As Burkina Faso’s death toll continues to climb from a meningitis epidemic, the family of Adele Kabore is still dealing with the fallout from her bout with the disease five years ago.

“She looks okay but for those who live with her there is something abnormal at times,” her father, Alexis Kabore, says. “She is nervous and reacts unexpectedly and violently sometimes.”

Adele, now 18, was once a bright secondary school student with a hopeful future. But after she was struck with meningitis all that changed. In addition to changed behaviour, she suffers from memory loss and has to concentrate intensely before answering a question. She spends her time helping her mother with cooking or roaming a local market helping women sell beer or spices.

About 10 percent of people who contract meningitis die and 10-20 percent of survivors suffer brain damage, hearing loss or learning disabilities.

In this year’s epidemic in Burkina Faso alone that means at least 2,000 people have become disabled in addition to the 1,337 people who have already died. The government says meningitis has infected 19,549 people in the country so far this year.

Across Africa the disease has claimed more than 1,600 lives in 2007, according to the World Health Organisation (WHO). Thirteen countries have been affected, including Burkina Faso, Benin, Cote d’Ivoire, Cameroon, Ghana, Mali, Niger, Nigeria, Chad and Togo in West Africa. Other countries include Sudan, the Central African Republic, the Democratic Republic of Congo and Ethiopia.

These countries lie in the semi-arid ‘meningitis belt’ that stretches from Senegal in the west to Ethiopia in the east. Meningitis outbreaks flare up each year during the dry season between December and June when strong, dust-laden winds and cold nights make people more prone to respiratory infections. The meningitis bacteria are transmitted by sneezing or coughing.

International health experts worry that meningitis-prone countries might be on the brink of a massive epidemic such as the one in 1995-1997 that claimed 25,000 lives among at least 250,000 people who were infected. WHO says it is particularly concerned about the appearance of a new serotype of meningitis in Burkina Faso and Niger.

To prepare for this year’s likely outbreak, Burkina Faso in January, in conjunction with the United Nations, adopted a preparedness and response plan but the country still ended up struggling because the disease this year spread faster than last year. Thirty-four of the country’s 55 health districts are experiencing an epidemic, Burkinabe health officials say.

As the government scrambled to secure additional vaccines and medication, a range of health partners stepped forward. In addition, the UN Central Emergency Response Fund (CERF) on 3 April allocated US$1.8 million to the UN children’s agency (UNICEF) and WHO to help battle the spread of the disease, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

During an inter-country meningitis workshop held in Mali last year, participants noted the risk of a large-scale epidemic in 2007-2008 and recommended a range of preparedness measures to be undertaken at the national and international level. A regional health working group was established in Dakar to ensure strong coordination among humanitarian partners.

As a result of the 1995-1997 wave of epidemics, WHO helped establish the International Coordination Group on Vaccine Provision for Epidemic Meningitis Control (ICG) to ensure rapid and equal access to low-cost meningitis vaccines and medicine. Only one pharmaceutical company produces the meningitis vaccines used during outbreaks in Africa and its production has slowed.

Should a major epidemic occur in the next few years, the estimated vaccine gap could be as much as 52 million doses in a worst-case scenario, WHO says.

To help shore up meningitis vaccines for the coming years, ICG has been seeking potential new vaccine producers. In addition, development of a new, longer-lasting vaccine is underway but is not expected to be ready until 2009 or 2010.

Health experts fear that these measures will not come soon enough to help avert a major epidemic.

“Weak health infrastructures would quickly become overwhelmed and thousands of human lives could potentially be at risk,” OCHA said.