Weekly Epidemiological Report

October 2018 Week 41

Editoral

Assessing the Economic Impact of Meningococcal Meningitis in Nigeria

Posted: 26-10-2018 08:25:12 AM

The Nigeria Centre for Disease Control (NCDC) in collaboration with the World Health Organization (WHO) has begun a study to assess the economic impact of acute meningitis in Nigeria focusing on three States in the Northwest region.

This study is expected to enhance the knowledge and understanding of the economic burden of acute meningitis for households and for health systems, following the mass preventive campaigns with the conjugate vaccine MenAfriVac against Neisseria meningitidis serogroup A (NmA). Until recently, NmA has been the leading cause of meningitis epidemics in the African meningitis belt, a region stretching from Senegal to Ethiopia with 500 million people estimated to be at risk.

Since 2010, a conjugate vaccine, MenAfriVac® was gradually introduced against NmA in countries of the African meningitis belt. The mass vaccination campaign was completed in Nigeria in 2015. The campaigns had a strong impact, with a reduction of more than 99% in the number of meningitis cases caused by NmA. Plans are in place to introduce MenAfrivac in the routine vaccination programme in July 2019 in Nigeria.

As part of the project, NCDC and WHO organised a three-day investigator and national level training for supervisors and field data collectors in Abuja from 16 – 18 October, 2018. The goal was to introduce all field participants to the survey methodology and ensure full understanding of the field guide. Data collection at Household Level, Health Facility, LGA, State and National Level is expected to commence immediately after.

This research project presents an opportunity for Nigeria to assess the economic impact of meningococcal meningitis on the health care system and households. The results from this research will help inform decision-making on the control of meningitis, including the introduction of a pentavalent vaccine that induces immunity against NmA, NmC, NmY, NmX, NmW.


SUMMARY OF REPORTS

In the reporting week ending on October 7, 2018:

o There were 168 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 2042 suspected cases of Cholera reported from 54 LGAs in ten States (Adamawa – 95, Bauchi – 1, Borno – 710, Enugu – 6, Gombe – 42, Kaduna – 4, Kano – 25, Katsina – 631, Yobe - 153 and Zamfara - 375). Of these, ten were laboratory confirmed and 13 deaths were recorded.

o There were 23 suspected cases of Lassa fever reported from seven LGAs in six States (Abia – 1, Bauchi – 1, Ebonyi – 7, Edo – 7, Ondo - 6 & Oyo - 1). Nine were laboratory confirmed and one death was recorded.

o There were nine suspected cases of Cerebrospinal Meningitis (CSM) reported from seven LGAs in six States (Ebonyi – 1, Enugu – 1, Katsina – 2, Kebbi – 2, Plateau - 1 & Yobe – 1). Of these, none was laboratory confirmed and no death was recorded.

o There were 232 suspected cases of measles reported from 29 States. None was laboratory confirmed and no death was recorded.

In the reporting week, all States sent in their report. Timeliness of reporting remains 87% in both previous and current weeks (39 & 40) 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. AFP

1.1. As at October 7th 2018, no new case of WPV was recorded

1.2. In the reporting week, 168 cases of AFP were reported from 141 LGAs in 33 States

1.3. Between week 1 and 40 2018, 6679 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

Table 1: 2018 SIAs


2. CEREBROSPINAL MENINGITIS (CSM)

2.1 In the reporting week, nine suspected Cerebrospinal Meningitis (CSM) cases were reported from seven LGAs (six States; Ebonyi – 1, Enugu – 1, Katsina – 2, Kebbi – 2, Plateau - 1 & Yobe – 1) compared with two suspected cases reported from two LGAs (two States) at the same period in 2017 (Figure 1)

2.2 Between weeks 1 and 40 (2018), 4342 suspected meningitis cases with 318 laboratory confirmed and 357 deaths (CFR, 8.2%) from 288 LGAs (33 States) were reported compared with 9807 suspected cases and 602 deaths (CFR, 6.1%) from 316 LGAs (33 States) during the same period in 2017.

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 - 40, 2018 as against 76.4% timeliness and 92.3% completeness recorded within the same period in 2017


3. CHOLERA

3.1 2042 suspected cases of Cholera with 10 Lab. Confirmed and 13 deaths (CFR, 0.64%) were reported from 54 LGAs (ten States; Adamawa – 95, Bauchi – 1, Borno – 710, Enugu – 6, Gombe – 42, Kaduna – 4, Kano – 25, Katsina – 631, Yobe - 153 and Zamfara - 375) in week 40, 2018 compared with 50 suspected cases and one death (CFR, 2.0%) reported from four LGAs (four States) during the same period in 2017 (Figure 2).

3.2 Between weeks 1 and 40 (2018), 26,780 suspected Cholera cases with 490 laboratory confirmed and 452 deaths (CFR, 1.7%) from 177 LGAs (26 States) were reported compared with 3418 suspected cases and 80 deaths (CFR, 2.3%) from 64 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.

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 NCDC and partners conducted the development of medium term strategies for Cholera control including mapping of the hot spots in Nigeria on the 19th of July, 2018.

3.6 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 40 (1 – 7 October, 2018) nine new confirmedI cases were reported from Edo (5), Ondo (2) and Ebonyi (2) States with one new death in Edo State and three deaths in probable cases from Ebonyi State.

