Weekly Epidemiological Report

August Week 35

Main Story

PUBLIC HEALTH PREPAREDNESS FOR DISASTER MANAGEMENT

Recently, there have been identified changes in climatic patterns across the globe. Experts have raised concerns over the increasing implications of this, including the risk of spread of communicable diseases. Given the incidents of flood in some States in Nigeria, it is very important that there is adequate preparedness for emergencies to inform prompt public health response.

Public health preparedness for disaster management should focus on key areas such as provision and sustainability of potable water, housing, sanitation, vector control particularly of endemic diseases, vaccination and treatment services. Focus should be also paid to sustaining the surveillance system as this would serve as a complimentary source of information on public health issues in the face of a disaster or an emergency

A disaster preparedness plan is an essential plan for all States, to guide public health preparedness and mitigate the impacts of disasters. The basis of development of a detailed plan should include the following:

1. Identifying vulnerability to natural or other hazards- It is important for the State Ministry of Health to gather information and collaborate with other sectors and institutions (meteorology, environment, geology, security agencies) that have the primary responsibility for collecting and analysing this information, to forecast disasters and prepare well ahead of time.

2. Building simple and realistic health scenarios of a possible and probable occurrence- A test run exercise will help States have a better understanding of their capabilities, and close gaps ahead of the occurrence of a disaster.

3. Ensuring regular and close communication among the main actors to develop a basic plan that outlines the responsibilities of each actor in the health sector (key departments of the Ministry of health, partner agencies, private sector, security agencies etc).

4. Sensitising and training the first health responders and managers to face the special challenges of responding to disasters and respond quickly in the event of an outbreak.

It is highly recommended that simulation and table top exercises be carried out as part of preparedness as it can provide further insight into how disaster situations can pan out, steps which may be missed can be assessed and aligned with established processes and also help to promote collaboration among agencies before the actual events occur.

References

1. Disease Control Priorities in Developing Countries, 2nd edition. Disease Control Priorities Project. Editors: Dean T Jamison, Joel G Breman, Anthony R Measham, George Alleyne, Mariam Claeson, David B Evans, Prabhat Jha, Anne Mills, and Philip Musgrove. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; New York: Oxford University Press; 2006.ISBN-10: 0-8213-6179-1.


In the reporting week ending on the 3rd of September, 2017:

o There were 171 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has assiduously reinvigorated its efforts at eradicating Polio.

o 424 suspected cases of Cholera were reported from seven LGAs (three States; Borno – 409, Kaduna - 3 and Kano - 12). None was laboratory confirmed and one death was recorded.

o 16 suspected cases of Lassa fever with two Laboratory confirmed and one deaths were reported from eight LGAs in seven States (Edo – 8, FCT – 1, Kogi – 1, Nassarawa – 1, Ogun -1, Ondo – 1 & Plateau - 3).

o There were five suspected cases of Cerebrospinal Meningitis (CSM) reported from four LGAs in four States (Cross River – 1, FCT – 1, Katsina – 2 & Ondo - 1). Of these, none was laboratory confirmed and no death was recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt.

o There were 155 suspected cases of Measles reported from 24 States. None was laboratory confirmed and no death was recorded.

In the reporting week, all States sent in their report. This is a remarkable improvement! Timeliness of reporting remains 84% in both previous and current weeks (Week 34 and 35) while completeness remains at 100%. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.


1. Lassa fever

Please note that the data reflects the routine reports i.e. all suspected cases including the laboratory positive and negative cases

1.1. 16 suspected cases of Lassa fever with two Laboratory confirmed and one death (CFR, 6.25%) were reported from eight LGAs (seven States; Edo – 8, FCT – 1, Kogi – 1, Nassarawa – 1, Ogun -1, Ondo – 1 and Plateau – 3) in week 35, 2017 compared with seven suspected cases and three deaths (CFR, 42.86%) reported from seven LGAs (three States) at the same period in 2016.

1.2. Laboratory results of the 16 suspected cases were two positives for Lassa fever (Kogi – 1, & Ondo -1) while 14 were negative for Lassa fever and other VHFs (Edo – 8, FCT- 1, Nassarawa – 1, Ogun - 1 and Plateau - 3).

