In Epi-week 8, Nigeria recorded 1081 suspected cases in the current Lassa fever outbreak. Of this, 325 cases have been classified as: 317 confirmed cases, 8 probable cases with 72 deaths (64 in Lab confirmed and 8 in probable) have been recorded giving a case fatality rate (CFR) of 22%. The number of confirmed cases recorded so far surpasses the number of confirmed cases (312) recorded in the year 2017.
With the increasing number of cases, the Nigeria Centre for Disease Control which activated its Emergency Operations Centre (EOC) in January 2018 has escalated this to highest possible level- Level 3.
Implications of escalating the current Lassa fever outbreak to Level 3 includes:
1. The primary focus of the Nigeria Centre for Disease Control (NCDC) will be to channel all available resources to control this outbreak.
2. Request for support from the World Health Organization (WHO) and other partners to control the outbreak.
3. Deployment of additional manpower with core technical expertise in outbreak response and management.
4. Increase in field response activities in affected States
5. Increased callout to affected states to increase support for the response.
Following the escalation, the National Lassa fever Emergency Operations Centre (EOC) has stepped up its coordination activities with an increase in manpower including Rapid Response Teams in affected States, requisition for needed consumables, targeted risk communication activities which are all focused on controlling the outbreak. Further information on the Lassa fever outbreak control efforts can be accessed on the NCDC website: www.ncdc.gov.ng
SUMMARY OF REPORTS
In the reporting week ending on February 18, 2018:
o There were 128 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 Three suspected cases of Cholera were reported from Kaduna South LGA in Kaduna States. Of these, none was laboratory confirmed and no death was recorded.
o 55 suspected cases of Lassa fever were reported from 21 LGAs in 11 States (Bauchi – 1, Ebonyi – 2, Edo – 10, Ekiti – 2, FCT- 2, Kebbi – 1, Kwara - 2, Nasarawa – 2, Ondo – 26, Plateau – 4 & Rivers - 4). 21 were laboratory confirmed and eight deaths were recorded.
o There were 128-suspected cases of Cerebrospinal Meningitis (CSM) reported from 41 LGAs in 16 States (Adamawa – 1, Bauchi – 1, Enugu – 1, , Gombe - 8, Jigawa – 10, Kano – 1, Katsina - 12, Kebbi – 8, Nasarawa – 1,Niger – 11, Sokoto – 12, Taraba – 6, Yobe - 8 & Zamfara - 48). Of these, two were laboratory confirmed and ten deaths were 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 507- suspected cases of Measles reported from 34 States. None was laboratory confirmed and four deaths were recorded.
In the reporting week, all States sent in their report except Cross River and Delta States. Timeliness of reporting decreases from 90% in the previous week to 86% in the current week (week 6 & 7, 2018) while completeness also decreases from 100% to 98% 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 February 18th, 2018, no new case of WPV was recorded
1.2. In the reporting week, 128 cases of AFP were reported from 109 LGAs in 29 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
1.2.3 The 2nd round of SIPDs is scheduled for 3rd to 6th of March, 2018 in Borno, Yobe and Adamawa States
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 7, 128 suspected Cerebrospinal Meningitis (CSM) cases with two Lab. confirmed and ten deaths (CFR, 7.81%) were reported from 45 LGAs (14 States; Adamawa – 1, Bauchi – 1, Enugu – 1, , Gombe - 8, Jigawa – 10, Kano – 1, Katsina - 12, Kebbi – 8, Nasarawa – 1,Niger – 11, Sokoto – 12, Taraba – 6, Yobe - 8 & Zamfara - 48) compared with 26 suspected cases with two Lab. Confirmed cases from nine LGAs (seven States) at the same period in 2017 (Figure 2)
2.2 Between weeks 1 and 7 (2018), 475 suspected meningitis cases with 27 laboratory confirmed and 25 deaths (CFR, 5.79%) from 106 LGAs (24 States) were reported compared with 299 suspected cases and 38 deaths (CFR, 12.71%) from 57 LGAs (21 States) during the same period in 2017.
