An epidemic was declared in mid-July by the Rwandan health authorities and undertook the vaccination of the entire population of Butare Province - some 800,000 people.

MSF has provided 150,000 doses of vaccines to the Rwanda Ministry of Health for a meningitis vaccination campaign, following an outbreak in Rwanda that has already killed 40 people since mid-June. Initially only isolated cases of meningitis were spotted in the health district of Kibilizi, in the southern province of Butare, 136 kms from the capital Kigali, so an initial round of vaccinations was organised by the Ministry of Health. It targeted 10,000 people aged over six months in the district of Kibilizi.

Vaccination campaigns usually target people aged from two years to 30. Older people have often acquired a natural imunity over the years. Infants do not tend to mount a good immune response to the vaccine, but if the older children and other people in their group are all vaccinated, this will afford the youngest ones some measure of protection through what is called "herd immunity".

Despite this first effort, the number of cases of meningitis increased. After a few days it became clear that a much higher number of patients than expected presented similar symptoms. By mid-July, the health authorities declared the epidemic and decided to launch a massive vaccination campaign for the entire population of Butare Province - some 800,000 people. The number of deaths due to meningitis is difficult to verify, and official figures probably underestimate the impact of the epidemic.

Many people are thought to have died at home after mistaking the meningitis symptoms for food poisoning. "The population is in panic now. Some patients we met said they would rather die at home than (pay for a medical consultation)", said Dr Saidou Disoning and - because they cannot afford to pay for health care - they would not see a doctor in the national health centres".

Following this information, MSF medical team explained to the people that they would get free treatment and encouraged them to go and consult with a doctor in any of the health centres. In addition to supplying the vaccines to the local health authorities and providing treatment for 500 patients, MSF has sent a nurse experienced in dealo, MSF medical coordinator. "Initially people thought they had food poialing with epidemics to support the local medical staff in taking care of meningitis patients.

Fatality rates with meningitis The case fatality rate for untreated meningococcal meningitis approaches 50 per cent, and even those people who survive may have subsequent damage causing disabilities such as paralysis or deafness. Even when it treated early and appropriately, meningitis is an extremely dangerous disease and the patient cannot always be saved - the case fatality rate tends to be between five per cent and 15 per cent.