Weekly Epidemiological Report

January 2019 Week 4

Editoral

Strengthening Nigeria’s contribution to the Global Antimicrobial Resistance Surveillance System

Posted: 12-02-2019 08:21:05 AM

The World Health Organization (WHO) developed the Global Antimicrobial Resistance Surveillance System (GLASS) to support implementation of the Global Action Plan on Antimicrobial Resistance (GAP-AMR). Nigeria is a signatory to GLASS, and is expected to provide regular AMR surveillance reports.

It is important to have national and local AMR surveillance teams who are knowledgeable and well-grounded in microbiological methods such as testing for AMR, susceptibility testing (AST) and basic epidemiological principles and methods of public health surveillance.

To achieve this, Nigeria Centre for Disease Control (NCDC) in collaboration with WHO organised a five-day training workshop in Ibadan from 4th – 8th February, 2019. The goal was to strengthen national AMR surveillance and data management in reporting to GLASS. This training provided a detailed overview of antimicrobial susceptibility testing methods, the vision, goals, objectives, methods/tools involved, data management and how to report to GLASS. Participants were members of the National Coordination Centre (NCC), staff from the National Reference Laboratory (NRL) for AMR, and staff from the AMR surveillance sites

The GLASS promotes and supports a standardised approach to the collection, analysis and sharing of AMR data at a global level. With this training, Nigeria continues working towards the establishment of a national AMR surveillance system, capable of monitoring AMR trends and producing reliable and comparable data for decision making.


SUMMARY OF REPORTS

In the reporting week ending January 27, 2019:

o There were 132 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 14 suspected cases of cholera reported from two LGAs in two States (Ebonyi – 12 & Kano – 2). There was no laboratory confirmed case and three deaths were recorded.

o There were 171 suspected cases of Lassa fever reported from 29 LGAs in 16 States (Edo – 58, Ebonyi – 7, FCT – 3, Ondo – 61, Nasarawa – 2, Plateau – 14, Rivers – 1, Taraba – 6, Kwara – 4, Gombe – 1, Kaduna – 1, Benue – 5, Kogi – 1, Enugu – 4, Oyo – 2 & Borno - 1). 77 were laboratory confirmed and 11 deaths were recorded.

o There were 31 suspected cases of Cerebrospinal Meningitis (CSM) reported from 20 LGAs in eight States (Cross River – 3, Enugu – 2, Jigawa – 1, Kano – 1, Katsina – 12, Plateau – 1, Sokoto – 4 & Zamfara – 7). Of these, one was laboratory confirmed and two deaths were recorded.

o There were 626 suspected cases of measles reported from 30 States. None was laboratory confirmed and no deaths was recorded.

In the reporting week, all States sent in their reports except Edo State. Timeliness of reporting increases from 91.0% in week three to 93.0% in week four while completeness remains 99.0% 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 January 27 2019, no new case of WPV was recorded

1.2. In the reporting week, 132 suspected cases of AFP were reported from 114 LGAs in 31 States

1.3. Between week 1 and 4 (2019), 385 suspected cases of AFP were reported from 265 LGAs in 36 state


2. CEREBROSPINAL MENINGITIS (CSM)

2.1 In the reporting week, 31 suspected Cerebrospinal Meningitis (CSM) cases with one laboratory confirmed and two deaths (CFR, 6.5%) were reported from 20 LGAs in eight States(Cross River – 3, Enugu – 2, Jigawa – 1, Kano – 1, Katsina – 12, Plateau – 1, Sokoto – 4 & Zamfara – 7) compared with 37 suspected cases with and one death (CFR, 2.7%) reported across 21 LGAs (eight States) at the same period in 2018 (Figure 1)

2.2 Between weeks 1 and 3 (2019), 125 suspected meningitis cases with six laboratory confirmed and seven deaths (CFR, 5.6%) from 56 LGAs (15 States) were reported compared with 324 suspected cases with 47 Laboratory confirmed and 23 deaths (CFR, 7.1%) from 83 LGAs in 20 states during the same period in 2018

