Cerebrospinal Meningitis (CSM) outbreaks are currently reported in 19 States with five States mostly affected (Zamfara, Katsina, Kebbi and Sokoto in the North-West zone and Niger in the North-Central zone of Nigeria).
The worst hit State in this current outbreak has been Zamfara State. It is important to note that the onset of the first case of the disease was in November 2016. However, the National level through the Nigeria Centre for Disease Control was only notified in February 2017.
A robust surveillance structure is highly essential in the detection, prevention and response to diseases during and out of outbreak seasons. The Integrated Disease Surveillance and Response (IDSR) technical guideline clearly states that Meningitis is an epidemic prone disease and therefore a suspected case should be notified immediately to the next reporting level.
To ensure proper reporting of cases to inform adequate public health action, the Meningitis Emergency Operations Centre (EOC) Nigeria sited at the Nigeria Centre for Disease Control, has provided line list forms and other documents for immediate reporting of suspected cases by States not currently affected by the outbreak, and daily situation reporting for States that are currently reporting cases in this outbreak.
These line list from the States will enable the National EOC understand the extent of the outbreak of bacterial meningitis C among States in the country. This will not only guide appropriate public health actions such as reactive vaccination campaigns, but also ensure proper communication with the general public. It is important to know that the other various causes of meningitis are not considered to be part of the current outbreak, and only a laboratory confirmed cases of Meningitis C forms part of outbreak cases.
Therefore, all States especially those in the meningitis belt are encouraged to ensure early and complete submission of data to the national EOC, as we work towards curtailing the outbreak.
In the reporting week:
o There were 431 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 to eradicate Polio.
o There were 20 suspected cases of Cholera reported from Dukku LGA (Gombe State). No death was reported. Further investigation confirmed them to be gastroenteritis.
o There were 1343 suspected cases of Cerebrospinal Meningitis (CSM) reported from 77 LGAs in 15 States. Of these, 14 cases were laboratory confirmed and 97 deaths were recorded. Surveillance for CSM is ongoing and intensified in the States, particularly as the dry season has set in.
o There were 882 suspected cases of Measles reported from 33 States including the FCT. Four laboratory confirmed cases and 11 deaths were recorded.
In the reporting week, two States (Abia and Akwa-Ibom) failed to report while three States reported late. Timeliness of reporting increased from 76.0% in the previous week to 77.0% in the current week while completeness remains 99.0% in both previous and current weeks. It is very important for all States to ensure timely and complete reporting at all times.
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. 17 suspected cases of Lassa fever with three laboratory confirmed case and four deaths (CFR, 23.53%) were reported from seven LGAs (five States) in week 13, 2017 compared with 29 suspected cases with three laboratory confirmed cases from two LGAs (two States) during the same period in 2016.
1.2. Laboratory results of the 17 suspected cases were three positive for Lassa fever (Edo – 2 and Kogi -1), six negative for Lassa fever and other VHFs (Edo - 5 and Kogi - 1) while eight results are pending (FCT – 1, Kano – 6 and Kebbi - 1).
1.3. Between weeks 1 and 13 (2017), 231 suspected Lassa fever cases with 57 laboratory confirmed cases and 43 deaths (CFR, 18.61%) from 44 LGAs (16 States) were reported compared with 580 suspected cases with 58 laboratory confirmed cases and 73 deaths (CFR, 12.59%) from 113 LGAs (26 States) during the same period in 2016 (Figure 2).
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 3).
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 prepositioned across the country by NCDC at the beginning of the dry season
1.5.3. New VHF guidelines being developed by the NCDC (Interim National Viral Haemorrhagic fevers preparedness guidelines and Standard Operating Procedures for Lassa fever management)
1.5.4. Ongoing reclassification of reported Lassa fever cases
1.5.5. Ongoing review of the variables for case-based surveillance for VHF
1.5.6. 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.
