The Lassa fever outbreak is currently active in 9 States across Nigeria; Ogun, Bauchi, Plateau, Ebonyi, Ondo, Edo, Taraba, Nasarawa and Rivers. In reporting week 5, 13 new suspected cases were reported from 7 LGAs in 7 States. Laboratory investigations carried out for Lassa Fever and other VHFs confirmed 4 Lassa Fever positive cases. One death was recorded (Case Fatality Rate for the week among suspect cases: 7.69%). The onset of this outbreak in Nigeria dates back to December 2016 (week 49). Cumulatively, a total of 196 suspected cases have been reported. So far, 53 cases have been laboratory confirmed and 5 cases classified as probable. Of these, 31 deaths have been recorded, 26 of them occurring in confirmed cases and 5 in probable cases. The Case fatality rate for all cases is 20.4% and for all confirmed/probable cases is 53.4%.
Nigeria records an annual increase in Lassa fever cases in the in the dry season. The Nigeria Centre for Disease control (NCDC) has the responsibility of coordinating the response to the c outbreaks in Nigeria and has increased its efforts to respond to the current outbreak. In 2016, NCDC pre-positioned of commodities for case management of Lassa fever across the 36 states of the federation including the Federal Capital Territory (FCT). New VHF interim guidelines were developed and circulated and also put on the NCDC website. This year, we are collecting detailed epidemiological information on all probable or confirmed cases.
Furthermore, the NCDC has provided on-site support to Ogun, Taraba, Nasarawa and Ondo States in outbreak management and response.
The NCDC is working in collaboration with media to share key prevention messages with members of the public. For the first time ever, we are providing weekly updates on the Lassa Fever on the NCDC website. A social media campaign is ongoing via dedicated NCDC Facebook and twitter channels. Jingles are also being aired on identification of Lassa fever in selected radio and TV stations.
In the reporting week, ending 10th February 2017:
o There were 329 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 assiduously reinvigorated its efforts to eradicate Polio.
o There were 5 new suspected cases of Cholera reported. No deaths were reported. There has been a gradual decline in reported cases of Cholera as the dry season sets in..
o There were 51 suspected cases of Cerebrospinal Meningitis (CSM) reported from 13 LGAs in 9 States. Of this, 1 was lab confirmed and 2 deaths were recorded (CFR 3.92%). Surveillance for CSM is ongoing and intensified in the States, particularly as the dry season has set in.
o There were 404 suspected cases of measles reported from 29 States including the FCT. 17 were laboratory confirmed and 4 deaths were recorded, giving a case fatality rate of 0.99%.
In the reporting week, five states (Cross River, Delta, Imo, Kaduna and Abia) failed to report and five states reported late. Timeliness of reporting increased from 70.3% in the previous week to 73.0 % in the current week while completeness decreased from 91.9% in the previous week to 86.5%.
1. Lassa fever
Please note that the data reflects the routine reports i.e. all suspected cases including the laboratory positive and negative cases
1.1. Thirteen (13) suspected cases of Lassa fever with four (4) Lab. Confirmed and 1 death (CFR, 7.69%) were reported from 7 LGA (7 States) in week 5, 2017 compared with 22 suspected cases with 5 Lab. Confirmed and 4 deaths (CFR, 18.2%) from 9 LGAs (8 States) at the same period in 2016 (Figure 2).
1.2. Laboratory results of the 13 suspected were 4 positive & 4 negative for Lassa fever and other VHFs while 5 pending.
1.3. Between weeks 1 and 5 (2017), 107 suspected Lassa fever cases with 18 lab-confirmed and 10 deaths (CFR, 9.35%) from 20 LGAs (10 States) were reported compared with 342 suspected cases with 32 lab-confirmed and 57 deaths (CFR, 16.67%) from 83 LGAs (23 States) at the same period in 2016 (Figure 2).
1.4. Between weeks 1 & 52 2016, 921 suspected Lassa fever cases with 109 lab-confirmed and 119 deaths (CFR, 12.92%) from 144 LGAs (28 States & FCT) were reported compared with 430 suspected cases with 25 lab-confirmed and 40 deaths (CFR, 9.30%) from 37 LGAs (14 States & FCT) at the same period in 2015 (Figure 3).
1.5. Investigation and active case search ongoing in affected states with coordination of all response activities by NCDC and support from partners.
1.5.1. National Surveillance and Outbreak Response Working Group meeting on-going at NCDC to assess the current Lassa fever situation in the Country
1.5.2. Response materials for VHFs prepositioned across the country by NCDC
1.5.3. New VHF guidelines being produced by NCDC
1.5.4. Reclassification of reported Lassa fever cases is ongoing
1.5.5. Reviewing the variable for case based surveillance for VHF
1.5.6. VHF case based forms completed by affected States are being entered into the new VHF management system. This system allows for creation of a VHF database for the country.
1.5.7. Onsite support ongoing in Ondo State with off-site support to all the other affected States
1.5.8. Onsite support was earlier provided to Ogun, Nasarawa and Taraba.
1.5.9. Additional supplies (Medicines, PPEs etc.) provided to Plateau, Nasarawa and Ogun States
1.5.10. States are enjoined to intensify surveillance
2.1. In the reporting week, four hundred & four (404) suspected cases of Measles with 17 Lab. Confirmed and 4 deaths (CFR, 0.99%) were recorded from 29 States & FCT compared with 486 suspected measles cases and 4 deaths (CFR,0.82%) from 29 States & FCT at the same period in 2016.
