Weekly Epidemiological Report

October Week 43

Editoral

Commencement of the Meningitis season: A call for Preparedness

The Nigeria Centre for Disease Control (NCDC) announces the commencement of the Meningitis season that usually starts from November to June with a peak in April. 26 States including Federal Capital Territory in Nigeria fall within the defined Africa Meningitis belt.

It is important to note that Nigeria experienced a large outbreak of Meningitis during 2016/2017 season and with State’s support, we achieved over 70% reduction in cases and deaths during the 2017/2018 season and it is possible to prevent more cases/deaths this season (2018/2019) if we prepare early.

Therefore, this is a wakeup call to all States to be better prepared to respond in event of an outbreak. As such, States are requested to intensify their support for these activities;

1. Strengthen active surveillance and notification for meningitis in communities and health facilities using standard case definition. For all suspected cases, ensure immediate collection of Cerebrospinal fluid (CSF) sample and send to the State Public Health Laboratory along with completed IDSR001B, immediately report the case to next level using IDSR001 A and line list same in IDSR001 C and all cases should be reported to NCDC using the shared line list template to ensure that you have appropriate support for response.

2. Set up an incident management system for Cerebrospinal meningitis (CSM) in anticipation of cases given the risk within your State

3. Procure and preposition Ceftriaxone, intravenous fluids and other medical supplies for immediate case management.

4. Train appropriate healthcare workers in all your health facilities to collect CSF samples from all suspected cases of CSM before commencement of treatment, and send same to the appropriate laboratory for diagnosis.

5. Commence social mobilization and health education of the public on signs and symptoms of CSM, prompt reporting of all suspected cases to health facilities for treatment and improving environmental sanitation/personal hygiene.

6. Produce and translate jingles to local languages in the State.

7. Resuscitate Epidemic Preparedness & Response (EPR) committee and Rapid Response Team (RRT) at the State and LGA levels.

8. Conduct regular supportive supervision to the LGAs and health facilities.

9. Enhance healthcare workers’ capacity to respond using the “National guidelines on Preparedness & Response to CSM” available via http://ncdc.gov.ng/themes/common/docs/protocols/511510449270.pdf

10. Involve all relevant stakeholders/partners in the State in planning and response.

The Nigeria Centre for Disease Control will continue to support State in their efforts to prevent and control diseases to better protect the health of Nigerians.


SUMMARY OF REPORTS

In the reporting week ending on October 28, 2018:

o There were 174 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 with the goal to eliminate polio in Nigeria.

o There were 454 suspected cases of Cholera reported from 29 LGAs in eight States (Adamawa – 106, Bauchi – 5, Borno – 197, Gombe – 7, Kano – 4, Katsina – 22, Yobe - 76 and Zamfara - 37). Of these, 25 were laboratory confirmed and eight deaths were recorded.

o There were 46 suspected cases of Lassa fever reported from 12 LGAs in seven States (Ebonyi – 3, Edo – 22, Gombe – 1, Kogi – 1, Nasarawa – 1, Ondo - 15 & Rivers - 3). Nine were laboratory confirmed and two deaths were recorded.

o There were 12 suspected cases of Cerebrospinal Meningitis (CSM) reported from nine LGAs in eight States (Borno – 1, Cross River – 1, Delta – 1, Katsina – 3, Ondo – 1, Taraba – 2, Yobe – 2 & Zamfara –1). Of these, none was laboratory confirmed and no death was recorded.

o There were 178 suspected cases of measles reported from 30 States. None was laboratory confirmed and three death were recorded.

