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WHO says undiagnosed illness in Liberia initially appeared to be undetermined poisoning after 31 cases, 13 deaths - April 26, 2017+ Neisseria meningi

Govt. sends for pathologist

05 May 2017
...
Briefing reporters on Thursday, 4 May at the Ministry of Information in Monrovia, he says a total of 28 probable cases have been recorded and of this number, 12 persons have died - 10 in Sinoe and two in Montserrado.
...
Dr. Kateh narrates that the story behind the mysterious deaths came as the result of a man, who came to Monrovia, and died and his remains were taken back to the county for wake-keeping, funeral and subsequent interment.
...
?Some of the analysis we are looking at could be probable exposure, probably it could be chemical or other things, but our analysis is leading us to the tea, there could be some probability that a container was not washed properly before using it, but there are lot of things that are being analyzed.?
...
http://www.thenewdawnliberia.com/politics/13549-govt-sends-for-pathologist
 
https://guardian.ng/features/health/poisoning-appears-cause-of-mystery-liberia-illness-says-who/
[h=1]Poisoning appears cause of mystery Liberia illness, says WHO[/h] Evidence suggests a mysterious illness that has killed 12 people in Liberia is linked to food or drink poisoning and is not a viral infection, the UN said Friday, confirming three new cases.
The World Health Organization said that as of Wednesday the number of patients had risen to 28, with the sickness still unexplained although Ebola and Lassa fever have been ruled out.
Results from ongoing tests at labs in the United States and Europe are still pending, but WHO spokesman Tarik Jaserevic told reporters in Geneva that ?the overall risk of spread is low.?
 
Source: http://www.who.int/csr/don/05-may-2017-unexplained-cluster-of-deaths-liberia/en/


[h=1]Unexplained cluster of deaths ? Liberia[/h] Disease outbreak news
5 May 2017

On 25 April 2017, the Ministry of Health of Liberia notified WHO and partners of a cluster of sudden deaths of unknown aetiology in Sinoe County. The event started on 23 April 2017 when an 11-year-old child had been admitted to hospital presenting with diarrhoea, vomiting and mental confusion after attending the funeral of a religious leader on 22 April 2017. The child died within one hour of admission.
As of 4 May 2017, a total of 28 cases including 12 deaths (case fatality rate: 43 %) were reported. Of those, 26 cases including 10 deaths were reported from Sinoe County, all in persons who had attended the funeral. The other two cases, both fatal, were reported from the capital Monrovia in Montserrado County. The first case in Monrovia had attended the funeral in Sinoe County and presented with fever, headache and vomiting on 27 April 2017. He passed away at a hospital in Monrovia. On 29 April 2017, his partner who did not attend the funeral also became ill and passed away the same day. Investigations are still ongoing.
To date, a total of 21 specimens have tested negative for Ebola virus disease (EVD) and Lassa fever. Samples from individuals (e.g. blood, urine, rectal swab, and others) and environment, including food samples are being further analyzed and tested.
[h=3]Public health response[/h] The Sinoe County Health Team is coordinating the response with the support of WHO, UNICEF, CDC, Africa Field Epidemiology Network (AFENET), and other partners. The Rapid Response Team (RRT) and the Incident Management System are activated for the management of the event.
Cases from Sinoe are being managed in the local hospital in Greenville, the capital of Sinoe County. The initial investigation was conducted by the RRT and active case search is being implemented in the affected and surrounding communities and among people that attended the funeral. In Montserrado County, a total of 42 individuals who participated in the burial in Greenville on 22 April 2017 are being closely monitored. In addition, close contacts of the two cases that died in Montserrado County are also being closely monitored.
The National Epidemic Preparedness and Response Committee led by the National Public Health Institute of Liberia has also been activated to support the response. National multidisciplinary teams are deployed to the affected county to provide technical support.
Surveillance is being strengthened through line-listing of cases, contact identification and follow-up, active case search and collection of food and drink samples for toxicology testing. Attendants of the funeral and contacts have been listed and are under follow-up.
The laboratory analysis is being strengthened. Water testing from the sources serving the affected areas has been conducted and preliminary results ruled out bacterial contamination. Heavy metal and chemical testing is ongoing. The government has requested WHO, CDC, and MSF to support the process of toxicological testing outside the country. Samples are being sent to different laboratories for additional testing.
Community engagement is being strengthened, with the support of UNICEF, through mass public awareness, local leaders? mobilization, and community member sensitization. Infection prevention and control measures are being implemented, namely re-enforcement of hand hygiene practices, water points testing and safe burials.
[h=3]WHO risk assessment[/h] At this stage the overall risk of spread of the event is considerate as low. The event is clustered among the participants of the funeral. In addition, there is a sharp decrease in the number of cases and deaths reported since 25 April 2017. These findings are indicative of a point source of exposure. The possibility of a food/ drink/ water contamination event is being actively investigated and the toxicology laboratory test will help to elaborate this hypothesis. A case-control study to identify possible exposures linked to illness is being conducted.
The efficient and timely implementation of the response to this event is a result of the expertise developed in Liberia following the large outbreak of EVD in 2014. This led to the quick identification of the event, testing and ruling out EVD as a causative agent, identification of contacts and their follow-up and the ongoing collaboration of the country with partners to perform laboratory testing of human and environmental specimen to identify the disease aetiology.
[h=3]WHO advice[/h] WHO recommends the close follow up of the cases and persons who attended the funeral as well as the reinforcement of hygiene and food safety measures in the affected areas. Additionally, WHO supports the ongoing epidemiological and laboratory investigations to identify the aetiological agent of this cluster of cases to guide additional control measures.
WHO does not recommend any restriction on travel and trade to Liberia on the basis of the information available on the current event.
 
