1. Neisseria meningitides outbreak-Harenabuluk District, Ethiopia,2011 Yembo Gole Ejeta 1, Fikire Bulti 2 an Kebabe Tolasa 3 1 Addis Ababa University, 2 Oromia Health Bureaus, 3 Madawalabu University Introduction Acknowledgements Results Ethiopia Within the "meningitis belt" of Sub-Saharan Africa Neisseria meningitides(NM) outbreaks occur yearly with >3000 cases/year and 1.4-8.5% case fatality rate February 2011, a cluster of suspected meningitis cases in Harenabuluk; outside the classical meningitis belt areas Investigated to confirm the outbreak, identify etiologic agent, determine risk factors, and establish control measuresFETPEthiopia Methods Descriptive study followed by case-control study Introduced identical structured questionnaires to both patients and controls Case was a person from Harenabuluk in which NM was isolated by bacterial culture from cerebrospinal fluid between 02/02/-17/03/2011 Selected age and sex matched controls from the neighbor of patients in the ratio of 1:1 Adjusted odds ratios (AOR) with 95% of confidence interval (CI) Bivariate and multivariate analysis logistic regression Collected laboratory specimens from 49 patients Collected meteorological data Results Forty-nine cases identified in the outbreak Median age of 12 years(range,1-60years) Sixty (62%) were female Observed highest attack rate ( 115/10,000) among 20-29 years old (Table1) This was NM outbreak caused by serogroup A The outbreak showed two unusual characteristics Geographical location outside the meningitis belt and high age specific AR among 20-29 years The occurrence of the outbreak and the identified meningitis risk factors, demonstrate that meningitis outbreaks are possible in all situations once the NM has been introduced Our recommendations led to start vaccination (1-30 age groups) and active surveillance with monthly community health education on meningitis and its risk factors. Conclusions Map 1: Site of Meningitis outbreak-Harenabuluk, Ethiopia,2011 Laboratory analysis showed that all 49 patients were positive for NM serogroup A Harenabuluk District experienced extended drought We would like to thank the staff from the Oromia Regional Health Bureau, Madawalabu University and Bale Zone Health Department who participated in this investigation o Table2: Bivaiate analysis results-Harenabuluk,Ethiopia,2011 Date investigation began Figure 1: Meningitis case by date of onset, Harenabuluk, Ethiopia, 2011 Table1: Meningitis attack rate and case fatality rate by age group-Harenabuluk, Ethiopia,2011 Age group s Populati on Number of cases (%) of the total cases (N=49) Attack rate / 10,000 Deaths Case fatality rate / 100 0-4231714(29.17)60.4200 5-14195118(37)92.29211.11 15-29121014(27.08)115.7429 30+25413(6.25)11.800 Total801949(100)61.168.16 ExposureProportion exposed Odd ratio 95% confidence interval Cases (n %) Control (n (%) Having no ventilation31(63.3)10(24.4)8.33.2-10.6 Attendance at Koran teaching39(79.6)19(38.8)7.24.1-13.2 Having kitchen in the living room42(85.7)26(5.3)6.31.9-1-12.1 Living in one house with more than 4 peoples40(81.6)26(53.1)5.91.6-12 Sharing bedroom with more than two people37(75.5)19(38.8)4.82.0-11.6 Exposure to dusty environment34(69.4)26(53.1)41.1-4.5 Contact history with case-patient30(62.5)18(67.5)2.71.2-6.3 Sharing house with animals44(89.8)43(87.8)1.92.1-7 Travel history14(28.6)9(18.4)1.82-4-12 Bivariate analysis identified nine risk factors (Table2) Four risk factors remained associated in logistic regression (Table3) ExposureProportion exposed Odd ratio 95%confide nce interval Cases (n %)) Control (n (%)) Having no ventilation31(63.3)10(24.4)6.72.7-16.6 Attendance at Koran teaching39(79.6)19(38.8)6.12.5-15.2 Having kitchen in the living room42(85.7)26(5.3)5.32-13 Living in one house with more than 4 peoples40(81.6)26(53.1)3.91.6-11 Table3. Logistic regression analysis results-Harenabuluk, Ethiopia, 2011