In one of West Africa's worst outbreaks of infectious disease in recent memory, bacterial meningitis has infected more than 100,000 people in the last three months, killing more than 10,000, international health care workers say.
The epidemic, which has been most intense in the region just south of the Sahara, known as the Sahel, began in February, when arid, dust-laden air and cool evenings typically lead to widespread outbreaks of colds and other respiratory infections.The disease causes inflammation of the lining of the brain and spinal cord. An airborne bacterial form, meningococcal meningitis, is easily spread through sneezing and close personal contact. Symptoms include high fever, trembling and, in severe cases, seizures and sometimes death.
Once the disease is contracted, it can be treated in its early stages with antibiotics, but once it takes hold and invades the bloodstream, doctors say death comes quickly.
A preventive vaccine is available and is now being administered on an emergency basis in the region.
In northern Nigeria, where the disease has hit hardest, about 10 percent of the 50,000 or so cases officially reported so far have ended in death. Children, the aged and women of childbearing age are most vulnerable to dying.
International health care workers who have distributed meningitis vaccines and helped fight the spread of the disease in Nigeria say the true extent of infection is still unknown but is presumed to be far greater than what official figures reflect.
"The meningitis epidemic of 1996 is by far the worst that Sub-Saharan Africa has ever seen," said Marc Gastellu Etchegorry, deputy director of Doctors Without Borders, a French relief organization that has been active in Nigeria. "The death toll just keeps going up, and it is pretty certain that the official figures underestimate the size of the problem."
The fact that the outbreak coincided with the annual Muslim pilgrimage to Mecca, known as the haj, compounded problems in northern Nigeria, which is heavily Muslim, international health experts said. As news of the outbreak spread, Saudi Arabia temporarily blocked entry into the country to pilgrims from Nigeria and several other African countries hit hard by meningitis.
Because of this, health experts say that for a time, Nigerian officials were eager to play down reports of the spread of the disease in the north of the country.
"The delay in jumping on this crisis cannot be explained only by financial reasons," said one health care worker in the Nigerian city of Kano, who spoke on condition of anonymity. "Unfortunately, there is also a political side. For a time, it seems, there was an effort to minimize this thing because of the haj. That was a purely political decision."
Precautions against the disease were also hindered for cultural reasons, many experts say. In many places, the disease carries a stigma because the folklore, especially in rural areas, holds that illnesses like meningitis are akin to moral plagues being visited upon the people as punishment.
In northern Nigeria, many people were reluctant to come forward until religious leaders were enlisted in a public education campaign to encourage vaccination.
In Nigeria and elsewhere in the Sahel, health experts say, the fact that the last major outbreak of meningitis occurred in the early 1980s also meant that the level of natural immunity from previous exposure to the disease was low throughout the region.
"In Burkina Faso, for example, the last big outbreak came in 1983," said Dr. Gaoussou Traore, an official of the World Health Organization in Ouagadougou, the capital. "Consequently, very few young people had any resistance.
"Things were made worse by the fact that the disease broke out in a great number of places all at once, spreading resources thin. There has not been enough vaccine to go around, and medical personnel have really been badly taxed."
Burkina Faso has the second-highest number of cases. About 4,000 of the 40,000 people who have contracted the disease there have died. Most of them are women and children.
Yalgado Ouedraogo Hospital in Ouagadougou has already treated more than 2,500 cases. The numbers of ill people coming to the hospital center have been so high that the hospital was forced to open a new ward that was only partly built.
"In March, when things were at their worst, each patient had four or five visitors looking after them," said Dr. Idrissa Ouedraogo, the hospital's director. "It was so crowded that you couldn't walk through the wards."
In many rural areas of Burkina Faso, where there are no hospitals, churches have been flooded with the sick and have become de facto treatment centers.
So far, meningitis cases have turned up in 14 African countries. In addition to Nigeria and Burkina Faso, the other countries that have been hit hard by the outbreak are Niger, Mali and Chad.
Regional health care authorities say that although this season's epidemic has been unusually virulent, it is expected to taper off by the end of May, when the start of the rainy season and the return of blistering hot weather interfere with its transmission.
Throughout the region, doctors treating patients with the disease have expressed frustration that in the poverty of West Africa, where large vaccine stocks are too costly to maintain and health care is often unavailable, a disease that is easily preventable can run out of control.
"When it rains, the epidemic stops," said Ouedraogo. "But it is not normal that in the 20th century, people should be dying of meningitis, just as if we were living in the 18th century."