2.2. So far, 2,006 suspected Measles cases with 32 Lab. Confirmed and 20 deaths (CFR,1.0%) have been reported in 2017 from 34 states & FCT (Figure 3 & 4) compared with 2,515 suspected cases and 5 deaths (CFR, 0.20%) from 35 states & FCT at the same period in 2016.
2.3. In 2016 (week 1 -52), 25,251 suspected measles cases with 102 deaths (CFR, 0.40%) were reported from 36 States and FCT compared with 24,421 suspected cases with 127 deaths (CFR, 0.52%) at the same period in 2015
2.4. Response measure includes immunization for all vaccine-preventable diseases in some selected/ affected wards/LGAs during SIAs with case management.
2.5. Scheduled measles campaign in the North East conducted from 12th – 17th January, 2017 in Adamawa, Borno & Yobe States (Phase I) and phase II from 21st – 25th January, 2017, Borno State & 4th – 8th February, 2017, Yobe State
3.1. As at February 5th 2017, no new case of WPV recorded
3.2. No new cVDPV2, environmental derived and Polio compatible cases identified
3.2.1. In the reporting week, 326 cases of AFP were reported from 227 LGAs in 30 States and FCT
3.2.2. AFP Surveillance has been enhanced and outbreak response is on-going in Borno and other high risk states
3.2.3. The 1st round of NIPDs in 2017 was conducted from 28th – 31st January 2017 in the 18 high risk states. This was carried out using mOPV2 (2nd mOPV2 OBR). The schedule for other SIAs is as in Figure 8.
3.2.4. Between weeks 1 & 52, 2016 four WPVs were isolated from Borno State compared to no WPV isolated at the same period in 2015.
3.3. No circulating Vaccine Derived Polio Virus type 2 (cVDPV2) was isolated in both week 1 - 5, 2016 and 2015.
3.4. Between weeks 1 & 52, 2016 two (2) cVDPV2 were isolated in 2 LGAs (2 States) while one (1) cVDPV2 were isolated from Kwali, FCT at the same period in 2015.
3.5. Six (6) confirmed WPV were isolated in 2014.
3.6. The SIAs were strengthened with the following events:
3.6.1. Immunization for all vaccine-preventable diseases in some selected wards/LGAs.
3.6.2. Use of health camp facilities.
3.6.3. Field supportive supervision and monitoring.
3.6.4. Improved Enhanced Independent Monitoring (EIM) and Lots Quality Assessments (LQAs) in all Polio-high risk States.
3.6.5. High level of accountability framework
4.1. Five suspected cases of Cholera reported from Kuje Area Council (FCT) in week 5 (2017), compared with 5 cases from 2 LGAs (2 States) at the same period in 2016 (Figure 9).
4.2. Between weeks 1 and 5 (2017), 36 suspected cholera cases and 4 deaths (CFR, 11.11%) from 5 LGAs (5 States) were reported compared with 84 suspected cases from 5 LGAs (3 States) at the same period in 2016 (Figure 9).
4.3. Between weeks 1 and 52 (2016), 768 suspected cholera cases with 14 lab-confirmed and 32 deaths (CFR, 4.17%) from 57 LGAs (14 States and FCT) were reported compared with 5,301 cases with 29 lab confirmed and 186 deaths (CFR, 3.51%) from 101 LGAs (18 States and FCT) at the same period in 2015 (Figure 10).
4.4. States are enjoined to intensify surveillance.
5. CEREBROSPINAL MENINGITIS (CSM)
5.1. In the reporting week, 51 suspected cerebrospinal meningitis (CSM) cases with 1 Lab. Confirmed and 2 deaths (CFR, 3.92%) were reported from 13 LGAs (9 States) compared with 14 cases from 8 LGAs (6 States) at the same period in 2016.
5.2. Between weeks 1 & 5 (2017), 152 suspected CSM cases with 1 Lab. confirmed and 13 deaths (CFR, 8.55%) were recorded from 36 LGAs (18 States) compared with 39 suspected cases and 1 death (CFR, 2.56%) from 25 LGAs (13 States) at the same period in 2016 (Figure 11).
5.3. Between weeks 1 & 52, 2016, 831 suspected CSM cases with 43 lab-confirmed and 33 deaths (CFR, 3.97%) were recorded from 154 LGAs (30 States and FCT) compared with 2711 suspected cases and 131 deaths (CFR, 4.83%) from 170 LGAs (28 States and FCT) at the same period in 2015 (Figure 12)
5.4. Timeliness/completeness of CSM case-reporting from States to National Level (2017 versus 2016): on the average, 75.0% of the 26 endemic states sent CSM reports timely while 86.7% were complete in week 1 – 5, 2017 as against 79.8% timeliness and 96.2% completeness recorded within the same period in 2016.
5.5. CSM preparedness checklist sent to 36 States and FCT in response to 2017 meningitis season
5.6. CSM surveillance evaluation to be held in first quarter of 2017
5.7. Intensive Surveillance is on-going in high risk States.
6. GUINEA WORM DISEASE
6.1. In the reporting week, No rumour reports of Guinea Worm disease was received from any State.
6.2. Nigeria has celebrated 8 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 NIGEP NC/Director: Mrs. I, Anagbogu: +2348034085607, [email protected])
FOR MORE INFORMATION CONTACT
Nigeria Centre for Disease Control
801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.