Weekly Epidemiological Report

May Week 17

Editoral

EMERGENCY PHASE OF 2018 LASSA FEVER OUTBREAK DECLARED OVER

In the reporting week, the Nigeria Centre for Disease Control (NCDC) through the Federal Ministry of Health declared the emergency phase of the Lassa fever outbreak over. This was given during a press briefing by the Honourable Minister of Health, Prof. Isaac Adewole. This declaration was made following the declining number of confirmed cases of Lassa fever recorded in the last 6 weeks.

Since onset of the outbreak on Jan 1st, 2018, a total of 423 confirmed cases have been recorded over an 18-week period and 106 deaths reported. This outbreak was the largest outbreak of Lassa fever that Nigeria has encountered and response level was at level three during which all personnel and available resources were mobilized to respond to the outbreak, alongside deployment of international emergency teams to support the efforts of the Lassa fever Emergency Operations Centre (LF-EOC). The LF-EOC serves as the coordinating platform for all response activities and has been de-escalated and reverted to watch mode with gradual winding down of all response activities.

Minimal activities will be carried out at the LF-EOC and this will include:

1. Enhanced surveillance activities in all states

2. Case finding

3. Increased risk communications activities

4. Increased community engagement

It is important to note that cases of Lassa fever will be recorded post-declaration and they will be managed at the treatment centres across the country. The NCDC will continue to heighten preparedness and response through various media and long-term strategies.


SUMMARY OF REPORTS

In the reporting week ending on April 29, 2018:

o There were 169 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 reinvigorated its efforts at eradicating Polio.

o 527 suspected cases of Cholera were reported from seven LGAs in six States (Bauchi – 371, Borno – 9, Ebonyi – 128, Kaduna – 1, Yobe – 15 & Zamfara – 3). Of these, two were laboratory confirmed and four deaths were recorded.

o 11 suspected cases of Lassa fever were reported from ten LGAs in seven States (Adamawa – 2, Ebonyi – 1, FCT – 2, Kogi– 1, Ogun – 2, Ondo - 1 & Taraba – 2). None was laboratory confirmed and no death was recorded.

o There were 70 suspected cases of Cerebrospinal Meningitis (CSM) reported from 26 LGAs in 11 States (Adamawa – 1, Borno – 4, Gombe – 1, Kano – 19, Kebbi – 1, Lagos – 1, Ondo – 3, Sokoto – 6, Taraba – 1, Yobe - 1 & Zamfara - 32). Of these, none was laboratory confirmed and 17 deaths were recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt and case-based surveillance commenced from 4th December 2017

o There were 508 suspected cases of Measles reported from 32 States. No laboratory-confirmed and one death were recorded.

In the reporting week, all States sent in their report except Edo and Katsina States. Timeliness of reporting increases from 89% in the previous week to 90% in the current week (week 16 & 17) while completeness remains 100% at the same period. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.


REPORT ANALYSIS AND INTERPRETATION

1. AFP

1.1. As at April 29th, 2018, no new case of WPV was recorded

1.2. In the reporting week, 169 cases of AFP were reported from 137 LGAs in 34 States & FCT

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

12.2 Two SIPDs and one NIPDs were conducted from January to April 2018 using bOPV in 18 high-risk States and 36 States plus FCT respectively

1.3. The SIAs were strengthened with the following events:

1.3.1. Immunisation for all vaccine-preventable diseases in some selected wards/LGAs.

1.3.2. Use of health camp facilities.

1.3.3. Field supportive supervision and monitoring.

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

1.3.5. High level of an accountability framework


2. CEREBROSPINAL MENINGITIS (CSM)

2.1 In the reporting week, 70 suspected Cerebrospinal Meningitis (CSM) cases and 17 deaths (CFR, 24.29%) were reported from 26 LGAs (11 States; Adamawa – 1, Borno – 4, Gombe – 1, Kano – 19, Kebbi – 1, Lagos – 1, Ondo – 3, Sokoto – 6, Taraba – 1, Yobe - 1 & Zamfara - 32) compared with 1041 suspected cases with four Lab. Confirmed cases and 50 deaths (CFR, 4. 8%) from 88 LGAs (16 States) at the same period in 2017 (Figure 2)

