Over the last nine months, the Nigeria Centre for Disease Control (NCDC) has begun the establishment and roll out of State Public Health Emergency Operations Centres (EOC). The goal is to create a coordination platform at the State level, for the preparedness for, detection and response to infectious disease outbreaks.
To understand the level of implementation and gaps therein, NCDC in collaboration with Public Health England (PHE) organised a stimulation exercise from 3-4 October 2018, in Abuja, tagged “Exercise Keep Pushing”. The goal of the exercise was to explore the NCDC’s capacity and capability to coordinate and support the national and state response to outbreaks of any infectious disease using the six existing State Public Health EOCs.
During the exercise, participants simulated a Lassa fever outbreak that spread across the states. Participants focused on the pillars of surveillance, case investigation, logistics management, coordination, risk communications and case management.
The Exercise “Keep Pushing” provided an opportunity to evaluate the existing structures/arrangements and make recommendations for necessary improvements. For the first time, we pulled together all the State EOCs and showed a strong network to NCDC at the federal level. The lessons learnt will drive improved strategies for emergency preparedness and response coordination in Nigeria.
SUMMARY OF REPORTS
In the reporting week ending on September 23, 2018:
o There were 200 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 2492 suspected cases of Cholera reported from 58 LGAs in ten States (Adamawa – 94, Borno – 824, Gombe – 77, Kaduna – 7, Kano – 151, Katsina – 529, Kwara – 4, Osun – 1, Yobe - 233 and Zamfara - 572). Of these, eight were laboratory confirmed and 44 deaths were recorded.
o Seven suspected cases of Lassa fever were reported from seven LGAs in four States (Delta – 1, Edo – 2, Ondo - 3 & Plateau - 1). Four were laboratory confirmed and one death was recorded.
o There were 21 suspected cases of Cerebrospinal Meningitis (CSM) reported from eight LGAs in eight States (Benue – 1, Delta – 1, Ebonyi – 1, Enugu – 10, Katsina – 1, Ondo – 1, Taraba - 3 & Yobe – 3). Of these, none was laboratory confirmed and no death was recorded.
o There were 227 suspected cases of measles reported from 32 States. Six were laboratory confirmed and two deaths were recorded.
In the reporting week, all States sent in their report. Timeliness of reporting remains 87% in both previous and current weeks (37 & 38) 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 September 23rd 2018, no new case of WPV was recorded
1.2. In the reporting week, 200 cases of AFP were reported from 169 LGAs in 33 States
1.3. Between week 1 and 38 2018, 6336 suspected cases of AFP have been reported from 743 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, 21 suspected Cerebrospinal Meningitis (CSM) cases were reported from eight LGAs (eight States; Benue – 1, Delta – 1, Ebonyi – 1, Enugu – 10, Katsina – 1, Ondo – 1, Taraba - 3 & Yobe – 3) compared with seven suspected cases reported from seven LGAs (six States) at the same period in 2017 (Figure 1)
2.2 Between weeks 1 and 38 (2018), 4324 suspected meningitis cases with 318 laboratory confirmed and 356 deaths (CFR, 8.2%) from 286 LGAs (33 States) were reported compared with 9800 suspected cases and 602 deaths (CFR, 6.1%) from 315 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 - 38, 2018 as against 76.4% timeliness and 92.3% completeness recorded within the same period in 2017
3.1 2492 suspected cases of Cholera with eight Lab. Confirmed and 44 deaths (CFR, 1.8%) were reported from 58 LGAs (ten States; Adamawa – 94, Borno – 824, Gombe – 77, Kaduna – 7, Kano – 151, Katsina – 529, Kwara – 4, Osun – 1, Yobe - 233 and Zamfara - 572) in week 38, 2018 compared with 107 suspected cases and two deaths (CFR, 1.9%) reported from six LGAs (five States) during the same period in 2017 (Figure 2).
3.2 Between weeks 1 and 38 (2018), 22,686 suspected Cholera cases with 454 laboratory confirmed and 421 deaths (CFR, 1.9%) from 169 LGAs (26 States) were reported compared with 3348 suspected cases and 79 deaths (CFR, 2.4%) from 60 LGAs (18 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
4.1 In the reporting Week 38 (17 – 23 September, 2018) four new confirmed I cases were reported from Edo (2), Ondo (1) and Delta (1) States with one new death recorded in Delta State.
4.2 From 1st January to 23rd September 2018, a total of 2576 suspected cases have been reported from 22 states. Of these, 510 were confirmed positive, 10 are probable, 2055 negative (not a case)
4.3 Since the onset of the 2018 outbreak, there have been 134 deaths in confirmed cases and 10 in probable cases. Case Fatality Rate in confirmed cases is 26.3%
4.4 22 states have recorded at least one confirmed case across 89 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). Nineteen states have exited the active phase of the outbreak while three – Edo, Delta and Ondo States remain activeiv
4.5 NCDC and Partners deployed Rapid Response Team (RRT) to Delta State
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, 227 suspected cases of Measles with six Lab. Confirmed and two deaths (CFR, 0.9%) were reported from 32 States compared with 209 suspected cases reported from 29 States during the same period in 2017
5.2 So far, 14309 suspected Measles cases with 901 Lab. Confirmed and 115 deaths (CFR, 0.8%) were reported from 36 States and FCT compared with 18047 suspected cases with 108 laboratory confirmed and 105 deaths (CFR, 0.58 %) 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 17th – 23rd September, 2018, 86 suspected cases were added to the national line list
6.2 Three new in-country presumptive positive cases and one inconclusive case were reported in the reporting week from three 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 3,101 suspected yellow fever cases with 47 Laboratory confirmed and 51 deaths (CFR, 1.6%) have been reported from 555 LGAs (36 States & FCT)
6.4 Predominant age groups affected among the suspected cases are 20 years and below accounting for 62.3%; [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 Surveillance activities have been intensified across all States
6.8 NPHCDA, NCDC and partners concluded a 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 – 39, 2018
7.1. From week 1- 39, 260-suspected cases were reported, of which 235 were Influenza like-illness (ILI), 25 Severe Acute Respiratory Infection (SARI).
7.2 A total of 260 samples were received and 259 samples were processed. Of the processed samples, 234(90.3%) were ILI cases, 25 (9.7%) were Severe Acute Respiratory Infection (SARI).
7.4. Of the 234 processed ILI samples, 18 (7.7%) was positive for Influenza A; 29(12.4%) positive for Influenza B and 187 (79.9%) were negative.
7.5 For the processed 25 SARI samples, five (20.0%) were positive for Influenza A, two (8.0%) was positive for Influenza B, while the remaining 18 (72.0%) were negative.
7.6 47 (18.1%) of the processed 259 samples were positive for Influenza, with 18 (38.3%) of these positive for Influenza A and 29 (61.7%) positive for Influenza B.
7.5. The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for (0.0%), 18 (100.0%) and 0 (0.0%) of the total influenza A positive samples respectively.
7.6 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 23(79.3%), 5(17.2%) and 1(3.5%) 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 -39, one sample is undergoing processes in the National Reference Laboratory
FOR MORE INFORMATION CONTACT
Nigeria Centre for Disease Control,
801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.