In the reporting week, all States sent in their report except Delta and Kano States. Timeliness of reporting remains 87% in both previous and current weeks (42 & 43) while completeness also remains 99% at 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 October 28th 2018, no new case of WPV was recorded

1.2. In the reporting week, 174 cases of AFP were reported from 149 LGAs in 34 States

1.3. Between week 1 and 43 2018, 7245 suspected cases of AFP have been reported from 750 LGAs in 37 States

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

1.3.2. The 2nd NIPDs was conducted from 30th June to 3rd July, 2018 using bOPV in 36 States plus FCT

1.3.3. The 1st & 2nd Outbreak response (OBR) to cVDPV2 in Jigawa & Gombe States, Polio event in Sokoto (SLGAs) and mop-up response in 11 LGAs in Bauchi State conducted from 10th – 13th & 26th – 29th May, 2018 using mOPV2 respectively

1.3.4. 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


2. CEREBROSPINAL MENINGITIS (CSM)

2.1 In the reporting week, 12 suspected Cerebrospinal Meningitis (CSM) cases a were reported from nine LGAs (eight States; Borno – 1, Cross River – 1, Delta – 1, Katsina – 3, Ondo – 1, Taraba – 2, Yobe – 2 & Zamfara – 1) compared with eight suspected case reported from six LGAs (six States) at the same period in 2017 (Figure 1)

2.2 Between weeks 1 and 43 (2018), 4380 suspected meningitis cases with 318 laboratory confirmed and 358 deaths (CFR, 8.2%) from 293 LGAs (34 States) were reported compared with 9828 suspected cases and 602 deaths (CFR, 6.1%) from 320 LGAs (33 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 - 43, 2018 as against 76.4% timeliness and 92.3% completeness recorded within the same period in 2017


CHOLERA

3.1 454 suspected cases of Cholera with two Lab. Confirmed and 30 deaths (CFR, 6.6%) were reported from 29 LGAs (eight States; Adamawa – 106, Bauchi – 5, Borno – 197, Gombe – 7, Kano – 4, Katsina – 22, Yobe - 76 and Zamfara - 37) in week 43, 2018 compared with 108 suspected cases and three deaths (CFR, 2.8%) reported from six LGAs (four States) during the same period in 2017 (Figure 2).

3.2 Between weeks 1 and 43 (2018), 48,686 suspected Cholera cases with 829 laboratory confirmed and 1110 deaths (CFR, 2.3%) from 239 LGAs (29 States) were reported compared with 3642 suspected cases and 84 deaths (CFR, 2.3%) from 70 LGAs (19 States) during the same period in 2017.

3.3 A National Emergency Operations Centre (EOC) for Cholera has been activated at level 2 at NCDC. There has been a decline in number of new cases reported.

3.4 Rapid Response Teams have been deployed to respond to recent cluster of cases in Kano, Bauchi, Plateau, Zamfara, Adamawa and Katsina States.

3.5 National Preparedness and Response to Acute Watery Diarrhoea/ Cholera Guidelines available via http://ncdc.gov.ng/themes/common/docs/protocols/45_1507196550.pdf


4 LASSA FEVER

4.1 In the reporting Week 43 (22 – 28 October, 2018) nine new confirmed I cases were reported from Ondo (4), Edo (4) and Ebonyi (1) States with two new deaths reported from Ondo (1) and Edo (1) States and one probable case from Ebonyi State

4.2 From 1st January to 28th October 2018, a total of 2834 suspectedi cases have been reported from 22 states. Of these, 548 were confirmed positive, 17 are probable, 2604 negative (not a case)

4.3 Since the onset of the 2018 outbreak, there have been 141 deaths in confirmed cases and 17 in probable cases. Case Fatality Rate in confirmed cases is 25.7%

4.4 22 states have recorded at least one confirmed case across 89 Local Government Areas (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba, Delta, Osun, Rivers, FCT, Gombe, Ekiti, Kaduna, Abia, Adamawa and Enugu). sixteen states have exited the active phase of the outbreak while six – Edo, Delta, Ondo, Ebonyi, Kogi and Imo States remain activeiv

4.5 NCDC and Partners deployed Rapid Response Team (RRT) to Delta State

4.6 Lassa fever international Conference registration, abstract submission and sponsorship now open to the public on the conference website www.lic.ncdc.gov.ng

