Nigeria conducted a Joint External Evaluation (JEE) in 2017 which has led to the development of the National Action Plan for Health Security (NAPHS) in line with IHR (2005). One of the key recommendations from the JEE and NAPHS is the development of a contingency plan for major outbreaks of epidemic prone diseases in the country as evident in the outbreaks of infectious diseases like Lassa fever, Cerebrospinal meningitis, cholera as well as resurgence of Monkey pox and yellow fever experienced over the years.
The Strategic Assessment of Risk (STAR) for the country was also conducted in July 2018 with risk profiling of infectious hazards and vulnerability assessment, where developing a contingency plan is critical to identifying resources, priority interventions, and mitigation that contributes to the reduction of morbidity and mortality in populations at risk.
As a follow up to achieving this, the Nigeria Centre for Disease Control (NCDC) in collaboration with World Health Organisation (WHO) organised a workshop in Barcelona Hotels, Abuja from 17th to 21st September, 2018. The workshop had representatives from the Port Health service, National Primary Healthcare Development Agency, Federal Ministry of Water Resources, State Ministries of Health (State Director of Public health & State Epidemiologists), UNICEF, US-CDC, AFENET, Pro-Health, UMB, MSF, Academia and other stakeholders. The goal was to develop a contingency plan that will improve/guide preparedness and response to disease outbreaks, and ensure effective utilisation of available resources within the country. It will also help to reduce the impact of outbreak or emergency of public health events.
With this, Nigeria through NCDC becomes better prepared for infectious disease threats that will reduce their potential public health consequences. This contingency plans will also serves as a guide to monitor progress of implementation across all levels.
SUMMARY OF REPORTS
In the reporting week ending on September 9, 2018:
o There were 195 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 1715 suspected cases of Cholera reported from 48 LGAs in ten States (Adamawa – 151, Bauchi – 4, Borno – 165, Ebonyi – 1, Gombe – 88, Kaduna – 11, Kano – 216, Katsina – 439, Kebbi – 11 and Zamfara - 629). Of these, 27 were laboratory confirmed and 38 deaths were recorded.
o Ten suspected cases of Lassa fever were reported from six LGAs in three States (Edo – 6, FCT – 3 & Rivers - 1). Five were laboratory confirmed and two deaths were recorded.
o There were 15 suspected cases of Cerebrospinal Meningitis (CSM) reported from nine LGAs in five States (Ebonyi – 7, Enugu – 1, Ondo – 1, Plateau -1 & Yobe – 5). Of these, none was laboratory confirmed and one deaths was recorded.
o There were 194 suspected cases of Measles reported from 29 States. None was laboratory confirmed and 13 deaths were recorded.
In the reporting week, all States sent in their report except Delta, Edo and Taraba States. Timeliness of reporting remains 87% in both previous and current weeks (35 & 36) 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
1.1. As at September 9th 2018, no new case of WPV was recorded
1.2. In the reporting week, 195 cases of AFP were reported from 159 LGAs in 32 States
1.3. Between week 1 and 36 2018, 5938 suspected cases of AFP have been reported from 731 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, 15 suspected Cerebrospinal Meningitis (CSM) cases and one death (CFR, 6.7%) were reported from nine LGAs (five States; Ebonyi – 7, Enugu – 1, Ondo – 1, Plateau -1 & Yobe – 5) compared with nine suspected cases reported from seven LGAs (six States) at the same period in 2017 (Figure 1)
2.2 Between weeks 1 and 36 (2018), 3283 suspected meningitis cases with 108 laboratory confirmed and 210 deaths (CFR, 6.4%) from 269 LGAs (32 States) were reported compared with 9781 suspected cases and 602 deaths (CFR, 6.2%) from 314 LGAs (33 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 - 36, 2018 as against 76.4% timeliness and 92.3% completeness recorded within the same period in 2017
3.1 1715 suspected cases of Cholera with 27 Lab. Confirmed and 38 deaths (CFR, 2.2%) were reported from 48 LGAs (ten States; Adamawa – 151, Bauchi – 4, Borno – 165, Ebonyi – 1, Gombe – 88, Kaduna – 11, Kano – 216, Katsina – 439, Kebbi – 11 and Zamfara - 629) in week 36, 2018 compared with 708 suspected cases with four Lab. Confirmed and 18 deaths (CFR, 2.5%) reported from ten LGAs (six States) during the same period in 2017 (Figure 2).