2.3 Timeliness/completeness of CSM case-reporting from States to the National Level (2017 versus 2016): on average, 87.9% of the 26 endemic States sent CSM reports in a timely manner while 88.5% were complete in week 1 - 7, 2018 as against 76.4% timeliness and 91.2% completeness recorded within the same period in 2017
2.4 The National CSM Emergency Operations Centre has been activated and is currently in response mode
2.5 Enhanced surveillance/ case-based surveillance began 1st of December 2017
2.6 Rapid Response Team has been deployed to Niger State
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
2.9 Preventive vaccination conducted in Yobe State with Men Afrivac in two phases -7th to 11th and 14th to 18th February 2018
2.10 Reactive vaccination using A, C W135 polysaccharide vaccine carried out in Katsina Central Prison
2.11 Monitoring of risk communication activities in all States especially high-risk States
2.12 Surveillance Outbreak and Response Management Analysis System (SORMAS) tool deployed in Zamfara, Sokoto and Katsina states
3.1 Three suspected cases of Cholera were reported from Kaduna South LGA (Kaduna State) in week 7, 2018 compared with one suspected cases reported from Gombe LGA (Gombe State) during the same period in 2017 (Figure 3).
3.2 Between weeks 1 and 7 (2018), 187 suspected Cholera cases with one laboratory confirmed and 13 deaths (CFR, 6.95%) from 26 LGAs (eight States) were reported compared with 38 suspected cases and four deaths (CFR, 10.53%) from seven LGAs (seven 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 Ongoing plans for nationwide Cholera campaign with Federal Ministry of Water Resources and partner agencies
Please note that the data reflects the routine reports i.e. all suspected cases including the laboratory positive and negative cases
4.1 55 suspected cases of Lassa fever with 21 Laboratory confirmed and eight deaths (CFR, 14.5%) were reported from 21 LGAs (11 States: Bauchi – 1, Ebonyi – 2, Edo – 10, Ekiti – 2, FCT- 2, Kebbi – 1, Kwara - 2, Nasarawa – 2, Ondo – 26, Plateau – 4 & Rivers - 4) in week 7, 2018 compared with eight suspected cases with one Lab. Confirmed and two deaths (CFR, 25.0%) reported from six LGAs (four States) at the same period in 2017
4.2 Laboratory results of the 55 suspected cases; 21 positive for Lassa fever (Edo – 4, Ekiti – 1, FCT – 1 & Ondo – 15), 34 were negative for Lassa fever & other VHFs (Bauchi – 1, Ebonyi – 2, , Edo – 6, Ekiti – 1, FCT – 1, Kebbi – 1, Kwara – 2, Ondo – 11, Plateau – 4 & Rivers – 4)
4.3 Between weeks 1 and 7 (2018), 514 suspected Lassa fever cases with 147 laboratory confirmed cases and 45 deaths (CFR, 8.76%) from 103 LGAs (26 States) were reported compared with 146 suspected cases with 38 laboratory confirmed cases and 23 deaths (CFR, 15.22%) from 29 LGAs (21 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 NCDC provided Ribavirin and other necessary supportive management to States and their treatment centres
4.9 NCDC Rapid Response Teams currently in Ebonyi, Edo and Ondo States
4.10 High-level advocacy and assessment visit by joint NCDC/WHO Team to Edo and Ondo States
4.11 Offsite support provided by NCDC/partners in all affected States
4.12 NCDC in collaboration with ALIMA is providing support to treatment centres in
Ebonyi, Ondo and Edo States where most of the patients are managed
4.13 States are enjoined to intensify surveillance and promote Infection, Prevention and Control (IPC) measures in health facilities
5.1 In the reporting week, 507 suspected cases of Measles and four deaths (CFR, 0.79%) were reported from 34 States compared with 352 suspected cases reported from 29 States during the same period in 2017
5.2 So far, 2450 suspected Measles cases and 24 deaths (CFR, 0.98%) were reported from 36 States and FCT compared with 2945 suspected cases with 35 laboratory confirmed and 22 deaths (CFR, 0.75%) from 36 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 - 8, 2018
7.1. From week 1- 8, 78-suspected cases were reported, of which 74 were Influenza-like-illness (ILI), four Severe Acute Respiratory Infection (SARI).
7.2 78 samples were received of which 70 were processed. Of the processed samples, 68(97.140%) were ILI cases, two (2.86%) were Severe Acute Respiratory Infection (SARI).
7.4. Of the 70 processed ILI samples, seven (10.0%) was positive for Influenza A; 21(30.0%) positive for Influenza B and 42(60.0%) were negative.
7.5. 28 (40.0%) of the processed 70 samples were positive for Influenza, with seven (25.0%) of these positive for Influenza A and 21 (75.5%) positive for Influenza B.
7.6. The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for (0.0%), 0 (0.0%) and seven (100.0%) of total influenza A positive samples respectively.
7.7. The percentage influenza positive was highest (50.0%) in week 3, 2018
7.8. In the reporting week 8, eight samples were left unprocessed
FOR MORE INFORMATION CONTACT
Nigeria Centre for Disease Control,
801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.