Chapter 2
Box 2.1 Volunteers vital for meningitis vaccination

Sudan has experienced widespread meningitis epidemics in ten-year cycles during the dry seasons in 1979 and 1989. Although outbreaks are now reported at any time of year and outside the so-called ‘meningitis belt’ of sub-Saharan Africa, epidemiologists tentatively predicted 1999 as the year for another major outbreak. So, close monitoring was already in place when numbers of reported cases and mortality rates began to climb in December.

On 12 December 1998, 25 cases of cerebrospinal meningitis were reported in North Darfour state which escalated to 190 cases within a month. The highest disease rates are found in the young, with older children, teenagers and young adults also affected. The mortality rate was very high and prompted plans for a mass vaccination campaign by Sudan’s Ministry of Health (MoH).

A Red Cross/Red Crescent training of trainers workshop during the first week of February 1999 covered vaccination techniques, methods for preventing the spread of the epidemic, and active case-finding. As part of the awareness programme, 10,000 posters and pamphlets were produced and distributed and 250 volunteers took part in the North Darfour vaccination campaign.

Outbreaks were reported in 12 other states in February, transmitted along the main road and rail transport routes. Weekly coordination meetings between the MoH, the Sudanese Red Crescent (SRC) and the Inter-agency Coordinating Group (ICG, comprising the International Federation, WHO, UNICEF and MSF) decided priority regions and presented new figures on reported cases and deaths.

The average number of cases reported per day was 135, but a very sharp increase took place between 21 and 31 March, when 3,454 cases and 146 deaths were reported over the ten-day period. The SRC and ICG launched a vaccination and health education campaign on 1 March which could be implemented quickly thanks to swift donor response to both an initial appeal and an appeal for further funds following the rapid spread of the epidemic.

Within three weeks, drugs and vaccines were delivered to begin targeting people aged from 2 to 30 years, lowering morbidity and mortality rates and controlling the spread of the disease in the initial target area. Peaking at the end of April, having spread to 17 states, meningitis infected more than 33,000 people and killed at least 2,375 of them. Eleven million people nationwide were targeted with vaccines, and, as part of the intervention, a disaster preparedness plan was put in place, which included stocking 30,000 vials of oily chloramphenicol at five strategically-located treatment facilities.
SRC volunteers were described by the annual ICG meeting as crucial in helping organize the vaccination programme and identifying suspected cases early for treatment. Local radio and television, posters and leaflets were used to help spread information.

To try to contain a future meningitis epidemic as quickly and efficiently as possible, response plans are now being set up by the MoH and SRC. A local-level prevention training programme is now planned for the seven states where the SRC has a major presence, to try and ensure treatment campaigns take place as soon as the next cycle of disease sweeps through the region.