Weekly Epidemiological Report

February 2018 Week 5

Editoral

PROMPT TESTING FOR LASSA FEVER TO IMPROVE OUTBREAK OUTCOMES

Posted: 20-02-2018 08:01:37 PM

In Epi-week 6, the Lassa fever outbreak continued with a total of 615 suspected cases reported across 17 states. Of this, 193 have been confirmed positive to the Lassa fever virus. 43 deaths were recorded in confirmed cases giving a case fatality rate (CFR) of 23.9%.

Since the onset of the outbreak, there has been a high case identification rate through the use of standard case definition employed via the integrated disease surveillance and response (IDSR) strategy. This is an indication of an active and improved surveillance system. This in itself, is a part of the case detection process as all cases have to be subjected to laboratory testing for further classification and disease burden estimation.

Laboratories play a major role in outbreak response and management. It is important that all cases identified undergo laboratory testing. Delays in carrying out laboratory testing could range from poor sample collection techniques, ineffective sample management processes to poor testing techniques. Addressing these delays would be contributory to better outbreak outcomes.

Prompt testing of samples provides insight into better outbreak response. It provides a good background for better projection of scarce resources and promotes judicious use. In summary, it reduces CFR as confirmed cases are detected earlier, offered prompt health care services and most importantly, brings about improvement in the health status of the larger community.

Currently, Lassa fever testing is carried out across three (3) laboratories in Nigeria. The Nigeria Centre for Disease Control (NCDC) has provided support for all testing laboratories with provision of reagents and other consumables. It is hoped that in the near future, States are able to build and support laboratories to carry out Lassa fever testing.


SUMMARY OF REPORTS

In the reporting week ending on January 28, 2018:

o There were 141 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 reinvigorated its efforts at eradicating Polio.

o 15 suspected cases of Cholera were reported from two LGAs in two States (Ebonyi – 12 & Enugu – 3). Of these, none was laboratory confirmed and two deaths were recorded.

o 168 suspected cases of Lassa fever were reported from 46 LGAs in 21 States (Adamawa – 1, Anambra – 1, Bayelsa – 2, Benue – 1, Cross River – 1, Ebonyi – 4, Edo – 91, FCT- 10, Gombe – 8, Kaduna – 2, Katsina – 2, Kogi - 3, Kwara – 1, Nasarawa – 5, Niger – 2, Ogun – 1, Ondo – 23, Osun – 1, Plateau – 2, Rivers – 4 & Taraba - 3). 30 were laboratory confirmed and seven deaths were recorded.

o There were 51-suspected cases of Cerebrospinal Meningitis (CSM) reported from 27 LGAs in 12 States (Adamawa – 1, Benue – 1, Cross River – 3, Gombe -6, Jigawa – 3, Kaduna – 1, Katsina - 15, Oyo – 1, Sokoto – 2, Taraba – 4 & Zamfara - 13). Of these, three were laboratory confirmed and one death was recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt and case-based surveillance commenced from 4th December 2017.

o There were 460- suspected cases of Measles reported from 33 States. None was laboratory confirmed and 13 deaths were recorded.

In the reporting week, all States sent in their report. This is a remarkable improvement! Timeliness of reporting remains 92% in both previous and current weeks (week 4 & 5, 2018) while completeness remained 100% 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 February 4th, 2018, no new case of WPV was recorded

1.2. In the reporting week, 141 cases of AFP were reported from 121 LGAs in 31 States & FCT

1.2.1. AFP Surveillance has been enhanced and outbreak response is on-going in Borno and other high-risk States

1.2.2. The 1st round of SIPDs in 2018 conducted from 20th – 23rd January 2018 in the 14 high-risk States using bOPV. The schedule for other SIAs is as described in Table 2

