Weekly Epidemiological Report

April Week 17

Editoral

Health Security in Nigeria: Four Years of Progress

This week’s editorial is a redacted version of an opinion piece written by the Honourable Minister of Health, Professor Isaac Adewole as part of the launch of the NCDC 2018 annual report and the NCDC Act communications campaign.

One of the biggest priorities of the President Muhammadu Buhari’s led government in its first tenure, was to strengthen and revitalise Nigeria’s health sector. This was evident in several ways. Perhaps one of the most valuable long-term investments of this administration is the passage of the Act establishing the Nigeria Centre for Disease Control (NCDC). This agency which was established in 2011 to lead the response to the challenges of public health emergencies and to enhance Nigeria’s preparedness and response to epidemics, had existed for over 10 years without a legislative mandate. This led to some uncertainty about its role and mandate. This has now been resolved by the leadership of His Excellency, President Muhammadu Buhari, providing an unambiguous mandate to NCDC as contained in the new Act.

Across the world, there is a rise in the awareness of people, on the critical importance of science driven national public health institutes, in protecting the health of its citizens. In several global health meetings which I have been privileged to attend and in some cases chair, Nigeria’s national public health institute is often cited as a model for other countries. In recognition of this, the Director General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus visited the agency in 2018, together with all his Regional Directors from across the world. They were impressed by the progress made by this nascent but vibrant new centre.

Prior to 2017, the ability of NCDC to completely deliver its mandate was limited by the absence of a legislative mandate. Other factors that limited effective and smooth operationalisation of activities included inadequate funding, limited development partners support, a non-effective incident coordination mechanism, limited laboratory diagnostic capacity, lack of standard operation procedures and guidelines, etc. This had a negative impact on outbreak preparedness and response in the country. However, since the Buhari administration prioritised health security and universal health coverage in the last four years, we have recorded incredible progress across several areas.

The NCDC Annual Report launched on the 10th of May 2019 by the Honourable Minister of Health outlines important progress the agency made in 2018 and in the last four years. The report can be accessed via https://ncdc.gov.ng/themes/common/docs/protocols/99_1557245340.pdf


Summary of incidents

The location of ongoing incidents by disease and State affected is indicated in the map below. These incidents are currently being investigated and or managed by States and NCDC.

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 36 suspected cases of Lassa Fever in 9 states (Edo 13, Ondo 10, Ebonyi 4, Bauchi 1, Plateau 1, Taraba 3, Kebbi 2, Adamawa 1, Gombe 1). 8 were confirmed with 1 death.

• In week 17, one new health care worker was affected in Kebbi State.

• 13 health care workers currently on admission in treatment centers.

Actions

To date:

• National Lassa fever Emergency Operations Centre (EOC) continues to coordinate the response activities at all levels

Planned:

• Support FMoE to conduct LF National Environmental Response (Community rodent control, hygiene promotion) in collaboration with WHO

• Deployment of RRT to LF outbreak in Kebbi State

• Declaration of outbreak emergency phase over based on composite indicators

• SORMAS case management training in FETHA, JUTH and BHUTH


Cerebrospinal Meningitis (CSM)

Key points

• There were 34 suspected cases of Cerebrospinal Meningitis (CSM) reported from 42 LGAs in 19 States (Bauchi – 1, Bayelsa – 1, Cross River – 3, Katsina – 7, Kebbi - 3, Nasarawa – 2, Rivers – 1, Sokoto – 7 & Zamfara - 3). Of these, one was laboratory confirmed and no deaths were recorded

• Shinkafi LGA, Zamfara State crossed Alert Threshold in week 15 with an attack rate of 4.4 per 100.000 population

Actions

To date:

• The National CSM EOC meets weekly to review the national situation


Yellow Fever

Actions

To date:

• A multiagency Yellow fever TWG is coordinating the response activities

• Yellow fever risk communication assessment plan has been developed

• Training on Yellow fever testing is ongoing in three new labs (UBTH, UNTH & NRL Gaduwa)

• ICG request for reactive vaccination campaigns have been approved for Edo (5 LGAs), Ondo (7 LGAs) and Delta States (1 LGA)

Planned:

• 2019 Preventive mass vaccination campaign to take place in Katsina, Edo, Ekiti and Rivers States

• Follow up with the yellow fever reactive vaccination campaign pre-implementation activities in the approved states and their respective LGAs

• Yellow fever AAR and post SimEx feedback meeting is scheduled to hold in June 2019.


Cholera

Key points

There were 85 suspected cases of cholera reported from five LGAs in three States (Bayelsa – 82, Cross River - 1 & Kano – 2). None was laboratory confirmed and no death recorded.

Actions

To date:

• NCDC cholera Technical Working Group (TWG) continues to coordinate Cholera activities in states collaborating with FMWR and support from partners

• Development of Checklist for Assessment of level of Preparedness in all states

• Inception workshop conducted for members of the National Core Group on Water Quality {NACOWQ}

• Establishment of “State WASH Working Group” in Hotspot States ongoing

• Development and dissemination of Memo on ‘’clean Nigeria, use the Toilet’’ to FEC

Planned:

• Launch of a National Strategy for Open Defecation Free (ODF) in Nigeria and creation of a secretariat for ODF campaign

• A second round of OCV campaign to be conducted in Argungu LGA, Kebbi state and Michika LGA, Adamawa State in May

• Review cholera advisory and disseminate ahead of the season


Measles

Key points

• There were 1901 suspected cases reported from 31 States and FCT. None was laboratory confirmed and sixteen deaths were recorded

Actions

To date:

• The Measles Emergency Operation Center (EOC) continues to coordinate activities weekly

• Rapid response teams (RRT) have been deployed to Borno, Katsina, Adamawa and Yobe states to support data management, intensify surveillance, case management and community sensitization

• Media messages have been developed and disseminated across social and conventional media

• Measles case management quick guide has been developed, printed and distributed to Borno, Yobe, Katsina and Adamawa states

Planned:

• Phase 2 reactive vaccination in Borno planned for 14th of May for the five most affected states


Monkeypox

Key points

• There was one confirmed case of Monkey pox reported from Ibadan North-East LGA of Oyo State,

• Oyo State reported confirmed cases of Monkey pox between September 2017 and June 2018.

Actions

To date:

• Enhanced surveillance ongoing in affected states

Planned:

• Follow up with Bayelsa State team on limited reporting of cases

• Supportive supervision to apparently silent States and states with evidence of poor case follow up.

• Deployment of rapid response team to Oyo State


Acute Flaccid Paralysis (AFP)

Key points

• In the reporting week, 146 suspected cases of AFP were reported from 116 LGAs in 31 States and FCT

• As at 28th April 2019, no new case of WPV was recorded

• The last reported case of polio in Nigeria was in August 2016

Actions

To date:

• Documentation for Polio certification is ongoing

Planned:

• Complete documentation to be presented to ARCC December, 2019


National Influenza Sentinel Surveillance

Key points

• The predominant Influenza A subtype so far this year was A seasonal H3 19 (95%).

• The predominant Influenza B subtype so far this year was B not subtyped 2(100%).

• The percentage influenza positive was highest (100.0%) in week 8

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

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