Except for the partner in Monrovia, all 27 other cases attended the single funeral on April 22. There is no mention of anyone becoming ill after any of the other funerals, including that of the 11 year old.

​I don't know how we're accounting for the case mentioned to have taken ill after drinking the canned beverage on April 22 (unless she also attended the funeral and didn't take ill until after the funeral). Perhaps her case has been discarded?

http://www.who.int/csr/don/05-may-20...hs-liberia/en/
Unexplained cluster of deaths ? Liberia

Disease outbreak news
5 May 2017

On 25 April 2017, the Ministry of Health of Liberia notified WHO and partners of a cluster of sudden deaths of unknown aetiology in Sinoe County. The event started on 23 April 2017 when an 11-year-old child had been admitted to hospital presenting with diarrhoea, vomiting and mental confusion after attending the funeral of a religious leader on 22 April 2017. The child died within one hour of admission.
As of 4 May 2017, a total of 28 cases including 12 deaths (case fatality rate: 43 %) were reported. Of those, 26 cases including 10 deaths were reported from Sinoe County, all in persons who had attended the funeral. The other two cases, both fatal, were reported from the capital Monrovia in Montserrado County. The first case in Monrovia had attended the funeral in Sinoe County and presented with fever, headache and vomiting on 27 April 2017. He passed away at a hospital in Monrovia. On 29 April 2017, his partner who did not attend the funeral also became ill and passed away the same day. Investigations are still ongoing.
To date, a total of 21 specimens have tested negative for Ebola virus disease (EVD) and Lassa fever. Samples from individuals (e.g. blood, urine, rectal swab, and others) and environment, including food samples are being further analyzed and tested.
Public health response

The Sinoe County Health Team is coordinating the response with the support of WHO, UNICEF, CDC, Africa Field Epidemiology Network (AFENET), and other partners. The Rapid Response Team (RRT) and the Incident Management System are activated for the management of the event.
Cases from Sinoe are being managed in the local hospital in Greenville, the capital of Sinoe County. The initial investigation was conducted by the RRT and active case search is being implemented in the affected and surrounding communities and among people that attended the funeral. In Montserrado County, a total of 42 individuals who participated in the burial in Greenville on 22 April 2017 are being closely monitored. In addition, close contacts of the two cases that died in Montserrado County are also being closely monitored.
The National Epidemic Preparedness and Response Committee led by the National Public Health Institute of Liberia has also been activated to support the response. National multidisciplinary teams are deployed to the affected county to provide technical support.
Surveillance is being strengthened through line-listing of cases, contact identification and follow-up, active case search and collection of food and drink samples for toxicology testing. Attendants of the funeral and contacts have been listed and are under follow-up.
The laboratory analysis is being strengthened. Water testing from the sources serving the affected areas has been conducted and preliminary results ruled out bacterial contamination. Heavy metal and chemical testing is ongoing. The government has requested WHO, CDC, and MSF to support the process of toxicological testing outside the country. Samples are being sent to different laboratories for additional testing.
Community engagement is being strengthened, with the support of UNICEF, through mass public awareness, local leaders? mobilization, and community member sensitization. Infection prevention and control measures are being implemented, namely re-enforcement of hand hygiene practices, water points testing and safe burials.
WHO risk assessment