2.3 Timeliness/completeness of CSM case-reporting from states to the national level (2019 versus 2018): on average, 92.6% of the 26 endemic States sent CSM reports in a timely manner while 99.3% were complete in week 1 - 4, 2019 as against 93.7% timeliness and 100.0% completeness recorded within the same period in 2018

2.4 The CSM National Emergency Operations Centre (EOC) is on alert mode and meets weekly to review the situation

2.5 CSM preparedness and response assessment checklist form sent to all States


3. CHOLERA

3.1 14 suspected cases of cholera and three deaths (CFR, 21.4%) were reported from two LGAs in two states (Ebonyi – 12 & Kano – 2) in week 4, 2019 compared with eight suspected cases reported from three LGAs in three States during the same period in 2018 (Figure 2).

3.2 Between weeks 1 and 4 (2019), 57 suspected cholera cases with one laboratory confirmed and six deaths (CFR, 10.53%) from seven LGAs (five States) were reported compared with 228 suspected cases and 20 deaths (CFR, 8.77%) from 34 LGAs in eight States during the same period in 2018

3.3 NCDC has disseminated cholera alert mails and line list template to all states in preparedness for dry season transmission

3.4 The cholera National Emergency Operations Centre (EOC) is on watch mode and the Technical Working Group meets weekly to review the situation

3.5 National Preparedness and Response to Acute Watery Diarrhoea/Cholera Guidelines. Available from

http://ncdc.gov.ng/themes/common/docs/protocols/45_1507196550.pdf


4 LASSA FEVER

4.1 In the reporting Week 4 (21 – 27 January, 2019), seventy-seven new confirmed I cases were reported from Edo (24), Ondo (28), Bauchi (3), Ebonyi (6), Plateau (5), Taraba (3), Gombe (1), Kaduna (1), Kwara (1), FCT (1),Benue (2), Rivers (1) and Kogi (1) States with eleven new deaths in Ondo (2), Edo (4), Benue (1), Rivers (1), Plateau (2) and Taraba (1) States

4.2 From 1st - 27th January 2019, a total of 538 suspectedi cases have been reported from 15 States. Of these, 213 were confirmed positive, 2 probable and 325 negatives (not a case)

4.3 Since the onset of the 2019 outbreak, there have been 42 deaths among confirmed cases. Case Fatality Rate in confirmed cases is 19.7%

4.4 Fifteen states have recorded at least one confirmed case across 40 LGAs (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Plateau, Taraba, FCT, Adamawa, Gombe, Kaduna, Kwara, Benue, Rivers & Kogi) and remain active.iv

4.5 National rapid response team deployed to Edo, Ondo, Bauchi, Ebonyi and Plateau States

4.6 Disseminated Lassa fever alert mails to all states in preparedness for high transmission season

4.7 NCDC prepositioned PPEs, Ribavirin (injection and tablets), beds, Tents, body-bags, thermometers, hypochlorite hand sanitizers, IEC materials, guidelines and SOPS distributed across 36 states, FCT and treatment centres

4.8 A National Emergency Operations Centre has been activated and coordinates response activities. State EOCs have also been activated in Edo, Ondo and Ebonyi


5 MEASLES

5.1 In the reporting week, 626 suspected cases of measles were reported from 30 states compared with 357 suspected cases and two deaths (CFR,0,56%) reported from 35 states during the same period in 2018

5.2 Since the beginning of the year, 1853 suspected measles cases with 88 laboratory confirmed and three deaths (CFR, 0.16%) were reported from 35 states and FCT compared with 1049 suspected cases and three deaths (CFR, 0.29 %) from 36 States and FCT, during the same period in 2018

5.3 National rapid response team to be deployed to support outbreak response in Katsina and Borno States

5.4 Response measures include immunization for all vaccine-preventable diseases in some selected/affected wards and LGAs during Supplementary Immunization Activities (SIAs), as well as case management


