This week’s editorial focuses on the Surveillance, Outbreak Response Management and Analysis System (SORMAS), an application used for case based surveillance in Nigeria.
SORMAS is a mobile and web based outbreak response task management system that includes contact tracing, laboratory result and rumour management platforms. The tool was developed based on the experience of the 2014 Ebola outbreak response by a consortium of partners from Nigeria, Germany and USA.
Over the last one year, SORMAS has been deployed in the 2017/2018 response to Lassa fever, Meningitis and Monkey pox outbreaks across fifteen States. This system had strengthened real time reporting and the development of response interventions, as both surveillance and laboratory management processes are included in one single system.
Based on the lessons learnt from the roll-out, the Nigeria Centre for Disease Control (NCDC) has engaged additional manpower to effectively support States, LGAs and Health facilities in implementing SORMAS at the various levels (health facility to LGA to State). As part of this process, NCDC organised a workshop in Abuja from 8th to 10th August, 2018. The goal was to train and orient the new support staff on SORMAS to effectively understand the operations of the application and develop strategies to improve its utilisation at State, LGA and health facility levels.
These officers will support State and LGA disease surveillance officers with the goal to ensure an effective roll out of the digital tool for surveillance. With the increase in workforce, it is expected that there will be an improvement in the level of completeness and timeliness of reports.
States are therefore encouraged to support the LGAs and health facilities in the implementation of SORMAS, as NCDC works to improve the process.
SUMMARY OF REPORTS
In the reporting week ending on July 29, 2018:
o There were 192 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 534 suspected cases of Cholera were reported from 37 LGAs in 11 States (Adamawa – 11, Bauchi – 2, Bayelsa – 1, Borno – 27, Ebonyi – 5, FCT – 20, Kaduna – 10, Kano – 130, Katsina – 104, Yobe – 19 and Zamfara - 204). Of these, 23 were laboratory confirmed and 12 deaths were recorded.
o 16 suspected cases of Lassa fever were reported from seven LGAs in four States (Edo – 5, Kogi – 3, Ogun – 1, Ondo – 5 & Plateau - 2). Five were laboratory confirmed and no death were recorded.
o There were eight suspected cases of Cerebrospinal Meningitis (CSM) reported from seven LGAs in five States (Katsina – 1, Ondo – 2, Oyo – 1, Plateau - 1 & Yobe – 3). Of these, no was laboratory confirmed case and no death was recorded.
o There were 246 suspected cases of Measles reported from 30 States. One was laboratory confirmed and three deaths were recorded.
In the reporting week, all States sent in their report except Abia and Cross River States. Timeliness of reporting remains 88% in both previous and current weeks (week 29 & 30) 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
1.1. As at July 29th 2018, no new case of WPV was recorded
1.2. In the reporting week, 192 cases of AFP were reported from 156 LGAs in 33 States and FCT
1.3. Between week 1 and 30 2018, 4995 suspected cases of AFP have been reported from 718 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
2. CEREBROSPINAL MENINGITIS (CSM)
2.1 In the reporting week, eight suspected Cerebrospinal Meningitis (CSM) cases and one death (CFR, 12.5%) were reported from seven LGAs (five States; Katsina – 1, Ondo – 2, Oyo – 1, Plateau - 1 & Yobe – 3) compared with 17 suspected cases reported from ten LGAs (seven States) at the same period in 2017 (Figure 1)
2.2 Between weeks 1 and 30 (2018), 3231 suspected meningitis cases with 108 laboratory confirmed and 207 deaths (CFR, 6.41%) from 258 LGAs (30 States) were reported compared with 9753 suspected cases and 602 deaths (CFR, 6.2%) from 306 LGAs (32 States) during the same period in 2017.
2.3 After Action Review (AAR) meeting to evaluation the response to 2017/2018 CSM outbreak is scheduled for 13-15 August, 2018 in Abuja
2.4 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 - 30, 2018 as against 76.4% timeliness and 92.3% completeness recorded within the same period in 2017
3.1 534 suspected cases of Cholera with 23 Laboratory Confirmed cases and 12 deaths (CFR, 2.25%) were reported from 37 LGAs (11 States; Adamawa – 11, Bauchi – 2, Bayelsa – 1, Borno – 27, Ebonyi – 5, FCT – 20, Kaduna – 10, Kano – 130, Katsina – 104, Yobe – 19 and Zamfara - 204) in week 30, 2018 compared with two suspected cases reported from Ilorin East LGA (Kwara State) during the same period in 2017 (Figure 2). There is a decline in the number of new cases reported.
3.2 Between weeks 1 and 30 (2018), 12286 suspected Cholera cases with 349 laboratory confirmed and 189 deaths (CFR, 1.54%) from 118 LGAs (22 States) were reported compared with 972 suspected cases and 25 deaths (CFR, 2.57%) from 36 LGAs (14 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 and Adamawa States.