At this stage the overall risk of spread of the event is considerate as low. The event is clustered among the participants of the funeral. In addition, there is a sharp decrease in the number of cases and deaths reported since 25 April 2017. These findings are indicative of a point source of exposure. The possibility of a food/ drink/ water contamination event is being actively investigated and the toxicology laboratory test will help to elaborate this hypothesis. A case-control study to identify possible exposures linked to illness is being conducted.
The efficient and timely implementation of the response to this event is a result of the expertise developed in Liberia following the large outbreak of EVD in 2014. This led to the quick identification of the event, testing and ruling out EVD as a causative agent, identification of contacts and their follow-up and the ongoing collaboration of the country with partners to perform laboratory testing of human and environmental specimen to identify the disease aetiology.
WHO advice

WHO recommends the close follow up of the cases and persons who attended the funeral as well as the reinforcement of hygiene and food safety measures in the affected areas. Additionally, WHO supports the ongoing epidemiological and laboratory investigations to identify the aetiological agent of this cluster of cases to guide additional control measures.
WHO does not recommend any restriction on travel and trade to Liberia on the basis of the information available on the current event.
 
WORLDPOST 05/06/2017 06:22 pm ET | Updated 24 minutes ago

13 Dead From Unexplained Illness In Liberia
...
By Lauren Weber

A mysterious illness has killed 13 people and sickened 30 others in Liberia since April 23, according to the World Health Organization.

Dr. Alex Gasasira, the WHO?s representative in Liberia, told HuffPost on Saturday that while authorities have not found the ?smoking gun? of what has caused the unexplained illnesses and deaths in Sinoe County, Grand Bassa County and the capital city of Monrovia, all signs seem to point to an accidental ?poisoning event? of some sort.
...
Of those that have died, 12 attended the funeral on April 22 or wake the night before for a religious leader in Sinoe County. One lived in the same house as people that had attended the wake or funeral, Dr. Francis Kateh, Liberia?s deputy health minister and chief medical officer, told HuffPost. Only one person of the 30 who fell ill remains hospitalized, and she is expected to recover, Kateh said.

?Much of everything is pointing to this poisoning event, but we have not entirely ruled out the possibility of an infectious process,? Gasasira said. ?Clinical signs are not completely classical with any common chemical that we have seen as being poisonous in the past, so we continue to follow all leads.?

Gasasira and Kateh said authorities believe that tea drunk at the wake and funeral may be the culprit, as those that consumed the tea have shown an increased association with falling ill and have said it tasted different than it should. However, health authorities were still gathering samples of food and drink from the homes of those who had attended the wake and funeral.
...
The most common symptoms of those that fell ill included abdominal pain, vomiting, weakness, headache, and mental confusion. Some had a hard time breathing and others foamed at the mouth, Gasasira said.

Patients were given oxygen and fluids to treat the dehydration from vomiting. They were also given a broad spectrum antibiotics. Amongst those that have gotten better, an unusual rash around their feet and wrists has developed called petechiae, according to Kateh.
...

http://www.huffingtonpost.com/entry...llness-in-liberia_us_590e2c2ae4b0104c734f7302
 
The article also contains the statement:
It is common practice in Liberia to contribute food or drink for the wake and funeral and then bring it back to the home ? which is how Gasasira says the other case is believed to have been infected.

​(The unusual rash reported above also suggests some kind of hemorrhagic process is going on. There are several anticoagulants used worldwide as rodenticides that might produce symptoms like this if ingested in high enough doses. - alert)
 
During the ebola crisis there were rumors about wells being poisoned in Liberia. Turns out chlorine and possibly other disinfectants were being added to wells out of fear of ebola and overdoses happened. The Observer has a follow-up on that and general drinking water problems in the country.

https://www.liberianobserver.com/columns/women/the-shocking-truth-about-our-drinking-water/
[h=1]The Shocking Truth About Our Drinking Water[/h] -I?m thirsty
By
Claudia Smith -

April 19, 2017

... Meanwhile, a family in Caldwell recalls that during the Ebola period many women and children became ill and lost their lives from drinking from contaminated or ?poisoned? wells. In reality, those poisoning the wells were those who thought an added quantity of chlorine could keep their wells safe from the Ebola virus.
?People would drink a cup and start vomiting; and before two or three days, die from stomach challenges,? the family added.
Presently, children (like the one pictured above) drink directly from wells whose waters are not intended for direct consumption; and in some instances, skin conditions, stomach cramps and loss of appetite occur after a cup of water from such wells.
When asked if the drinking water has any signs of chemicals, the children replied that ?the water is sweet.?
So what are the risks of using too much chlorine?...
Click to expand...
 
