Weekly Epidemiological Report

December Week 51

Editoral

Strengthening outbreak coordination and response in Nigeria

The response to outbreaks usually involve multiple activities, many of which occur concurrently. In most situations, resources are scarce and few personnel are involved or available to respond to an outbreak. To strengthen coordination across the country, one of the recent projects of the Nigeria Centre for Disease Control (NCDC) has been the establishment of state level Emergency Operations Centre (EOC).

An EOC is a structure set up for the preparation, coordination and management of response activities to public health events. It is also known as an incident command centre (ICC) and can operate in three different modes namely -Watch, Alert and Response Modes. These different modes function based on information received by the EOC on public health events. An Incident Manager (IM) is usually appointed as the lead in an EOC and is responsible for proper allocation of resources, aligning of activities, facilitating EOC meetings and production/approval of outbreak related documentations.

NCDC has also over the past eight months supported 11 States across the country to establish well-defined Public Health Emergency Operation Centres (PHEOC), which has improved the surveillance and response to public health threats and incidents. The replication of this at the State level, has greatly contributed to a stronger and better coordinated response to outbreaks in the country.

In addition, ahead of the dry season when there is usually an increase in cases of diseases such as meningitis and Lassa fever, NCDC is working with state EOCs and Ministries of Health to ensure preparedness. Based on epidemiological forecast, NCDC prepositioned some medicines and other medical consumables in states, to respond to disease outbreaks.

It is important for all States in the country to support their PHEOC structure and provide the needed support and logistics to better prepare and respond to outbreaks within the State.


SUMMARY OF REPORTS

In the reporting week ending December 23, 2018:

o There were 94 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 six suspected cases of Cholera reported from 3 LGAs in 2 States (Bauchi –1 and Kano -5). Of these, none was laboratory confirmed and no death was recorded.

o There were 34 suspected cases of Lassa fever reported from 13 LGAs in 6 States (Bauchi –5, Edo –12, Nasarawa –1, Ondo – 8, Plateau - 3 & Taraba - 3). 22 were laboratory confirmed and 5 deaths were recorded.

o There were 19 suspected cases of Cerebrospinal Meningitis (CSM) reported from 8 LGAs in 4 States (Cross River - 7, Katsina – 9, Yobe - 1 & Zamfara – 2). Of these, none was laboratory confirmed and two deaths were recorded.

o There were 230 suspected cases of measles reported from 25 States. None was laboratory confirmed and one death was recorded.

In the reporting week, all States sent in their report except Jigawa State. Timeliness of reporting remains 87% in both previous and current weeks (50 & 51) while completeness also remains 99% 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 December 23 2018, no new case of WPV was recorded

1.2. In the reporting week, 94 suspected cases of AFP were reported from 82 LGAs in 31 States

1.3. Between week 1 and 51 (2018), 8504 suspected cases of AFP were reported from 754 LGAs in 37 States


2. CEREBROSPINAL MENINGITIS (CSM)

2.1 In the reporting week, 19 suspected Cerebrospinal Meningitis (CSM) cases and two deaths (CFR, 10.5%) were reported from 8 LGAs in 4 states( Cross River - 7, Katsina – 9, Yobe - 1 & Zamfara – 2) compared with 17 suspected cases with one Lab confirmed and one deaths (CFR, 5.9%) reported across 13 LGAs in five states at the same period in 2017 (Figure 1)

2.2 Between weeks 1 and 51 (2018), 4504 suspected meningitis cases with 318 laboratory confirmed and 363 deaths (CFR, 8.1%) from 30 LGAs (35 States) were reported compared with 10010 suspected cases and 612 deaths (CFR, 6.1%) from 328 LGAs in 34 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 - 51, 2018 as against 76.4% timeliness and 92.3% completeness recorded within the same period in 2017


CHOLERA

3.1 Six suspected cases of cholera were reported from 3 LGAs in 2 states; (Bauchi –1 and Kano -5) in week 51, 2018 compared with 172 suspected cases and five deaths (CFR, 2.9%) reported from 16 LGAs in 2 states during the same period in 2017 (Figure 2).

3.2 Between weeks 1 and 51 (2018), 50,711 suspected cholera cases with 956 laboratory confirmed and 1135 deaths (CFR, 2.2%) from 247 LGAs in 30 States were reported compared with 4100 suspected cases and 98 deaths (CFR, 2.4%) from 83 LGAs in 20 States during the same period in 2017.

3.3 The cholera National Emergency Operations Centre (EOC) has been de-escalated to a Technical Working Group following decline in number of new cases reported from States in the last six weeks.

3.4 National Preparedness and Response to Acute Watery Diarrhoea/Cholera Guidelines. Available from

http://ncdc.gov.ng/themes/common/docs/protocols/45_1507196550.pdf

Figure 2: Status of LGAs/States that reported Cholera cases in week 1 - 51, 2017 & 2018

4 LASSA FEVER

4.1 In the reporting Week 52 (24 – 30 December, 2018), twenty-two new confirmed I cases were reported from Edo (9), Ondo (6), Bauchi (5) and Taraba (2) States with five new deaths in Ondo (2), Bauchi (2) and Taraba (1) States and one probable case from Ondo State

4.2 From 1st January to 31st December 2018, a total of 3498 suspectedi cases have been reported from 23 states. Of these, 633 were confirmed positive, 20 probable and 2853 negative (not a case)

4.3 Since the onset of the 2018 outbreak, there have been 171 deaths among confirmed cases and 20 among probable cases. Case Fatality Rate in confirmed cases is 27.0%