6 Yellow fever

6.1 In the reporting week 5 (28th January - – 3rd February, 2019), no new confirmed case at WHO reference laboratory, Institute Pasteur Dakar (IP Dakar)

6.2 From the onset of this outbreak on September 12, 2017 to date, a total of 4,100 suspected yellow fever cases have been reported from 36 States & FCT. Of the 3,780 samples taken, 274 were presumptive positives in-country

6.3 A total of 95 cases have been confirmed by IP Dakar from 14 states (Kwara, Kogi, Kano, Zamfara, Kebbi, Nasarawa, Niger, Katsina, Edo, Ekiti, Rivers, Anambra, FCT, and Benue States)

6.4 Since the onset of the outbreak, 27 deaths among IP Dakar confirmed cases and 50 deaths among suspected/presumptive positive cases have been recorded. Case Fatality Rates among IP Dakar confirmed cases and presumptive positives are 1.8% and 22. 4% respectively

6.5 Yellow fever reactive vaccination campaigns were conducted in the following States: Edo (13 LGAs), Kebbi (7 LGAs), Niger (5 LGAs), Sokoto (1 LGA) & Katsina (1 LGA)

6.6 A multi-agency national Emergency Operations Centre is coordinating the national response

6.7 Yellow fever vaccination campaigns have been successfully completed in 12 States (Nasarawa, Cross River, Akwa-Ibom, Kogi, Kwara, Zamfara, Sokoto, Kebbi, Niger, FCT, Plateau & Borno) and 57 political wards in 25 LGAs in Borno State. Another campaign to commence in Vandekeiya LGA in Benue State

6.8 The 2018 phase 2b November Preventive Mass Vaccination Campaign (PMVC) was conducted (22nd November – 1st December, 2018) in Sokoto, Kebbi, Niger, FCT, Plateau and some LGAs in Borno States. Target population is 9 months to 44 years (85% of the total population)


7. Update on national Influenza sentinel surveillance, Nigeria week 1 – 52, 2018 & 1 – 4, 2019

7.1. From week 1- 52 2018, 403 suspected cases were reported, of which 363 were Influenza like-illness (ILI), 40 were Severe Acute Respiratory Infection (SARI).

7.2. From week 1- 4 2019, a total of 25 samples were recruited and all were Influenza like-illness (ILI). All samples were processed

7.2 A total of 403 samples were received and all samples were processed. Of the processed samples, 363(90.1%) were ILI cases, 40 (9.9%) were Severe Acute Respiratory Infection (SARI).

7.3 Of the 363 processed ILI samples, 40 (11.0%) were positive for Influenza A; 33(9.3%) were positive for Influenza B and 290 (79.7%) were negative.

7.4 Out of the processed 40 SARI samples, 7 (17.5%) were positive for Influenza A, 2 (5.0%) were positive for Influenza B, while the remaining 31 (77.5%) were negative.

7.5 Of the 403 processed samples, 82 (20.3%) were positive for Influenza, with 47 (57.3%) of these positive for Influenza A and 35 (42.7%) positive for Influenza B.

7.6 The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for 8(17.4%), 28 (59.6%) and 11 (23.4%) of the total influenza A positive samples respectively.

7.7 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 24(70.6%), 8(20.6%) and 3(8.8%) of the total influenza B positive samples respectively

7.8 The percentage of influenza positive was highest (100.0%) in week 43, 2018

7.9 In the reporting week 1- 52, five samples are processed in the laboratory

FOR MORE INFORMATION CONTACT

Surveillance Unit:

Nigeria Centre for Disease Control,

801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.

[email protected]

www.ncdc.gov.ng/reports

0800-970000-10

Highlight of the week

  • SUMMARY OF REPORTS
  • REPORT ANALYSIS AND INTERPRETATION
  • 2. CEREBROSPINAL MENINGITIS (CSM)
  • 3. CHOLERA
  • 4 LASSA FEVER
  • 5 MEASLES
  • 6 Yellow fever
  • 7. Update on national Influenza sentinel surveillance, Nigeria week 1 – 52, 2018 & 1 – 4, 2019

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