1.3. Between weeks 1 and 35 (2017), 502 suspected Lassa fever cases with 111 laboratory confirmed cases and 61 deaths (CFR, 12.15%) from 80 LGAs (26 States) were reported compared with 823 suspected cases with 80 laboratory confirmed cases and 96 deaths (CFR, 11.66%) from 132 LGAs (28 States) during the same period in 2016 (Figure 1).

1.4. Between weeks 1 and 52 2016, 921 suspected Lassa fever cases with 109 laboratory confirmed cases and 119 deaths (CFR, 12.92%) from 144 LGAs (28 States and FCT) were reported compared with 430 suspected cases with 25 laboratory confirmed cases and 40 deaths (CFR, 9.30%) from 37 LGAs (14 States and FCT) during the same period in 2015 (Figure 2).

1.5. Investigation and active case search ongoing in affected States with coordination of response activities by the NCDC with support from partners.

1.5.1. National Lassa Fever Working Group meeting and weekly National Surveillance and Outbreak Response meeting on-going at NCDC to keep abreast of the current Lassa fever situation in the country.

1.5.2. Response materials for VHFs provided to support States

1.5.3. New VHF guidelines have been developed by the NCDC (National Viral Haemorrhagic Fevers Preparedness guidelines, Infection Prevention and Control of VHF and Standard Operating Procedures for Lassa fever management) and are available on the NCDC website.

1.5.4. National Lassa fever outbreak review meeting carried out with all affected States and partners

1.5.5. Ongoing reclassification of reported Lassa fever cases

1.5.6. Ongoing review of the variables for case-based surveillance for VHF

1.5.7. VHF case-based forms completed by affected States are being entered into the new VHF management system. This system allows for the creation of a VHF database for the country.

1.5.8. Confirmed cases are being treated at identified treatment/isolation centres across the States with Ribavirin and necessary supportive management also instituted

1.5.9. Onsite support was earlier provided to Ogun, Nasarawa, Taraba, Ondo and Borno States by the NCDC and partners

1.5.10. Offsite support provided by NCDC/partners in all affected States

1.5.11. NCDC and partners are providing onsite support in Ondo and Plateau State

1.5.12. States are enjoined to intensify surveillance and promote Infection, Prevention and Control (IPC) measures in health facilities.


2. MEASLES

2.1. In the reporting week, 155 suspected cases of Measles were reported from 24 States compared with 288 suspected measles cases and 1 death (CFR, 0.35%) reported from 27 States during the same period in 2016.

2.2. So far, 17,340 suspected Measles cases with 108 laboratory confirmed cases and 105 deaths (CFR, 0. 61%) have been reported in 2017 from 36 States and FCT (Figure 4) compared with 22,239 suspected cases and 98 deaths (CFR, 0.44%) from 36 States and FCT during the same period in 2016.

2.3. In 2016 (week 1 -52), 25,251 suspected Measles cases with 102 deaths (CFR, 0.40%) were reported from 36 States and FCT compared with 24,421 suspected cases with 127 deaths (CFR, 0.52%) during the same period in 2015 (Figure 5)

2.4. Response measures include immunisation for all vaccine-preventable diseases in some selected/affected wards/LGAs during SIAs, as well as case management.

2.5. Scheduled Measles campaigns in the North East were conducted from 12th – 17th January 2017 in Adamawa, Borno and Yobe States (Phase I) and Phase II from 21st – 25th January 2017 in Borno State and 4th – 8th February 2017 in Yobe State

2.6. Measles Surveillance Evaluation and Establishment of the burden of Congenital Rubella Syndrome (CRS) in 12 selected States in the six geopolitical zones from the 17th -21st July 2017 conducted

2.6.1 Debrief meeting to review results and next steps from Measles evaluation conducted, held on the 15th of September 2017

2.7. Harmonization of measles surveillance data with laboratory-confirmed cases


3. POLIOMYELITIS

3.1. As at August 20th, 2017, no new case of WPV was recorded

3.2. Three new cVDPV2, environmental derived and Polio compatible cases identified

3.2.1. In the reporting week, 171 cases of AFP were reported from 135 LGAs in 31 States and FCT

3.2.2. AFP Surveillance has been enhanced and outbreak response is on-going in Borno and other high-risk States

3.2.3. The 1st round of SIPDs in 2017 was conducted from 28th – 31st January 2017 in the 18 high-risk States. This was carried out using mOPV2 (2nd mOPV2 OBR). The schedule for other SIAs is as described in Table 2

3.2.4. The 2nd and 3rd round of SIPDs completed (25th-28th February and 8th – 11th July 2017) in 14 & 18 high-risk States using bOPV respectively.