3.5 NCDC, Partners and stakeholders conducted development of medium term strategies for Cholera control including mapping of the hot spots in Nigeria on the 19th July, 2018
3.6 OCV vaccines for second round vaccination campaign in Adamawa State scheduled for 11-15 August, 2018 have been received from ICG
3.7 National Preparedness and Response to Acute Watery Diarrhoea/ Cholera Guidelines available via http://ncdc.gov.ng/themes/common/docs/protocols/45_1507196550.pdf
4.1 In the reporting Week 30 (July 23 - 29 , 2018) five new confirmed I cases were reported from Edo (4) and Ondo (1) with tone new death from Edo (1) States
4.2 From 1st January to 29nd July 2018, a total of 2291 suspectedi cases have been reported from 21 states. Of these, 472 were confirmed positive, 10 are probable, 1809 negative (not a case)
4.3 Since the onset of the 2018 outbreak, there have been 121 deaths in confirmed cases and 10 in probable cases. Case Fatality Rate in confirmed cases is 25.6%
4.4 21 states have recorded at least one confirmed case across 71 Local Government Areas (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba, Delta, Osun, Rivers, FCT, Gombe, Ekiti, Kaduna, Abia and Adamawa). Nineteen states have exited the active phase of the outbreak while two – Edo and Ondo States remain activeiv
4.5 NCDC and Partners deployed Rapid Response Team (RRT) to Enugu and Edo States
4.6 Supplies for Lassa fever management procured through UNICEF and distributed to all LF affected states
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
5.1 In the reporting week, 246 suspected cases of Measles with one Laboratory confirmed and three deaths (CFR, 1.25%) were reported from 30 States compared with 449 suspected cases and one death (CFR, 0.22%) reported from 33 States during the same period in 2017
5.2 So far, 12751 suspected Measles cases with 14 Lab. Confirmed and 99 deaths (CFR, 0.78 %) were reported from 36 States and FCT compared with 15607 suspected cases with 108 laboratory confirmed and 89 deaths (CFR, 0.57 %) from 37 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 NCDC and partners visited Edo and Cross River states to assess the laboratories in preparation for the establishment of a Zonal Measles/YF lab in the South South States
5.5 NCDC deployed RRT to investigate outbreak of measles in Oyo State
6 Yellow fever
6.1 In this reporting week 30th July – 5th August, 2018, 18 suspected cases were added to the national line list
6.2 No new in-country presumptive positive was report in the reporting week, last presumptive positive case in the Nigerian lab was 2-July-18 and last IP Dakar confirmed case from Nigeria was on 6-June -2018
6.3 From the onset of this outbreak on September 12, 2017, a total of 2,418 suspected yellow fever cases with 47 Laboratory confirmed and 47 deaths (CFR, 1.9%) have been reported from 504 LGAs (36 States & FCT)
6.4 Predominant age groups affected among the suspected cases are 20 years and below accounting for 62.4%; [male to female ratio is 1.4 to 1 (male 58.2%, female 41.8%)]
6.5 Surveillance activities have been intensified across all States
6.6 NCDC and partners have completed the assessment of some laboratories in Nigeria for possible inclusion into the testing laboratory network
6.7 NCDC & partners conducted detailed case investigation in Edo and Ekiti states following recent reports and currently in Rivers State
7. Update on national Influenza sentinel surveillance, Nigeria week 1 - 31, 2018
7.1. From week 1- 30, 175-suspected cases were reported, of which 155 were Influenza like-illness (ILI), 20 Severe Acute Respiratory Infection (SARI).
7.2 A total of 175 samples were received and all samples were processed. Of the processed samples, 155(88.6%) were ILI cases, 20 (11.4%) were Severe Acute Respiratory Infection (SARI).
7.4. Of the 155 processed ILI samples, 16 (10.3%) was positive for Influenza A; 26(16.8%) positive for Influenza B and 113 (72.9%) were negative.
7.5 For the processed 20 SARI samples, five (25.0%) were positive for Influenza A while the remaining 15 (75.0%) were negative.
7.6 42 (24.0%) of the processed 175 samples were positive for Influenza, with 16 (38.1%) of these positive for Influenza A and 26 (61.9%) positive for Influenza B.
7.5. The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for (0.0%), 11 (68.8%) and 5 (31.2%) of the total influenza A positive samples respectively.
7.6 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 10(38.5%), 16(61.5%) and 0(0.0%) of the total influenza B positive samples respectively
7.7 The percentage influenza positive was highest (75.0%) in week 6, 2018
7.8 In the reporting week 1 -31, all samples were processed
FOR MORE INFORMATION CONTACT
Nigeria Centre for Disease Control,
801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.