3.2 Between weeks 1 and 36 (2018), 18,068 suspected Cholera cases with 436 laboratory confirmed and 319 deaths (CFR, 1.77%) from 152 LGAs (24 States) were reported compared with 2330 suspected cases and 51 deaths (CFR, 2.2%) from 54 LGAs (17 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 A National coordination team led by the NCDC Incident Manager conducted an advocacy visit to Sokoto and Zamfara States to reinforce the ongoing response, strengthen the IMS structure and partner collaboration.
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. LASSA FEVER
4.1 In the reporting Week 36 (3 – 9 September, 2018) seven new confirmedI cases were reported from Edo (6) and Delta (1) States with no new death recorded.
4.2 From 1st January to 9th September 2018, a total of 2515 suspectedi cases have been reported from 22 states. Of these, 504 were confirmed positive, 10 are probable, 2002 negative (not a case)
4.3 Since the onset of the 2018 outbreak, there have been 132 deaths in confirmed cases and 10 in probable cases. Case Fatality Rate in confirmed cases is 26.2%
4.4 22 states have recorded at least one confirmed case across 87 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). Eighteen states have exited the active phase of the outbreak while four – Edo, Ebonyi, Bauchi and Delta 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 Lassa fever international Conference registration, abstract submission and sponsorship now open to the public on the conference website www.lic.ncdc.gov.ng
4.8 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
4.9 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, 194 suspected cases of Measles and 13 deaths (CFR, 6.7%) were reported from 29 States compared with 209 suspected cases reported from 29 States during the same period in 2017
5.2 So far, 13895 suspected Measles cases with 901 Lab. Confirmed and 113 deaths (CFR, 0.8%) were reported from 36 States and FCT compared with 17772 suspected cases with 108 laboratory confirmed and 105 deaths (CFR, 0.59 %) 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 RRT conducted detailed investigation of measles outbreak in Oyo State
6. Yellow fever
6.1 In this reporting week 10th – 16th September, 2018, 178 suspected cases were added to the national line list
6.2 Six new in-country presumptive positive cases and one inconclusive case were reported in the reporting week from two diagnostic laboratories and last IP Dakar confirmed case from Nigeria was on 6th June, 2018
6.3 From the onset of this outbreak on September 12, 2017, a total of 3,015 suspected yellow fever cases with 47 Laboratory confirmed and 51 deaths (CFR, 1.7%) have been reported from 543 LGAs (36 States & FCT)
6.4 Predominant age groups affected among the suspected cases are 20 years and below accounting for 57.4%; [male to female ratio is 1.4 to 1 (male 57.5%, female 42.5%)]
6.5 Yellow fever reactive vaccination campaigns conducted in the following States [Kebbi (7 LGAs), Niger (5 LGAs), Sokoto (1 LGA) & Katsina (1 LGA)]
6.6 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
6.7 Follow up on ICG request for Yellow fever reactive vaccination campaigns in Ekiti (Irepodun/Ifelodun LGA), Edo (Etsako East LGA) and Rivers (Ikwerre LGA)
6.8 Surveillance activities have been intensified across all States
6.9 NCDC and partners have completed the assessment of some laboratories in Nigeria for possible inclusion into the testing laboratory network
6.10 NCDC & partners conducted detailed case investigation in Edo and Ekiti states following recent reports and currently in Rivers State
6.11 NPHCDA, NCDC and partners concluded 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.
7. Update on national Influenza sentinel surveillance, Nigeria week 1 – 37, 2018
7.1. From week 1- 37, 242-suspected cases were reported, of which 218 were Influenza like-illness (ILI), 24 Severe Acute Respiratory Infection (SARI).
7.2 A total of 242 samples were received and 237 samples were processed. Of the processed samples, 213(89.9%) were ILI cases, 24 (10.1%) were Severe Acute Respiratory Infection (SARI).
7.4. Of the 213 processed ILI samples, 10 (4.7%) was positive for Influenza A; 27(12.8%) positive for Influenza B and 176 (82.6%) were negative.
7.5 For the processed 24 SARI samples, five (20.8%) were positive for Influenza A, 1 (4.2%) was positive for Influenza B, while the remaining 18 (75.0%) were negative.
7.6 43 (18.3%) of the processed 237 samples were positive for Influenza, with 15 (34.9%) of these positive for Influenza A and 28 (65.1%) positive for Influenza B.
7.5. The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for (0.0%), 12 (80.0%) and 3 (20.0%) of the total influenza A positive samples respectively.
7.6 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 21(75.0%), 6(21.4%) and 1(3.6%) 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 -36, five samples are currently undergoing Laboratory diagnosis