Meningococcal disease is symptomatically consistent, and would explain most of the reported symptoms (including the bizarre rash caused by broken blood vessels). It would also explain the rapid fatalities and the H2H spread, as well as the positive response to antibiotics.

​As West Africa is in the middle of multiple meningitis outbreaks elsewhere, I'm a bit surprised it would have taken this long to identify if this indeed is the cause. There are multiple strains of the bacteria; I wonder if the testing took so long because it might be a novel or uncommon strain?

​I'm looking, but I can't find any article confirming this fact, however.
 
sharon sanders said:
I have asked Kai for a link:
Click to expand...



His response:



Kai Kupferschmidt‏ @kakape 12m12 minutes ago More



Replying to @FluTrackers
This is what I was told by someone at the National Public Health Institute of Liberia. Apparently there was a press 1/2


Kai Kupferschmidt‏ @kakape 12m12 minutes ago More



Replying to @FluTrackers
conference by Liberian MoH at 11 this morning where this was made public as well. but have not found a record so far. 2/2


Kai Kupferschmidt‏ @kakape 2m2 minutes ago More



CDC tells me they have completed inf dis tests and are finalizing official statement @FluTrackers
 
[h=1]Mystery illness in Liberia appears to be meningitis -minister[/h]
MONROVIA, May 8 (Reuters) - Medical samples from four of the victims of a disease in Liberia that initially baffled scientists have tested positive for a type of meningitis, the minister of health said on Monday.
So far a total of 31 cases of the so-called mystery illness have been reported, including 13 deaths in an outbreak linked to the attendance of a religious leader's funeral.
While the symptoms are different from Ebola, the sudden deaths nevertheless stirred anxiety about an outbreak of the tropical illness which was often spread through burial rituals in the West African epidemic that ended less than a year ago.
Seven specimens from the deceased tested positive for Neisseria meningitis, a particularly contagious type of bacteria, Dr. Bernice Dahn told reporters on Monday.
"Based on these initial results from the CDC Atlanta (U.S. Center for Disease Control), we believe that we are dealing with a probable outbreak of meningitis in Sinoe, which spread to Montserrado and Grand Bassa counties," she added, while calling for calm.
She said the government was investigating options for mass vaccinations against the illness, characterised by swelling of the membranes in the brain and spinal cord. Further laboratory analysis is under way. (Reporting by James Harding Giahuye; writing by Emma Farge; editing by Mark Heinrich)


http://www.dailymail.co.uk/wires/re...ness-Liberia-appears-meningitis-minister.html
 
[h=1]Meningitis Suspected In Unexplained Cluster Of Deaths In Liberia[/h]
Senior Press Officer Sharon Hoskins wrote in a statement to HuffPost that the CDC is sending two meningitis laboratory scientists and one meningitis senior epidemiologist to Liberia this week to join the staff from the CDC Country Office in Liberia in the investigation.

On Saturday, Kateh stressed that this infection appears to be localized to those that attended the funeral and wake and one close contact. The CDC also reiterated that there is ?no direct threat to the United States.?

http://www.huffingtonpost.com/entry...deaths-in-liberia_us_59109a8ee4b0e7021e99b055
 
alert said:
Meningococcal disease is symptomatically consistent, and would explain most of the reported symptoms (including the bizarre rash caused by broken blood vessels). It would also explain the rapid fatalities and the H2H spread, as well as the positive response to antibiotics.

​As West Africa is in the middle of multiple meningitis outbreaks elsewhere, I'm a bit surprised it would have taken this long to identify if this indeed is the cause. There are multiple strains of the bacteria; I wonder if the testing took so long because it might be a novel or uncommon strain?

​I'm looking, but I can't find any article confirming this fact, however.
Click to expand...

