Weekly Epidemiological Report

November Week 47

Editoral

Optimising Sample Collection for Cerebrospinal Meningitis Management in Nigeria

Cerebrospinal Meningitis (CSM) is one of the priority epidemic-prone diseases that is reported all year round in Nigeria. Despite its endemicity, CSM has predilection for dry season with peak between January and May. It is characterised by acute severe infection of the central nervous system (CNS) causing inflammation of the meninges with morbidity and mortality. Highest burden occurs in the part of sub-Saharan Africa known as the “Meningitis Belt. In Nigeria, the belt covers all the 19 northern states and the Federal Capital Territory (FCT).

In the last few years, low sample collection rates have been reported resulting in low confirmation rates. In 2019, only 30 (3.9%) of the suspected cases of meningitis were confirmed. The report of the recent After Action Review also corroborates low CSF collection rates as well as poor sample handling. It is against this backdrop that the Nigeria Centre for Disease Control (NCDC) has continued to intensify efforts to optimise sample collection and ensure effective management of confirmed cases.

As part of the preparedness activities for 2020/2021 peak season, the Nigeria Centre for Disease Control (NCDC) has sent alert letters to states to put necessary public health measures in place. We are supporting them in the areas of training and retraining of their public and clinical workforce to ensure they are well equipped with prerequisite knowledge and skill set for timely detection and effective management of cases.

In line with the above, the Nigeria Centre for Disease Control from 24th – 26th November, 2020 conducted a training on case management, sample and data management for Clinicians as well as Disease Surveillance and Notification Officers in Kebbi State. Other key states had previously being trained in these areas. The objectives of the training were to:

1. Train clinicians on case definition and clinical management of meningitis cases

2. Develop clinicians’ competence and skills in performing the lumbar puncture procedure and CSF sample handling

3. Improve health workers knowledge on packaging and transportation of CSF samples

4. Improve the working relationship between clinicians and their respective LGA DSNOs

5. Raise awareness of the BLoTIMA study proposed to take place in the state: This is an ongoing study to enhance bacterial diagnosis of CSM in five Northern States.

With 21 LGA DSNOs, 26 clinicians and four rapid team members trained, key outputs from the meeting were increased skills in CSF collection and management among the trainees. The NCDC will continue to support the sub-national level to improve CSF collection and data gathering for timely decision making. We are working towards reducing significantly, the morbidity and mortality associated with CSM in Nigeria.


Summary of Incidents

Notes

1. Information for this disease was retrieved from the Technical Working Group and Situation Reports

2. Case Fatality Rate (CFR) for this disease is reported for confirmed cases only

3. Information for this disease was retrieved from IDSR 002 data

4. CFR for this disease is reported for total cases i.e. suspected + confirmed

5. Information for sentinel influenza was retrieved from the laboratory


Lassa Fever

Key points

• There were 81 suspected cases, 10 were laboratory confirmed and two deaths were recorded from 5 LGAs in 5 States

Actions

To date:

• National Lassa fever multi-partner, multi-sectoral Technical Working Group (TWG) continues to coordinate the response activities at all levels

• Enhanced surveillance (contact tracing and active case finding) ongoing in affected States

• Response commodities- PPEs, Ribavirin (Injection and tablets), beds, tents, body-bags, thermometers, hypochlorite hand sanitizers, IEC materials, guidelines and SOPs distributed to States and treatment centres

Planned:

• Continue mobilisation of resources

• Finalisation of Lassa fever five-year Strategic plan


Cerebrospinal Meningitis (CSM)

Key points

There were 12 suspected cases of Cerebrospinal Meningitis (CSM) reported from six LGAs in five States (Delta – 1, Ebonyi – 1, Enugu – 1, Katsina – 8 & Ondo – 1). One was laboratory confirmed and no death was recorded

Actions

To date:

• National CSM TWG meets weekly to review reports from States and plan appropriately

• Enhanced surveillance in all states

Planned:

• Continue harmonisation of the national line list and SORMAS data

• Continue to ensure that states reporting cases send their line lists and collect cerebrospinal fluid for testing


Yellow Fever

Key points

• There were 129 suspected cases of Yellow Fever (YF) reported from 56 LGAs in 21 States and FCT. One was laboratory confirmed and no death was recorded

Actions

To date:

• National COVID-19 multi-partner Emergency Operations Centre (EOC) continues to coordinate response activities across states

Planned:

• Finalise ICG request for reactive mass vaccination in Enugu and Bauchi States

• Print IEC materials and distribute to States to sensitise communities and increase awareness for YF

• Continue to support affected states across all pillars of response

• Continue harmonisation of surveillance and laboratory data ongoing


Cholera

Key points

There were 19 suspected cases of Cholera reported from three LGAs in two States (Kwara – 18 & Sokoto – 1). None was laboratory confirmed and no death was recorded

Actions

To date

• National Cholera Multi-Sectoral Technical Working Group (TWG) is monitoring all States and supporting affected States

Planned:

• Continue follow up and monitoring of non-reporting States

• Continue harmonisation of the national line list and SORMAS data


Measles

Key points

• There were 122 suspected cases of measles reported from 63 LGAs in 20 States. None was laboratory confirmed and no death was recorded

Actions

To date

• National Measles TWG is closely monitoring measles surveillance data and providing feedback to relevant agencies and development partners

• Weekly surveillance and laboratory data harmonisation ongoing

Planned:

• Intensify follow up with States to update and transmit line list

• Continue monthly measles surveillance data review


Monkeypox

Key points

• There was no suspected case of Monkeypox in the reporting week

Actions

To date

• National Monkeypox Technical Working Group (TWG) is monitoring activities in all States

Planned:

• Enhance surveillance for monkeypox in high burden States

• Continue harmonisation of the national line list and SORMAS data


Acute Flaccid Paralysis (AFP)

Key points

• There were 103 suspected cases of AFP reported from 87 LGAs in 28 States and FCT. None was laboratory confirmed and no death was recorded


National Influenza Sentinel Surveillance

Key points

• The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for 0(0.0%), 17(31.5%) and 37(68.5%) of the total influenza A positive samples respectively. The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 3(27.3%), 8(72.7%) and 0(0.0%) of the total Influenza B positive samples respectively

• The percentage Influenza positive was highest in week 7 with 37.5%.


Coronavirus Disease (COVID-19)

Actions

To date:

• National COVID-19 multi-partner Emergency Operations Centre (EOC) continues to coordinate response activities across states

• Ongoing monitoring and tracking of the implementation of State Incident Action Plan (IAP) activities for COVID-19

• Ongoing support for the NYSC stream testing as part of camp screening procedures

• Organised and supervised weekly data analysis meeting for private laboratories testing inbound travels

Planned:

• Finalise plans with PTF on testing 450 persons per Local Government Area (LGA) in a survey

• Conduct e-fresher courses training for IPC trainers

• Develop plan routine testing for COVID-19

• Follow up with assessment of hand hygiene facilities under the Orange Network programme

• Finalise laboratory quality assurance plan


Timeliness and Completeness of Reports


Timeliness and Completeness of Reports by State

Highlight of the week

  • Summary of Incidents
  • Lassa Fever
  • Cerebrospinal Meningitis (CSM)
  • Yellow Fever
  • Cholera
  • Measles
  • Monkeypox
  • Acute Flaccid Paralysis (AFP)
  • National Influenza Sentinel Surveillance
  • Coronavirus Disease (COVID-19)
  • Timeliness and Completeness of Reports
  • Timeliness and Completeness of Reports by State

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