A particularly severe epidemic of meningococcal meningitis (cerebrospinal m
eningitis, CSM) occurred in Nigeria between January and June 1996. There we
re 109 580 recorded cases and 11 717 deaths, giving a case fatality rate of
10.7% overall. This is the most serious epidemic of CSM ever recorded in N
igeria, and may be the largest in Africa this century. It took over 3 month
s and the combined efforts of a National Task Force set up by the Federal M
inistry of Health, the WHO, UNICEF, UNDP, Medecins Sans Frontieres, the Int
ernational Red Cross and several other non-governmental organizations to br
ing the epidemic under control. The main control measures centred on active
treatment of infected persons, mass vaccination and health education. The
exact number of persons treated cannot be ascertained, but there were treat
ment centres in almost every Local Government Area in the affected States.
A study of 1577 patients admitted at the Infectious Diseases Hospital, Kano
, showed that 84% of those infected were aged less than or equal to 20 year
s and that, for the first time, infants aged less than or equal to 2 months
were affected. Despite intervention, the case fatality rate of 9.1% among
this group of patients was similar to the nationwide figure of 10.7%. Long-
acting oily chloramphenicol proved highly effective in the treatment of pat
ients, and its routine use in epidemic CSM is recommended. Over 13 million
persons were vaccinated in the course of the epidemic. For the first time,
cases of CSM were reported from States south of the 'African meningitis bel
t', suggesting an extension of the belt. The severity of this epidemic yet
again underscores the need for a clear policy regarding control measures ai
med at forestalling future epidemics. The availability of the recently deve
loped polysaccharide-protein conjugate vaccine should facilitate a decision
on mass vaccination for the prevention of epidemic CSM in Africa.