3.2.5. The 1st and 2nd rounds of NIPDs completed (from 25th – 28th March 2017 and 22nd – 25th April 2017) nationwide respectively.

3.2.6. Between weeks 1 and 52 in 2016, four WPVs were isolated from Borno State compared to no WPV isolated during the same period in 2015.

3.3. No circulating Vaccine Derived Polio Virus type 2 (cVDPV2) was isolated in week 1 - 52, in both 2016 and 2015.

3.4. Between weeks 1 and 52, 2016 two (2) cVDPV2 were isolated in two LGAs (two States) while one (1) cVDPV2 was isolated from Kwali, FCT during the same period in 2015.

3.5. Six confirmed WPVs were isolated in 2014.

3.6. The SIAs were strengthened with the following events:

3.6.1. Immunization for all vaccine-preventable diseases in some selected wards/LGAs.

3.6.2. Use of health camp facilities.

3.6.3. Field supportive supervision and monitoring.

3.6.4. Improved Enhanced Independent Monitoring (EIM) and Lots Quality Assessments (LQAs) in all Polio high-risk States.

3.6.5. High level of accountability framework


4. CHOLERA

4.1. 424 suspected cases of Cholera and one death (CFR, 0.24%) were reported from seven LGAs (three States; Borno – 409, Kaduna - 3 and Kano - 12) in week 35 compared with zero cases reported during the same period in 2016.

4.2. Between weeks 1 and 35 (2017), 1622 suspected Cholera cases with 36 laboratory confirmed and 33 deaths (CFR, 2.03%) from 50 LGAs (16 States) were reported compared with 402 suspected cases and 13 deaths (CFR, 3.23%) from 34 LGAs (11 States) during the same period in 2016 (Figure 7).

4.3. Between weeks 1 and 52 (2016), 768 suspected Cholera cases with 14 laboratory confirmed cases and 32 deaths (CFR, 4.17%) from 57 LGAs (14 States) were reported compared with 5,301 cases with 29 laboratory confirmed cases and 186 deaths (CFR, 3.51%) from 101 LGAs (18 States and FCT) during the same period in 2015 (Figure 8).

4.4. Cholera preparedness workshop held from 31st May – 1st June 2017 in Abuja to

develop Cholera preparedness plan as the season set in.

4.5. NCDC/partners provided onsite support in Kwara, Zamfara and Kebbi States.

4.6 NCDC/partners are providing onsite support in Borno State.

4.7. Cholera Preparedness Checklist sent to all States to assess their level of preparedness with recommendations for prevention of and response to an outbreak.

4.8. RDT procured by NCDC and WHO currently being prepositioned in affected States

4.9. States are enjoined to intensify surveillance, implement WASH activities and ensure early reporting.


5. CEREBROSPINAL MENINGITIS (CSM)

5.7. In the reporting week 35, five suspected Cerebrospinal Meningitis (CSM) cases were reported from four LGAs (four States) compared with 12 suspected cases with one Laboratory-confirmed case from five LGAs (four States) at the same period in 2016.

5.8. Between weeks 1 and 35 (2017), 9781 suspected CSM cases with 108 laboratory confirmed cases and 602 deaths (CFR, 6.15%) were recorded from 312 LGAs (33 States) compared with 612 suspected cases and 29 deaths (CFR, 4.74%) from 134 LGAs (27 States) during the same period in 2016 (Figure 9).