2.2 Between weeks 1 and 17 (2018), 2724 suspected meningitis cases with 78 laboratory confirmed and 175 deaths (CFR, 6.42%) from 233 LGAs (28 States) were reported compared with 8357 suspected cases and 551 deaths (CFR, 6.83%) from 277 LGAs (31 States) during the same period in 2017.

2.3 Timeliness/completeness of CSM case-reporting from States to the National Level (2018 versus 2017): on average, 88.2% of the 26 endemic States sent CSM reports in a timely manner while 98.2% were complete in week 1 - 17, 2018 as against 76.4% timeliness and 92.3% completeness recorded within the same period in 2017

2.4 The National CSM Emergency Operations Centre has been activated and is currently in response mode

2.5 Enhanced surveillance/ case-based surveillance began on 1st of December 2017

2.6 The National CSM Guidelines are available via

2.7 State CSM Emergency Operations Centre has been activated in Zamfara, Katsina and Sokoto States respectively

2.8 Preventive vaccination conducted in Yobe State with Men Afrivac in two phases -7th to 11th and 14th to 18th February 2018

2.9 NCDC deployed multi-disease response team to Bauchi State on the 11th March 2018 to support the State

2.10 NCDC, NPHCDA and partners conducted reactive vaccination approved by ICG in 12 wards (three States: Zamfara, Katsina & Sokoto) from 21st – 27th April 2018

2.11 Monitoring of risk communication activities in all States especially high-risk States

2.12 Surveillance Outbreak and Response Management Analysis System (SORMAS) tool deployed in Zamfara, Sokoto and Katsina states


CHOLERA

3.1 527 suspected cases of Cholera with two Lab. Confirmed cases and four deaths (CFR, 0.76%) were reported from seven LGAs (six States; Bauchi – 371, Borno – 9, Ebonyi – 128, Kaduna – 1, Yobe – 15 & Zamfara – 3) in week 17, 2018 compared with zero suspected case reported during the same period in 2017 (Figure 3).

3.2 Between weeks 1 and 17 (2018), 3605 suspected Cholera cases with 95 laboratory confirmed and 57 deaths (CFR, 1.58%) from 48 LGAs (17 States) were reported compared with 75 suspected cases and four deaths (CFR, 5.33%) from 13 LGAs (11 States) during the same period in 2017.

3.3 National Preparedness and Response to Acute Watery Diarrhoea/ Cholera Guidelines have been finalised: http://ncdc.gov.ng/themes/common/docs/protocols/45_1507196550.pdf

3.4 Ongoing plans for nationwide Cholera campaign with Federal Ministry of Water Resources and partner agencies

3.5 NCDC & partners are mapping Cholera hotspots in Nigeria for necessary plan and intervention

3.6 Rapid Response Team deployed to respond to the recent cluster of cases in Bauchi State


LASSA FEVER

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

4.1 11 suspected cases of Lassa fever were reported from ten LGAs (seven States: Adamawa – 2, Ebonyi – 1, FCT – 2, Kogi– 1, Ogun – 2, Ondo - 1 & Taraba – 2) in week 17, 2018 compared with two suspected cases reported from two LGAs (two States) at the same period in 2017

4.2 Laboratory results of the 11 suspected cases; all 11 were negative for Lassa fever & other VHFs (Adamawa – 2 Ebonyi – 1, FCT – 2, Kogi– 1, Ogun – 2, Ondo - 1 & Taraba – 2)

