CASE 1

ACUTE ILLNESS ? ACUTE EPIDEMIOLOGY !

Approximately one year ago a short message was published on the front page of the Dutch daily
newspaper De Volkskrant, to draw attention to the outbreak of a devastating epidemic of
meningococcus A infection in the northern part of Nigeria. By the way, it is rather unusual for Dutch
national newspapers to deal with such topics on their front pages. At about the same time the British
Medical Journal reported as follows:

MENINGITIS EPIDEMIC SWEEPS NORTHERN NIGERIA
At least 1650 people in Nigeria have died in the past month as a result of a meningitis epidemic in the
north of the country. The Nigerian government was this week poised to declare a state of emergency
following the deaths. There are also epidemics of cholera and gastroenteritis.
The aid agency Mdecins sans Frontires says that the epidemic of meningococcus A infection is of
unprecedented dimensions. Death rates for the past two months have stood at almost 20%.
The worst affected area includes the northern capital of Kano and the towns of Bauchi, Kebbi, and
Katsina. By the end of last month at least 7000 cases had been reported, with daily admissions to Kanos
hospital almost trebling.
A 10 person team from Mdecins sans Frontires is already working with the sick in Kano, and further
volunteers were due to arrive this week. The agency has launched an international appeal for it 2.5 m
emergency medical assistance programme, saying: The assistance programma will be carried out in
close cooperation with the federal ministry of health, and will consist of a vaccination campaign for
about two million people in the worst affected areas and care for 15,000 people.
At The Nigeria High Commission in London the head of information, Grant Ehiobuche, said: The
government is making every effort to contain the spread of the disease and to bring in the necessary
supplies.
In Nigeria health minister Ikechukwu Maduboke called the epidemic a disaster and added: If it
continues next week we will declare a state of emergency. -- Claudia Court, BMJ
598 BMJ volume 312 9 march 1996

Confronted with such a news message you will realize that the same kind of problem may occur in
your own country as well - and actually will have occurred at several occasions in the past, probably
with a different disease as menace. It will be obvious that the successful control of a sudden outbreak
of such an acute illness depends on the availability of a ready-made scenario, that prescribes in
general which steps should me made, by whom, and in which sequence, and that can be easily adapted
to the specific disease conditions faced at that moment. It makes much difference, of course, whether
the alarm bell is raised for an old disease with a wellknown cause and course, or for a new disease of
unknown origin (old examples of these new diseases being, for instance: Lyme disease,
Legionnaires disease, the onset of the AIDS epidemic, etc.).

References
Gordis L. Epidemiology; 4
th
ed. Ch. 1: Introduction. Ch. 2: The dynamics of disease transmission. Philadelphia:
WB Saunders, 2008.

Ungchusak, K. The principles of an epidemic field investigation. In: Holland WW, Detels R, Knox G. Oxford
Textbook of Public Health; 4
th
ed. Vol. 4, pp. 529-542. New York: Oxford University Press, 2004.