Nope, not a new strain. Type C:

http://www.huffingtonpost.com/entry...deaths-in-liberia_us_59109a8ee4b0e7021e99b055
[h=1]Meningitis Suspected In Unexplained Cluster Of Deaths In Liberia[/h] [h=2]Four of the 13 patients who died have tested positive for Neisseria meningitidis serogroup C.[/h] By Lauren Weber








Four of the 13 patients who died of a mysterious illness in Liberia since April 23 have tested positive for Neisseria meningitidis serogroup C, a bacterial form of meningitis, according to the U.S. Centers for Disease Control and Prevention.

The news confirmed what Dr. Francis Kateh, Liberia?s deputy health minister and chief medical officer, told HuffPost Sunday.

Additional testing is ongoing to determine if the other deaths and 30 other illnesses in Sinoe County, Grand Bassa County and the capital city of Monrovia following the wake and funeral of a religious leader in Sinoe County are also due to this type of infection.
 
[h=1]Health Minister Links Outbreak in Sinoe County to Meningitis[/h]
It remains unclear how the disease spread to several persons in the same location at the same time as most of the deceased were not closely related. According to healthline.com, ?most of the bacteria that cause this form of infection are spread through close personal contact, such as coughing, sneezing, and kissing. Throat secretions from an infected person (for example, phlegm or saliva) contain bacteria. When you cough or sneeze, the bacteria travel through the air.
But most of the germs that can lead to bacterial meningitis are relatively non-contagious. In fact, the bacteria that cause meningitis are less contagious than the viruses that cause the cold or flu.?
The symptoms are, however, similar to that which was observed prior to the death of victims in Sinoe County.
Dr. Dahn during Monday?s press conference said a total of 27 cases and 10 deaths have been reported from Sinoe County, while Montserrado County recorded two cases and two deaths, and Grand Bassa County reported two cases and one death.
?Liberia has never experienced Meningitis before,? Dahn said, noting that Meningitis normally affects countries that are hot and have a long dry season; such as Mauritania, Burkina Faso, Sudan, Ethiopia and other sub-Sahara countries which usually experience Meningitis every two years or sometimes annually.


http://africa.madepress.com/?p=10669
 
hat tip @kakape [h=1]Liberian mystery disease may be solved[/h] [FONT=&quot]By Kai KupferschmidtMay. 8, 2017 , 5:45 PM[/FONT]
[FONT=&quot]When several people died suddenly late last month in Liberia after attending a funeral in the southern county of Sinoe, alarm bells sounded: Had Ebola returned to West Africa? In 2014 and 2015, the largest known outbreak of the deadly disease killed more than 11,000 people in Liberia and two neighboring countries. But instead of signaling the return of that virus, the outbreak?which so far has sickened 30 people and killed 13?may have highlighted its legacy: a disease-monitoring system put in place after Ebola. Although the public health response was far from flawless, it rapidly stilled Ebola fears and now points to a different disease: meningitis.[/FONT]
more...


http://www.sciencemag.org/news/2017/05/liberian-mystery-disease-may-be-solved
 
alert said:
Meningococcal disease is symptomatically consistent, and would explain most of the reported symptoms (including the bizarre rash caused by broken blood vessels). It would also explain the rapid fatalities and the H2H spread, as well as the positive response to antibiotics.

​As West Africa is in the middle of multiple meningitis outbreaks elsewhere, I'm a bit surprised it would have taken this long to identify if this indeed is the cause. There are multiple strains of the bacteria; I wonder if the testing took so long because it might be a novel or uncommon strain?

​I'm looking, but I can't find any article confirming this fact, however.
Click to expand...

Alert, did you read about cases responding to antibiotics, or are you thinking along the lines that the prophylactic antibiotics that were given may have terminated the H2H spread?

The Sciencemag article Sharon just posted has possible explanations as to why if this outbreak was caused by MenC, it wasn't recognized sooner.

"But the evidence for meningitis is mounting. A Kenyan pathologist who did autopsies this weekend on two of the bodies noted signs consistent with meningitis, Nagbe says. Although few patients had fever, a common sign of meningitis, other symptoms and the short time between onset of disease and death are typical. ?The clinical presentation was very unusual, that is why meningitis was not at the top of our list,? Gasasira says. Samples from the other patients will be tested for N. meningitidis as well, Gasasira says. ?Then we?ll be much more confident.? A big question is why N. meningitidis should suddenly appear in Liberia. Since a new vaccine was introduced in 2010, the number of meningitis cases in Africa has dropped dramatically. But that vaccine protects only against serotype A. The number of infections with serotype C has gone up; Nigeria and Niger are now battling a large outbreak. ?Meningitis C is filling the vacuum created where meningitis A was a problem,? Gasasira says. ?But we never had Type A.? Another possibility is that the disease was present in Liberia but just wasn?t picked up in the past. "

I'm still skeptical that this was a MenC outbreak due to the lack of fever, etc. I'd like to know how the positive test results can differentiate between benign carriage of the bacteria vs disease. Also, if this is a MenC outbreak and the current vaccine used in Africa only protects against serotype A, why are they considering a mass campaign with an A vaccine for a C outbreak?
 