1.3. Six confirmed WPVs were isolated in 2014.

1.4. The SIAs were strengthened with the following events:

1.4.1. Immunisation for all vaccine-preventable diseases in some selected wards/LGAs.

1.4.2. Use of health camp facilities.

1.4.3. Field supportive supervision and monitoring.

1.4.4. Improved Enhanced Independent Monitoring (EIM) and Lots Quality Assessments (LQAs) in all Polio high-risk States.

1.4.5. High level of accountability framework


2. CEREBROSPINAL MENINGITIS (CSM)

2.1 In the reporting week 5, 51 suspected Cerebrospinal Meningitis (CSM) cases with three Lab. Confirmed and one death (CFR, 1.96%) were reported from 27 LGAs (12 States; Adamawa – 1, Benue – 1, Cross River – 3, Gombe -6, Jigawa – 3, Kaduna – 1, Katsina - 15, Oyo – 1, Sokoto – 2, Taraba – 4 & Zamfara - 13) compared with 51 suspected cases and two deaths (CFR, 3.9%) from nine LGAs (nine States) at the same period in 2017 (Figure 2)

2.2 Between weeks 1 and 5 (2018), 260 suspected meningitis cases with 25 laboratory confirmed and 12 deaths (CFR, 4.62%) from 78 LGAs (22 States) were reported compared with 153 suspected cases and 13 deaths (CFR, 8.50%) from 37 LGAs (18

2.3 Timeliness/completeness of CSM case-reporting from States to the National Level (2017 versus 2016): on average, 88.5% of the 26 endemic States sent CSM reports in a timely manner while 88.5% were complete in week 1 - 5, 2018 as against 76.9% timeliness and 84.6% completeness recorded within the same period in 2017

2.4 The National CSM Emergency Operations Centre has been activated and is currently on response mode

2.5 Enhanced surveillance/ case based surveillance began 1st of December 2017

2.6 Rapid Response Teams currently deployed to support response in Zamfara and Katsina States

2.7 The National CSM Guidelines have been finalised and available via http://ncdc.gov.ng/themes/common/docs/protocols/51_1510449270.pdf

2.8 State CSM Emergency Operations Centre has been activated in Zamfara, Katsina and Sokoto States respectively


CHOLERA

3.1 15 suspected cases of Cholera were and two deaths (CFR, 13.33%) reported from two LGAs (two States: Ebonyi – 12 & Enugu – 3) in week 5, 2018 compared with five suspected cases reported Kuje LGA in FCT during the same period in 2017 (Figure 3).

3.2 Between weeks 1 and 5 (2018), 172 suspected Cholera cases with one laboratory confirmed and 13 deaths (CFR, 7.56%) from 23 LGAs (seven States) were reported compared with 37 suspected cases and four deaths (CFR, 10.81%) from six LGAs (six States) during the same period in 2017.

3.3 National Preparedness and Response to Acute Watery Diarrhoea/ Cholera Guidelines have been finalised: http://ncdc.gov.ng/themes/common/docs/protocols/45_1507196550.pdf

3.4 States are enjoined to intensify surveillance, implement WASH activities and ensure early reporting.


LASSA FEVER

Please note that the data reflects the routine reports i.e. all suspected cases including the laboratory positive and negative cases

4.1 168 suspected cases of Lassa fever with 30 Laboratory confirmed and seven deaths (CFR, 4.17%) were reported from 46 LGAs (21 States: Adamawa – 1, Anambra – 1, Bayelsa – 2, Benue – 1, Cross River – 1, Ebonyi – 4, Edo – 91, FCT- 10, Gombe – 8, Kaduna – 2, Katsina – 2, Kogi - 3, Kwara – 1, Nasarawa – 5, Niger – 2, Ogun – 1, Ondo – 23, Osun – 1, Plateau – 2, Rivers – 4 & Taraba - 3) in week 5, 2018 compared with 13 suspected cases with four Lab. Confirmed and one death (CFR, 7.7%) reported from seven LGAs (seven States) at the same period in 2017

