Fears of witchcraft delay meningitis declaration in DRC

An outbreak of meningitis with a high mortality rate of 50% was declared in the Democratic Republic of Congo’s northeastern Tshopo province. There are 261 suspected cases and 129 deaths.

DRC reported over 118,000 cases of meningitis between 2000 and 2018, with a mortality rate of 11.5%. But rumors that this new outbreak was linked to witchcraft have made containment difficult and pushed the mortality rate higher.

“Meningitis is a serious infection and a major public health challenge. We are moving fast, delivering medicines and deploying experts to support the government’s efforts to bring the outbreak under control in the shortest possible time,” said Dr. Matshidiso Moeti, regional director for Africa at the World Health Organization, in a press release.

Meningitis is spread through respiratory droplets or throat phlegm of those infected.

The outbreak was fueled by crowded conditions for those working in the region's mines of gold and other metals, Dr. Andre Fouda, medical officer at WHO, told Devex. 

The country was alerted to the outbreak in early July but establishing the infection as meningitis took time. Laboratories in the capital of Kinshasa do not have the capacity to confirm Neisseria meningitidis, which is the bacteria discovered in Tshopo. It is one of the most frequent types of bacterial meningitis with “the potential to cause large epidemics,” according to WHO. Instead, the samples were sent to the Institut Pasteur in Paris.

But first came delays. It was difficult for health officials to get cerebrospinal fluid from people in the community because rumors were swirling that the outbreak was linked to witchcraft and so was the extraction of fluids from their spines, said Fouda. Once health officials obtained the needed fluid, the samples had to be transported from the territory of Banalia to Kisangani, Tshopo’s capital, to Kinshasa, and then to France.

Even before it was confirmed, health officials started to treat people for meningitis with antibiotics about four weeks ago — which also faced some resistance as community members were concerned about whether the treatment was linked to witchcraft.

Mobile clinics were moved into the region and there are now two reference hospitals, which have dedicated meningitis case management. More than 100 people are already receiving treatment at home and in health facilities.

At the beginning of the outbreak the death rate was even higher, reaching about 80% at certain points due to people’s resistance, and the lack of access to health centers in the communities or to treatment, Fouda said.

Tshopo province is part of the “African meningitis belt” that runs across the continent from Senegal to Ethiopia and includes 26 countries. This strip of countries is the most vulnerable globally to recurrent outbreaks of meningitis. The meningitis epidemic season typically flares up during dry seasons from January through July, Fouda said.  

The province had undergone a massive vaccination campaign for meningitis in 2016, where more than 1.6 million people between ages 1 and 29 were vaccinated. But this vaccination targeted meningitis A, whereas meningitis W is responsible for this outbreak, Fouda said.

A new vaccination campaign is being prepared to target this strain, he said.  

Benin, Ghana, and Niger all experienced meningitis outbreaks this year, but with mortality rates below 8%.