Emily said:
Alert, did you read about cases responding to antibiotics, or are you thinking along the lines that the prophylactic antibiotics that were given may have terminated the H2H spread?

The Sciencemag article Sharon just posted has possible explanations as to why if this outbreak was caused by MenC, it wasn't recognized sooner.

"But the evidence for meningitis is mounting. A Kenyan pathologist who did autopsies this weekend on two of the bodies noted signs consistent with meningitis, Nagbe says. Although few patients had fever, a common sign of meningitis, other symptoms and the short time between onset of disease and death are typical. “The clinical presentation was very unusual, that is why meningitis was not at the top of our list,” Gasasira says. Samples from the other patients will be tested for N. meningitidis as well, Gasasira says. “Then we’ll be much more confident.” A big question is why N. meningitidis should suddenly appear in Liberia. Since a new vaccine was introduced in 2010, the number of meningitis cases in Africa has dropped dramatically. But that vaccine protects only against serotype A. The number of infections with serotype C has gone up; Nigeria and Niger are now battling a large outbreak. “Meningitis C is filling the vacuum created where meningitis A was a problem,” Gasasira says. “But we never had Type A.” Another possibility is that the disease was present in Liberia but just wasn’t picked up in the past. "

I'm still skeptical that this was a MenC outbreak due to the lack of fever, etc. I'd like to know how the positive test results can differentiate between benign carriage of the bacteria vs disease. Also, if this is a MenC outbreak and the current vaccine used in Africa only protects against serotype A, why are they considering a mass campaign with an A vaccine for a C outbreak?
Click to expand...

​I don't know if antibiotics were prophylactically used (to terminate H2H spread), but I do know that most of the cases that survived long enough to reach treatment survived. The articles said that treatment consisted of rehydration and antibiotics, so once we had ruled out things like cholera and dysentery (which the rash alone likely would do), it had to be the antibiotics that were helping.

​Also, we have a report here of a case that attended the funeral and was found alive and unconscious on May 1, that has apparently since recovered. That would be incredibly unlikely for a mass poisoning on April 22.
 
Update on unexplained cluster of deaths ? Liberia


10 May 2017

On 25 April 2017, the Ministry of Health of Liberia notified WHO and partners of a cluster of sudden deaths of unknown aetiology in Sinoe County. The event began on 23 April 2017 when an 11-year-old child was admitted to hospital presenting with diarrhoea, vomiting and mental confusion after attending a funeral on 22 April 2017.

As of 9 May 2017, a total of 31 cases including 13 deaths have been reported.

The Ministry of Health of Liberia (MOH) responded quickly to the cluster using the emergency management and laboratory infrastructure it developed during the Ebola outbreak alongside WHO, and other public health partners. The Liberian MOH sent blood, urine, and plasma samples to the US Centers for Disease Control and Prevention (CDC) for testing of infectious diseases and environmental toxins.

On 8 May, WHO was informed by Liberia?s MOH that samples from four of the deceased patients had tested positive for meningitis C (Neisseria menigitidis). Although these most recent reports point to meningitis as the probable cause of illness and death in these patients, the investigation is still ongoing to determine if this bacteria is responsible for other reported illnesses in this cluster.

While awaiting full toxicology reports, the Liberian MOH is exploring whether vaccination against meningitis is an appropriate course of action. WHO supports the ongoing epidemiological and laboratory investigations to identify the aetiological agent of this cluster of cases to guide additional control measures.

Since it was notified of the cluster of sudden deaths, WHO has worked closely with Liberian Ministry of Health and other partners in areas of overall coordination, surveillance, contact tracing, case management, social mobilization, community engagement, laboratory investigation, and infection prevention and control.
http://www.who.int/hac/crises/lbr/update-deaths-liberia/en/
 
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