The role of a national-emergency operations center in 2016/2017 meningitis outbreak response

Introduction : outbreaks of bacterial Cerebrospinal Meningitis are known to result in high morbidity and mortality. Outbreaks with such a high impact attract a multi-level, multi-partner response. While the accompanying deployment of human and material resources is beneficial for response, effective utilization may be compromised without a central coordinating structure. Activating an Incident Management System (IMS) is therefore vital. This paper describes the role of an IMS in coordinating response to the 2017 CSM outbreak, which resulted in 14,280 cases with CFR of 8%. Methods : on the 3rd of April, 2017, a national IMS led by the Nigeria Centre for Disease Control (NCDC) was activated coinciding with the peak of the outbreak (Epi-week 14, 2017). Terms of Reference and an emergency response plan was defined based on five response pillars- Coordination, Case management, Surveillance and Epidemiology, Risk Communications and Vaccines management. Activities implemented include: Bi-weekly CSM EOC meetings and situational report development, deployment of rapid response teams (RRT) to affected States, technical support to States to support reactive vaccination campaigns. Other activities included sensitization of stakeholders, monitoring of epidemiological trends using dashboards, development and review of SOPs, weekly feedbacks to affected States as well as multi-layered advocacies. Results : the IMS activation enhanced coordination of all response activities by the Government and partners. A long tail of the epidemic prior to EOC activation was shortened and CFR reduced from 11.2% to 8.0%. Reactive vaccination campaigns were better coordinated yielding high coverage rates in Zamfara (97%), Sokoto (97%) and Yobe (105%) States. Multi-level mapping and strategic deployment of all partners’ resources was achieved. Development and dissemination of bi-weekly situational reports aided response decisions and kept stakeholders and the general public abreast of outbreak status. Decision making was evidence-based as outbreak dashboards were used to review epidemic trends. Engagement with stakeholders (media, traditional and religious institutions) helped in social mobilization. Guidelines and SOPs development improved sub-national response by eliminating the use of multiple guidelines on same thematic area. Conclusion : the containment of CSM outbreak is partly attributable to the activation of the IMS, which aided timely identification of response gaps and proffering solutions. Although the IMS was activated only at the peak of the outbreak, a drastic reduction in new cases was recorded. The use of an IMS for coordinating future outbreaks is highly recommended.