4.2 From 1st January to 7th October 2018, a total of 2648 suspectedi cases have been reported from 22 states. Of these, 523 were confirmed positive, 15 are probable, 2109 negative (not a case)

4.3 Since the onset of the 2018 outbreak, there have been 135 deaths in confirmed cases and 15 in probable cases. Case Fatality Rate in confirmed cases is 25.8%

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). seventeen states have exited the active phase of the outbreak while five – Edo, Delta, Ondo, Bauchi and Ebonyi 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, 232 suspected cases of measles were reported from 29 States compared with 244 suspected cases reported from 34 States during the same period in 2017

5.2 Since the beginning of the year, 14671 suspected measles cases with 901 Lab. Confirmed and 116 deaths (CFR, 0.8%) were reported from 36 States and FCT compared with 18559 suspected cases with 108 laboratory confirmed and 105 deaths (CFR, 0.57 %) 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

NCDC RRT conducted detailed investigation of a measles outbreak in Ogun State


6. YELLOW FEVER

6.1 In this reporting week 1st – 7th October, 2018, 43 suspected cases were reported

6.2 Six new in-country presumptive positive cases and two inconclusive cases were reported from three diagnostics laboratories in the reporting week

6.3 The six in- country presumptive cases were from Edo State (1), Kogi State (2) Kebbi State (1) and Katsina State (2)

6.4 Last IP Dakar confirmed case from Nigeria was on 6th June, 2018

6.5 From the onset of this outbreak on September 12, 2017, a total of 3,162 suspected yellow fever cases with 47 Laboratory confirmed and 54 deaths (CFR, 1.7%) have been reported from 564 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 – 41, 2018

7.1. From week 1- 41, 284-suspected cases were reported, of which 254 were Influenza like-illness (ILI), 30 Severe Acute Respiratory Infection (SARI).

7.2 A total of 284 samples were received and all samples were processed. Of the processed samples, 254(89.4%) were ILI cases, 30 (10.6%) were Severe Acute Respiratory Infection (SARI).

7.3 Of the 254 processed ILI samples, 16 (6.3%) was positive for Influenza A; 29(11.4%) positive for Influenza B and 209 (82.3%) were negative.

7.4 For the processed 30 SARI samples, seven (23.3%) were positive for Influenza A, two (6.7%) was positive for Influenza B, while the remaining 21 (70.0%) were negative.

7.5 Of the 284 processed samples, 54 (19.0%) were positive for Influenza, with 23 (42.6%) of these positive for Influenza A and 31 (57.4%) positive for Influenza B.

7.6 The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for (0.0%), 19 (82.6%) and 4 (17.4%) of the total influenza A positive samples respectively.

7.7 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 23(74.2%), 7(22.6%) and 1(3.2%) of the total influenza B positive samples respectively

7.8 The percentage influenza positive was highest (75.0%) in week 6, 2018

7.9 In the reporting week 1 -41, all samples were processed in the Laboratory

FOR MORE INFORMATION CONTACT


Surveillance Unit:


Nigeria Centre for Disease Control, 
801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.

[email protected]


www.ncdc.gov.ng/reports


0800-970000-10


7. UPDATE ON NATIONAL INFLUENZA SENTINEL SURVEILLANCE, Nigeria Week 1 – 41, 2018

7.1. From week 1- 41, 284-suspected cases were reported, of which 254 were Influenza like-illness (ILI), 30 Severe Acute Respiratory Infection (SARI).

7.2 A total of 284 samples were received and all samples were processed. Of the processed samples, 254(89.4%) were ILI cases, 30 (10.6%) were Severe Acute Respiratory Infection (SARI).

7.3 Of the 254 processed ILI samples, 16 (6.3%) was positive for Influenza A; 29(11.4%) positive for Influenza B and 209 (82.3%) were negative.

7.4 For the processed 30 SARI samples, seven (23.3%) were positive for Influenza A, two (6.7%) was positive for Influenza B, while the remaining 21 (70.0%) were negative.

7.5 Of the 284 processed samples, 54 (19.0%) were positive for Influenza, with 23 (42.6%) of these positive for Influenza A and 31 (57.4%) positive for Influenza B.

7.6 The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for (0.0%), 19 (82.6%) and 4 (17.4%) of the total influenza A positive samples respectively.

7.7 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 23(74.2%), 7(22.6%) and 1(3.2%) of the total influenza B positive samples respectively

7.8 The percentage influenza positive was highest (75.0%) in week 6, 2018

7.9 In the reporting week 1 -41, all samples were processed in the Laboratory

FOR MORE INFORMATION CONTACT


Surveillance Unit:


Nigeria Centre for Disease Control, 
801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.

[email protected]


www.ncdc.gov.ng/reports


0800-970000-10

Highlight of the week

  • SUMMARY OF REPORTS
  • REPORT ANALYSIS AND INTERPRETATION: 1. AFP
  • 2. CEREBROSPINAL MENINGITIS (CSM)
  • 3. CHOLERA
  • 4. LASSA FEVER
  • 5. MEASLES
  • 6. YELLOW FEVER
  • 7. UPDATE ON NATIONAL INFLUENZA SENTINEL SURVEILLANCE, Nigeria Week 1 – 41, 2018
  • 7. UPDATE ON NATIONAL INFLUENZA SENTINEL SURVEILLANCE, Nigeria Week 1 – 41, 2018

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