4.2 Laboratory results of the 168 suspected cases; 30 positive for Lassa fever (Ebonyi – 4, Edo – 16, FCT – 1, Kogi – 1, Ondo – 7 & Osun - 1), 123 were negative for Lassa fever & other VHFs (Adamawa – 1, Bayelsa– 1, Edo – 75, FCT – 9, Kaduna – 2, Kogi – 2, Kwara – 1, Nasarawa – 5, Niger – 2, Ondo – 16, & Taraba - 3) while 15 are still pending (Anambra – 1, Gombe – 8, Plateau – 2 & Rivers – 4)

4.3 Between weeks 1 and 5 (2018), 371 suspected Lassa fever cases with 94 laboratories confirmed cases and 30 deaths (CFR, 8.09%) from 82 LGAs (26 States) were reported compared with 130suspected cases with 31 laboratory confirmed cases and 19 deaths (CFR, 14.62%) from 24 LGAs (ten States) during the same period in 2017 (Figure 4)

4.4 Investigation and active case search ongoing in affected States with coordination of response activities by the NCDC with support from partners

4.5 National Lassa Fever Working Group has been escalated to National Emergency Operations Centre on the 22nd January 2018

4.6 Response materials for VHF provided to support States and health facilities

4.7 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

4.8 Onsite support ongoing in Ebonyi, Edo and Ondo States by the NCDC and partners

4.9 Offsite support provided by NCDC/partners in all affected States

4.10 States are enjoined to intensify surveillance and promote Infection, Prevention and Control (IPC) measures in health facilities


5 MEASLES

5.1 In the reporting week, 460 suspected cases of Measles and 13 deaths (CFR, 2.83%) were reported from 33 States compared with 404 suspected cases with 17 Laboratory confirmed and four deaths (CFR, 0.99%) reported from 30 States during the same period in 2017

5.2 So far, 1509 suspected Measles cases and 16 deaths (CFR, 1.06%) were reported from 36 States and FCT compared with 2006 suspected cases with 32 laboratory confirmed and 20 deaths (CFR, 1.0%) from 35 States 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

5.4 Measles mass campaign for North Central States ongoing from February 8 - 20, 2018

5.5 Proposed Measles mass campaign for the Southern States scheduled for March 8 – 20, 2018

5.6 Measles mass campaign conducted in seven North West and North East States from 9th – 14th November 2017 and 30th November – 5th December 2017 respectively.


6 GUINEA WORM DISEASE

6.1 In the reporting week, no rumour report of Guinea Worm disease was received from any State.

6.2 Nigeria has celebrated eight 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 Nigeria Guinea Worm Eradication Program / Neglected Tropical Diseases Division, Public Health Department/Federal Ministry of Health)


7. Update on national Influenza sentinel surveillance, Nigeria week 1 - 52, 2017

7.1. From week 1-52, 162-suspected cases were reported, of which 154 were Influenza-like-illness (ILI), eight Severe Acute Respiratory Infection (SARI).

7.2 162 samples were received of which 114 were processed. Of the processed samples, 106(93.0%) were ILI cases, eight (7.0%) were Severe Acute Respiratory Infection (SARI).

7.4. Of the 106 processed ILI samples, 1(0.94%) was positive for Influenza A; six(5.66%) positive for Influenza B and 99(93.4%) were negative.

7.5. Of the eight processed SARI samples, none was positive for Influenza A and Influenza B.

7.6. Seven (6.60%) of the processed 106 samples were positive for Influenza, with one (14.29%) of these positive for Influenza A and six (85.71%) positive for Influenza B.

7.7. The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for (100%), 0 (0.0%) and 0 (0.0%) of total influenza A positive samples respectively.

7.8. The percentage influenza positive was highest (50.0%) in week 14, 2017

7.9. In the reporting week 52, 48 samples were left unprocessed

Highlight of the week

  • SUMMARY OF REPORTS
  • REPORT ANALYSIS AND INTERPRETATION
  • 2. CEREBROSPINAL MENINGITIS (CSM)
  • CHOLERA
  • LASSA FEVER
  • 5 MEASLES
  • 6 GUINEA WORM DISEASE
  • 7. Update on national Influenza sentinel surveillance, Nigeria week 1 - 52, 2017

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