Pneumococcal Meningitis Outbreak among boarding students in a Senior High School, Central Region-Ghana

On January 24, 2020, a 19-year-old female student at a senior high school in the Central Region of Ghana died in school following complaints of fever, vomiting, and neck stiffness. Following parental concerns raised after the unexpected event, we investigated the incident to determine the cause, and its magnitude and implemented control measures.

A cross-sectional study design was conducted. We interviewed students and staff of the school and reviewed medical records. We defined a suspected case as any student with fever (>37.5oC), headache, or vomiting with either neck stiffness, altered consciousness, or convulsions from January 14, 2020, to March 5, 2020. We conducted case search and generated a line list with socio-demographic, clinical, and laboratory variables. We performed lumbar puncture on suspected case-patients for laboratory confirmation. We conducted an environmental assessment of the dormitories. We conducted descriptive statistics and generated an epidemic curve.

Meningitis was confirmed with Streptococcus pneumoniae isolated from 33.3% (5/15) of suspected cases. Fifteen meningitis cases were recorded among 1,154 students (Attack rate=1.3 per 100 population). Overall case fatality rate was 13.3% (2/15), with mortalities being females. The mean age of case-patients was 17.9 years (standard deviation=±1.0). Sex-specific attack rate for females was 2.2 per 100 population (13/587) and 0.4 per 100 population (2/567) among males. Case-patients were from the school’s boarding facilities. Cases identified were managed according to the national treatment guidelines. We observed poor ventilation and overcrowding of female dormitories, demonstrated by 96 students in a 47×24 square meter space.

Streptococcus pneumoniae was the causative agent of the outbreak, affecting boarding students. Overcrowding of dormitories and poor ventilation were associated factors. Prompt management of cases and quarantine of contacts were measures put in place to contain the outbreak. We recommended disinfection of dormitories.

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