As part of preparedness efforts for the Lassa fever season, the Nigeria Centre for Disease Control (NCDC) organised a three-day meeting to review the current infection prevention and control (IPC) guideline for the management of Viral Haemorrhagic Fevers (VHF). The review was held as part of preparedness efforts and to outline steps for institutionalizing IPC in health facilities in the country.
The objective of the meeting was to update the guideline with recommendations, Standard Operating Procedures (SOPs), checklists and assessment tools that will assist providers of VHF care and recipients of such care in making informed IPC decisions. Participants included IPC experts, Lassa fever case management experts, members from the academia and the national Lassa fever Technical Working Group. Significant areas for inclusion in the guideline were considered and these included the occupational health services in healthcare as well as principles of waste management in VHF treatment centres.
Break-out sessions were held where in-depth discussions and documentation of summaries of discussions, backed by scientific evidence were carried out. A major outcome from the meeting is a well revised IPC guideline which will serve as a reference documents for Nigeria in VHF management disseminated across all health facilities and designated VHF treatment centres in the country.
SUMMARY OF REPORTS
In the reporting week ending December 2, 2018:
o There were 145 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 62 suspected cases of Cholera reported from ten LGAs in six States (Bayelsa –1, Borno –9, Cross River –2, Kano –34, Katsina –1 and Yobe -15). Of these, none was laboratory confirmed and five deaths were recorded.
o There were 33 suspected cases of Lassa fever reported from 16 LGAs in 11 States (FCT –1, Gombe –2, Edo –3, Kaduna –3, Kano -1, Katsina – 1, Kogi -2, Nasarawa –1, Ondo –16, Osun–1 & Plateau -2). Thirteen were laboratory confirmed and two deaths were recorded.
o There were 16 suspected cases of Cerebrospinal Meningitis (CSM) reported from 13 LGAs in eight States (Bayelsa – 1, Cross River –3, Gombe –1, Katsina –2, Nassarawa –1, Ondo –2, Yobe -3 & Zamfara –3). Of these, none was laboratory confirmed and no death was recorded.
o There were 240 suspected cases of measles reported from 31 States. None was laboratory confirmed and one death was recorded.
In the reporting week, all States sent in their report. Timeliness of reporting remains 87% in both previous and current weeks (47 & 48) 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
1.1. As at December 2 2018, no new case of WPV was recorded
1.2. In the reporting week, 145 suspected cases of AFP were reported from 114 LGAs in 35 States
1.3. Between week 1 and 48 (2018), 8132 suspected cases of AFP were reported from 752 LGAs in 37 States
2. CEREBROSPINAL MENINGITIS (CSM)
2.1 In the reporting week, 16 suspected Cerebrospinal Meningitis (CSM) cases were reported from 13 LGAs in 8 states( Bayelsa 1, Cross River –3, Gombe –1, Katsina –2, Nassarawa –1, Ondo –2, Yobe -3 & Zamfara –3) compared with 16 suspected cases and 4 deaths (CFR, 25.0%) reported across 8 LGAs in 6 states at the same period in 2017 (Figure 1)
2.2 Between weeks 1 and 48 (2018), 4448 suspected meningitis cases with 318 laboratory confirmed and 359 deaths (CFR, 8.1%) from 299 LGAs (35 States) were reported compared with 9918 suspected cases and 606 deaths (CFR, 6.1%) from 326 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 - 48, 2018 as against 76.4% timeliness and 92.3% completeness recorded within the same period in 2017
3.1 62 suspected cases of cholera and five deaths (CFR, 8.1%) were reported from 10 LGAs in six states; Bayelsa –1, Borno –9, Cross River –2, Kano –34, Katsina –1 and Yobe -15) in week 48, 2018 compared with 7 suspected cases reported from 3 LGAs in 3 states during the same period in 2017 (Figure 2).
3.2 Between weeks 1 and 48 (2018), 50,463 suspected cholera cases with 934 laboratory confirmed and 1132 deaths (CFR, 2.2%) from 245 LGAs in 30 States were reported compared with 3703 suspected cases and 84 deaths (CFR, 2.3%) from 73 LGAs in19 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
4 LASSA FEVER
4.1 In the reporting Week 48 (26 November – 2 December, 2018), 13 new confirmed I cases were reported from Edo (2), Ondo (8), Gombe (1), Plateau (1) and Kano (1) States with two new deaths in Plateau (1) and Gombe (1) States
4.2 From 1st January to 2nd December 2018, a total of 3229 suspectedi cases have been reported from 23 states. Of these, 581 were confirmed positive, 17 probable and 2631 negative (not a case)
4.3 Since the onset of the 2018 outbreak, there have been 146 deaths among confirmed cases and 17 among probable cases. Case Fatality Rate in confirmed cases is 25.1%
4.4 Twenty three states have recorded at least one confirmed case across 92 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). Eighteen states have exited the active phase of the outbreak while five – Edo, Ondo, Plateau, Gombe and Kano States remain activeiv
4.5 Good clinical practice workshop in collaboration with World Health Organisation concluded
4.6 Lassa fever international Conference scheduled for 16th to 17th January 2019,:registration is ongoing on @ 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.
In the reporting week, 240 suspected cases of measles and 1 death (CFR, 0.004%) were reported from 31 states compared with 278 suspected cases reported from 33 states during the same period in 2017
5.2 Since the beginning of the year, 16393 suspected measles cases with 1110 laboratory confirmed and 124 deaths (CFR, 0.8%) were reported from 36 states and FCT compared with 21162 suspected cases with 109 laboratory confirmed and 112 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 andLGAs during Supplementary Immunisation Activities (SIAs), as well as case management
6 Yellow fever
In the reporting week 47 (19th – 25th November), three new suspected cases were reported from Edo State with two presumptive positives
6.2 Two new confirmed cases from Nigeria were reported by the WHO reference laboratory, Institute Pasteur Dakar; from Katsina (1) and Kebbi (1).
6.3 From the onset of this outbreak on September 12, 2017, a total of 3,456 suspected yellow fever cases with 56 Laboratory confirmed and 55 deaths (CFR, 1.6%) have been reported from 570 LGAs (36 States & FCT)
6.4 A total of 58 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)
6.5 A multi-agency national Emergency Operations Centre is coordinating the national response
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 6 States (Nasarawa, Cross River, Akwa-Ibom, Kogi, Kwara & Zamfara) and 57 political wards in 25 LGAs in Borno State
6.8 Two Rapid Response Teams have been deployed to support the ongoing response in Edo state
6.9 The 2018 phase 2b November Preventive Mass Vaccination Campaign (PMVC) held from 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 – 49, 2018
7.1. From week 1- 49, 387suspected cases were reported, of which 347 were Influenza like-illness (ILI), 40 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%) was positive for Influenza A; 33(9.9%) 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, 16 samples were processe in the National Reference Laboratory
FOR MORE INFORMATION CONTACT
Nigeria Centre for Disease Control,
801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.