4.7 The Lassa fever national multi-partner, multi-agency Technical Working Group (TWG) continues to coordinate response activities at all levels. Response and laboratory supplies have been provided to priority States

4.8 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



5 MEASLES

5.1 In the reporting week, 178 suspected cases of measles and three deaths (CFR, 1.7%) were reported from 27 States compared with 321 suspected cases reported from 34 States during the same period in 2017

5.2 Since the beginning of the year, 15271 suspected measles cases with 1110 Lab. Confirmed and 123 deaths (CFR, 0.8%) were reported from 36 States and FCT compared with 19644 suspected cases with 108 laboratory confirmed and 109 deaths (CFR, 0.55 %) from 36 States and FCT, 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


6 Yellow fever

6.1 In this reporting week 22th – 28th October, 2018, 89 suspected cases were reported

6.2 No new in-country presumptive positive case was reported in the reporting week

6.3 Last confirmed case from Institut Pasteur (IP) Dakar is on the 18th October, 2018

6.4 A national yellow fever Emergency Operation Centre (EOC) has been activated to level 2

6.5 From the onset of this outbreak on September 12, 2017, a total of 3,347 suspected yellow fever cases with 56 Laboratory confirmed and 55 deaths (CFR, 1.7%) have been reported from 570 LGAs (36 States & FCT)

6.6 Yellow fever reactive vaccination campaigns conducted in the following States [Kebbi (7 LGAs), Niger (5 LGAs), Sokoto (1 LGA) & Katsina (1 LGA)]

6.7 Yellow fever vaccination campaigns have been successfully completed in six States (Nassarawa, Cross River, Akwa-Ibom, Kogi, Kwara & Zamfara) and 57 political wards in 25 LGAs in Borno State

6.8 Surveillance activities have been intensified across all States

6.9 NPHCDA, NCDC and partners concluded a micro plan training in Minna, Niger State for the six States (Borno, FCT, Kebbi, Niger, Plateau & Sokoto) implementing Yellow fever Preventive Mass Vaccination Campaign (PMVC) in November/December, 2018.

6.10 The 2018 phase 2b November PMVC to be implemented from 22nd November – 1st December, 2018 in Sokoto, Kebbi, Niger, FCT, Plateau and some LGAs in Borno States. Target population 9 months to 44 years, (85% of the total population)


7. Update on national Influenza sentinel surveillance, Nigeria week 1 – 44, 2018

7.1. From week 1- 44, 313-suspected cases were reported, of which 280 were Influenza like-illness (ILI), 33 Severe Acute Respiratory Infection (SARI).

7.2 A total of 313 samples were received and 305l samples were processed. Of the processed samples, 272(89.2%) were ILI cases, 33 (10.8%) were Severe Acute Respiratory Infection (SARI).

7.3 Of the 272 processed ILI samples, 20 (7.4%) was positive for Influenza A; 29(10.7%) positive for Influenza B and 223 (81.9%) were negative.

7.4 For the processed 33 SARI samples, seven (21.2%) were positive for Influenza A, two (6.1%) were positive for Influenza B, while the remaining 24 (72.7%) were negative.

7.5 Of the 305 processed samples, 58 (19.0%) were positive for Influenza, with 27 (46.6%) of these positive for Influenza A and 31 (53.4%) positive for Influenza B.

7.6 The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for (0.0%), 22 (81.5%) and 5 (18.5%) of the total influenza A positive samples respectively.

7.7 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 24(77.4%), 4(12.9%) and 3(9.7%) of the total influenza B positive samples respectively

7.8 The percentage of influenza positive was highest (100.0%) in week 43, 2018

7.9 In the reporting week 1 -44, eight samples are currently undergoing Laboratory processes

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
  • 4 LASSA FEVER
  • 5 MEASLES
  • 6 Yellow fever
  • 7. Update on national Influenza sentinel surveillance, Nigeria week 1 – 44, 2018

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