4.3 Between weeks 1 and 17 (2018), 760 suspected Lassa fever cases with 186 laboratory confirmed cases and 56 deaths (CFR, 7.37%) from 136 LGAs (29 States) were reported compared with 244 suspected cases with 58 laboratory confirmed cases and 46 deaths (CFR, 18.85%) from 51 LGAs (18 States) during the same period in 2017 (Figure 4)

4.4 Surveillance Outbreak and Response Management Analysis System (SORMAS) tool deployed in Edo, Ondo and Ebonyi States

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

4.6 Response materials for VHF provided to support States and health facilities

4.7 National VHF guidelines (National Viral Haemorrhagic Fevers Preparedness guidelines, Infection Prevention and Control of VHF and Standard Operating Procedures for Lassa fever management) are available on the NCDC website- http://ncdc.gov.ng/diseases/guidelines

4.8 Offsite support provided by NCDC/partners in all affected States

4.9 NCDC in collaboration with ALIMA is providing support to treatment centres in

Ebonyi, Ondo and Edo States where most of the patients are managed

4.13 NCDC deployed data management tools (SORMAS) on the field to encourage real-time reporting and data analysis/interpretation to inform prompt decision making

4.14 NCDC and Irrua Specialist teaching Hospital conducted the first phase of nationwide training on Lassa fever case management from 2nd to 4th May 2018 in Akure

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


5 MEASLES

5.1 In the reporting week, 508 suspected cases of Measles and one death (CFR, 0.2%) were reported from 32 States compared with 628 suspected cases with two Lab. Confirmed and one death (CFR, 0.16%) reported from 32 States during the same period in 2017

5.2 So far, 8682 suspected Measles cases with nine Lab. Confirmed and 85 deaths (CFR, 0.98%) were reported from 36 States and FCT compared with 9942 suspected cases with 63 laboratory confirmed and 64 deaths (CFR, 0.64 %) from 37 States during the same period in 2017

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

5.4 Measles mass campaign completed in the 17 Southern States from March 8 – 20, 2018

5.5 Measles mass campaign completed in the Northcentral States in February 2018 while North East and the North Western States were conducted in 2017


6 GUINEA WORM DISEASE

6.1 In the reporting week, no rumour report 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 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 - 18, 2018

7.1. From week 1- 18, 147-suspected cases were reported, of which 138 were Influenza like-illness (ILI), nine Severe Acute Respiratory Infection (SARI).

7.2 A total of 147 samples were received and 142 samples were processed. Of the processed samples, 133(93.7%) were ILI cases, nine (6.3%) were Severe Acute Respiratory Infection (SARI).

7.4. Of the 142 processed ILI samples, 16 (11.30%) was positive for Influenza A; 26(18.31%) positive for Influenza B and 100(70.4%) were negative.

7.5 For the processed nine SARI samples, five (55.56%) were positive for Influenza A while the remaining four (44.44%) were negative.

7.6 42 (29.6%) of the processed 142 samples were positive for Influenza, with 16 (38.1%) of these positive for Influenza A and 26 (61.9%) positive for Influenza B.

7.5. The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for (0.0%), 11 (68.8%) and 5 (31.2%) of the total influenza A positive samples respectively.

7.6 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 10(38.5%), 16(61.5%) and 0(0.0%) of the total influenza B positive samples respectively

7.7 The percentage influenza positive was highest (75.0%) in week 6, 2018

7.8 In the reporting week 1 -18, five samples were left unprocessed

Figure 19: Number of Influenza Positive Specimens and Percent Positive by Epidemiological Week (Week 1- 18, 2018)

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

  • SUMMARY OF REPORTS
  • REPORT ANALYSIS AND INTERPRETATION
  • 2. CEREBROSPINAL MENINGITIS (CSM)
  • CHOLERA
  • LASSA FEVER
  • 5 MEASLES
  • 6 GUINEA WORM DISEASE
  • 7. Update on national Influenza sentinel surveillance, Nigeria week 1 - 18, 2018

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