5.9. Between weeks 1 and 52, 2016, 831 suspected CSM cases with 43 laboratory confirmed cases and 33 deaths (CFR, 3.97%) were recorded from 154 LGAs (30 States and FCT) compared with 2,711 suspected cases and 131 deaths (CFR, 4.83%) from 170 LGAs (28 States and FCT) during the same period in 2015 (Figure 10)

5.10. Timeliness/completeness of CSM case-reporting from States to the National Level (2017 versus 2016): on average, 81.4% of the 26 endemic States sent CSM reports in a timely manner while 97.8% were complete in week 1 – 35, 2017 as against 85.3% timeliness and 98.9% completeness recorded within the same period in 2016

5.11. CSM preparedness checklist sent to 36 States and FCT ahead of 2017 meningitis season

5.12. Confirmed cases treated at identified treatment centres in affected States (Zamfara, Sokoto, Katsina, Kebbi, Niger, Kano, Yobe and Jigawa) and necessary supportive management also instituted

5.13. CSM National Emergency Operations Centre constituted at the Nigeria Centre for Disease Control

5.14. Onsite support provided to Zamfara, Sokoto, Katsina, Kebbi, Kano, Yobe and Niger States by NCDC and partners

5.15. Off-site support provided to other States

5.16. Intensive Surveillance in high-risk States and NCDC in communication with States reporting suspected cases.

5.17. Reactive vaccination completed in Zamfara, Sokoto and Yobe States

5.18. Medical teams were trained and deployed to support case management in Sokoto and Zamfara States completed (from Friday 5th - 26th May, 2017).

5.19. Deployed mobile testing laboratory to Zamfara State to aid diagnosis

5.20. A Team was deployed by NCDC/WHO to support surveillance activities, laboratory data harmonization and monitoring of the implementation plan in Yobe state

5.21. Evaluation of the CSM outbreak response in Zamfara and Sokoto States is ongoing by NCDC and WHO

5.22. National CSM After-Action Review meeting conducted in Sokoto State from the 24th – 25th of July 2017.

5.23. NCDC attended the 14th Annual Meeting on Surveillance, Preparedness and Response to Meningitis Outbreaks in Africa, and 4th Annual MenAfriNet Partners’meeting held in Ouagadougou, Burkina Faso in preparation of 2017/2018 meningitis season from 12th to 15th September, 2017.


6. GUINEA WORM DISEASE

6.7. In the reporting week, no rumour report of Guinea Worm disease was received from any State.

6.8. Nigeria has celebrated eight consecutive years of zero reporting of Guinea worm disease in the country. The Country has been officially certified free of Dracunculiasis transmission by the International Commission for the Certification of Dracunculiasis Eradication (ICCDE).

(For further information, contact Nigeria Guinea Worm Eradication Program / Neglected Tropical Diseases Division, Public Health Department/Federal Ministry of Health)


7. Update on national Influenza sentinel surveillance, Nigeria week 1 - 36, 2017

7.1. From week 1-36, a total of 103 cases were reported, of which 95 were Influenza like-illness (ILI), 8 Severe Acute Respiratory Infection (SARI).

7.2 A total of 103 samples were received and all were processed. Of the processed samples, 95(92.2%) were ILI cases, 8(7.8%) were Severe Acute Respiratory Infection (SARI).

7.3 Of the 95 processed ILI samples, 4(4.2%) were positive for Influenza A; 2(2.1%) positive for Influenza B and 89(93.7%) were negative. Of the 8 processed SARI samples, (12.5%) was positive for Influenza A while 0(0.0%) was positive for Influenza B. 7(87.5%) were all negative. (not clear)

7.4. 6 (6.9%) of the processed 95 samples were positive for Influenza, with 4(66.7%) of these positive for Influenza A and 2(33.3%) positive for Influenza B. The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for (0.0%), 0(0.0%) and 2(50.0%) of the total influenza A positive sample respectively.

7.5. The percentage influenza positive was highest (50.0%) in week 14

7.6. In the reporting week36, no samples were left unprocessed

FOR MORE INFORMATION CONTACT

Surveillance Unit:

Nigeria Centre for Disease Control

801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.

epidreport@ncdc.gov.ng

www.ncdc.gov.ng/reports

0800-970000-10

Highlight of the week

  • In the reporting week ending on the 3rd of September, 2017:
  • 1. Lassa fever
  • 2. MEASLES
  • 3. POLIOMYELITIS
  • 4. CHOLERA
  • 5. CEREBROSPINAL MENINGITIS (CSM)
  • 6. GUINEA WORM DISEASE
  • 7. Update on national Influenza sentinel surveillance, Nigeria week 1 - 36, 2017

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