4.4 Twenty three states have recorded at least one confirmed case across 93 LGAs (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba, Delta, Osun, Rivers, FCT, Gombe, Ekiti, Kaduna, Abia, Adamawa, Enugu and Kano). Fourteen states have exited the active phase of the outbreak while nine – Edo, Ondo, Plateau, Delta, Bauchi, Nasarawa, Adamawa, FCT and Taraba States remain active.iv


LASSA FEVER

4.1 In the reporting Week 52 (24 – 30 December, 2018), twenty-two new confirmed I cases were reported from Edo (9), Ondo (6), Bauchi (5) and Taraba (2) States with five new deaths in Ondo (2), Bauchi (2) and Taraba (1) States and one probable case from Ondo State

4.2 From 1st January to 31st December 2018, a total of 3498 suspectedi cases have been reported from 23 states. Of these, 633 were confirmed positive, 20 probable and 2853 negative (not a case)

4.3 Since the onset of the 2018 outbreak, there have been 171 deaths among confirmed cases and 20 among probable cases. Case Fatality Rate in confirmed cases is 27.0%

4.4 Twenty three states have recorded at least one confirmed case across 93 LGAs (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba, Delta, Osun, Rivers, FCT, Gombe, Ekiti, Kaduna, Abia, Adamawa, Enugu and Kano). Fourteen states have exited the active phase of the outbreak while nine – Edo, Ondo, Plateau, Delta, Bauchi, Nasarawa, Adamawa, FCT and Taraba States remain active.iv

4.5 Lassa fever international Conference is scheduled for 16th to 17th January 2019

4.6 The Lassa fever national multi-partner, multi-agency Technical Working Group (TWG) continues to coordinate response activities at all levels.



MEASLES

In the reporting week, 230 suspected cases of measles and one death (CFR, 0.4%) were reported from 25 states compared with 183 suspected cases reported from 24 states during the same period in 2017

5.2 Since the beginning of the year, 17162 suspected measles cases with 1316 laboratory confirmed and 128 deaths (CFR, 0.75%) were reported from 36 states and FCT compared with 21882 suspected cases with 109 laboratory confirmed and 117 deaths (CFR, 0.53 %) 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 and LGAs during Supplementary Immunisation Activities (SIAs), as well as case management


6 Yellow fever

In the reporting week 52 (24th – 30th December), no new confirmed case at WHO reference laboratory, Institute Pasteur Dakar (IP Dakar)

6.2 From the onset of this outbreak on September 12, 2017 to date, a total of 4,004 suspected yellow fever cases have been reported from 36 States & FCT. Of the 3,451 samples taken, 237 were presumptive positive in-country

6.3 A total of 82 cases have been confirmed by IP Dakar from 14 states (Kwara, Kogi, Kano, Zamfara, Kebbi, Nasarawa, Niger, Katsina, Edo, Ekiti, Rivers, Anambra, FCT, and Benue States)

6.4 Since the onset of the outbreak, 13 deaths among IP Dakar confirmed cases and 27 deaths among presumptive positive cases have been recorded. Case Fatality Rate among IP Dakar confirmed cases and presumptive positives is 15.9% and 11. 4% respectively

6.5 Yellow fever reactive vaccination campaigns were conducted in the following States: Edo (13 LGAs), Kebbi (7 LGAs), Niger (5 LGAs), Sokoto (1 LGA) & Katsina (1 LGA)

6.6 A multi-agency national Emergency Operations Centre is coordinating the national response

6.7 Yellow fever vaccination campaigns have been successfully completed in 6 States (Nasarawa, Cross River, Akwa-Ibom, Kogi, Kwara & Zamfara) and 57 political wards in 25 LGAs in Borno State

6.8 The 2018 phase 2b November Preventive Mass Vaccination Campaign (PMVC) was conducted (22nd November – 1st December, 2018) in Sokoto, Kebbi, Niger, FCT, Plateau and some LGAs in Borno States. Target population is 9 months to 44 years (85% of the total population)


7. Update on national Influenza sentinel surveillance, Nigeria week 1 – 50, 2018

7.1. From week 1- 50, 387 suspected cases were reported, of which 347 were Influenza like-illness (ILI), 40 were Severe Acute Respiratory Infection (SARI).

7.2 A total of 387 samples were received with 371 samples processed. Of the processed samples, 333(89.8%) were ILI cases, 38 (10.2%) were Severe Acute Respiratory Infection (SARI).

7.3 Of the 333 processed ILI samples, 39 (11.7%) were positive for Influenza A; 33(9.9%) were positive for Influenza B and 261 (79.3%) were negative.

7.4 Out of the processed 38 SARI samples, 7 (18.4%) were positive for Influenza A, 2 (5.3%) were positive for Influenza B, while the remaining 29 (76.3%) were negative.

7.5 Of the 371 processed samples, 81 (21.8%) were positive for Influenza, with 46 (56.8%) of these positive for Influenza A and 35 (43.2%) positive for Influenza B.

7.6 The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for 2(4.3%), 24 (52.2%) and 20 (43.5%) of the total influenza A positive samples respectively.

7.7 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 24(70.6%), 8(20.6%) and 3(8.8%) of the total influenza B positive samples respectively

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

7.5 In the reporting week 1- 50, all samples were processed

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
  • MEASLES
  • 6 Yellow fever
  • 7. Update on national Influenza sentinel surveillance, Nigeria week 1 – 50, 2018

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