1.5.7. Confirmed cases are being treated at identified treatment/isolation centers across the States with Ribavirin and necessary supportive management also instituted
1.5.8. Onsite support was earlier provided to Ogun, Nasarawa, Taraba and Ondo States by the NCDC and partners.
1.5.9. The NCDC has deployed a team to Borno state to support the outbreak response and coordinate case management of patients and support implementation of IPC measures amongst healthcare workers
1.5.10. States are enjoined to intensify surveillance
2.1. In the reporting week, 882 suspected cases of Measles, four laboratory confirmed cases and 11 deaths (CFR, 1.25%) were reported from 32 States and FCT compared with 933 suspected measles cases from 29 States and FCT during the same period in 2016.
2.2. So far, 7,539 suspected Measles cases with 55 laboratory confirmed cases and 50 deaths (CFR, 0. 66%) have been reported in 2017 from 36 states and FCT (Figure 5) compared with 12,146 suspected cases and 34 deaths (CFR, 0.28%) 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 6)
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 campaign in the North East was 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
3.1. As at March 31th 2017, no new case of WPV recorded
3.2. Three new cVDPV2, environmental derived and Polio compatible cases identified
3.2.1. In the reporting week, 431 cases of AFP were reported from 289 LGAs in 33 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 NIPDs 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 round of SIPDs completed (25th-28th February, 2017) in 14 high risk States using bOPV.
3.2.5. The 3rd round of NIPDs completed (from 25th – 28th March, 2017) nationwide.
3.2.6. Between weeks 1 and 52, 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 2 LGAs (2 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
4.1. 20 suspected cases of Cholera were reported from Dukku LGA (Gombe State) in week 13 (2017), compared with zero case during the same period in 2016.
4.2. Between weeks 1 and 13 (2017), 67 suspected Cholera cases and four deaths (CFR, 5.97%) from ten LGAs (nine States) were reported compared with 194 suspected cases and 1 death (CFR, 0.52%) from 21 LGAs (seven States) during the same period in 2016 (Figure 8).
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 (15 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 9).
4.4. States are enjoined to intensify surveillance.
5. CEREBROSPINAL MENINGITIS (CSM)
5.1. In the reporting week, 1343 suspected Cerebrospinal Meningitis (CSM) cases with 14 laboratory confirmed cases and 97 deaths (CFR, 7.22%) were reported from 77 LGAs (15 States) compared with 43 cases with four laboratory confirmed cases and seven deaths (CFR, 16.28%) from five LGAs (five States) during the same period in 2016.
5.2. Between weeks 1 and 13 (2017), 2875 suspected CSM cases with 42 laboratory confirmed cases and 289 deaths (CFR, 10.05%) were recorded from 163 LGAs (26 States) compared with 395 suspected cases and 22 deaths (CFR, 5.57%) from 88 LGAs (23 States) during the same period in 2016 (Figure 10).
5.3. 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 11)
5.4. Timeliness/completeness of CSM case-reporting from States to National Level (2017 versus 2016): on average, 77.8% of the 26 endemic states sent CSM reports in a timely manner while 95.6% were complete in week 1 – 13, 2017 as against 82.0% timeliness and 96.7% completeness recorded within the same period in 2016
5.5. CSM preparedness checklist sent to 36 States and FCT ahead of 2017 meningitis season completed
5.6. Confirmed cases are being treated at identified treatment centres in three states (Zamfara, Sokoto and Katsina) and necessary supportive management also instituted
5.7. Onsite support was earlier provided to Zamfara State.
5.8. Onsite support ongoing in Zamfara, Sokoto, Katsina, Kebbi, Kano and Niger States by NCDC/AFENET
5.9. Intensive Surveillance is on-going in high risk States.
5.10. Reactive vaccination completed in Zamfara State for people aged one to 29 years.
5.11. Proposed reactive vaccination in Sokoto and Katsina States on progress.
6. GUINEA WORM DISEASE
6.1. In the reporting week, no rumour reports of Guinea Worm disease was received from any State.
6.2. 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 NIGEP NC/Director: Mrs. I, Anagbogu: +2348034085607, firstname.lastname@example.org)
FOR MORE INFORMATION CONTACT
Nigeria Centre for Disease Control
801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.