的护士调查员到病例患者家中寻找他们，以评估后遗症的存在情况。发放了一份标准化问卷，并进行了重点体格检查。
两个地区共报告了1001例疑似病例和50例死亡（病死率5.0%）。国家参考实验室共分析了469份脑脊液样本（47%），其中220份PCR检测呈阳性（47%）。NmC是主要致病病原体（确诊病例的87%）。因距离原因排除了82例。在寻找的919例病例中，最终找到了570例并纳入研究。在这570例病例中，49例死亡（病死率8.6%）。在存活病例中，后遗症患病率为12%，在确诊的NmC脑膜炎幸存者中为18%。最常见的后遗症是听力损失（6%）、瘫痪（3%）和癫痫（2%）。
疫情期间的病死率似乎高于常规监测报告的水平。严重后遗症的患病率很高，后遗症的临床描述有助于未来的疫情管理。
