Given the tropical climate, population density and increasing migration, Nigeria is vulnerable to large outbreaks and other public health emergencies. Over the years, there has been outbreaks of epidemic prone diseases (Lassa fever, cholera, measles etc.) as well as humanitarian crisis in some parts of the country. This has highlighted the need for the development of a National Multi-hazard Public Health Emergency Preparedness and Response Plan to link all relevant sectors pre-, during and post emergencies. This gap was also identified during Nigeria’s first and midterm Joint External Evaluation of International Health Regulations (IHR) capacities conducted in 2017 and 2019 respectively.
In response to this need, the Nigeria Centre for Disease Control (NCDC) supported by the World Health Organization (WHO) AFRO and WHO Country Office conducted a hazard profiling and Vulnerability and Risk Assessment Mapping (VRAM) across 18 selected states across six geo-political zones in Nigeria. This was the first step in the development of a national multi-hazard plan, as hazards were identified and characterised based on existing vulnerabilities and capacities.
Following the initial assessment, NCDC and WHO convened a five-day workshop from the 2nd - 6th of December 2019 in Abuja, Nigeria. The meeting had 70 participants in attendance representing the Presidency, relevant Ministries, Departments and Agencies as well as key development partners. The objectives of the workshop were to:
1. Develop a draft national multi hazard public health emergency preparedness plan
2. Align the draft national multi hazard public health emergency preparedness plan to National contingency preparedness and response plan (NEMA).
3. Support the orientation of sub-national level on the development of public health multi hazard preparedness plans
At the end of the workshop, the objectives were met and a draft plan was developed. Following this deliverable, a core group will work to complete and pilot the plan; develop a costed implementation plan; validate and disemminate the final version. The group of stakeholders also agreed to carry out periodic review and update of the plan. The goal is for the plan to be published by the end of January 2020.
This plan will guide and provide a high level, unifying multi-sectoral, strategic framework for public health emergency preparedness and response for infectious and non-infectious hazards in Nigeria.
Summary of Incidents
Notes
1. Information for this disease was retrieved from the Technical Working Group and Situation Reports
2. Case Fatality Rate (CFR) for this disease is reported for confirmed cases only
3. Information for this disease was retrieved from IDSR 002 data
4. CFR for this disease is reported for total cases i.e. suspected + confirmed
5. Information for sentinel influenza was retrieved from the laboratory
Lassa Fever
Key points
• There were 90 suspected cases of Lassa Fever (LF) reported from 14 LGAs in nine states (Edo – 50, Ondo – 4, Ebonyi – 7, Bauchi – 2, Nasarawa – 1, Plateau – 1, Taraba – 1, Benue – 1 & Abia – 3). There were eight confirmed cases and no death was recorded
Actions
To date:
• National Lassa Fever multi-sectoral Technical Working Group (TWG) continues to coordinate response activities and support States
• Harmonisation of LF laboratory, case management and surveillance data into the SORMAS platform
Planned:
• Conduct meeting to finalise LF psychosocial guideline in December 2019
• Review of LF case management & surveillance tools and SOPs in December 2019
• Finalise advocacy packages for national and subnational policy/decision makers
Cerebrospinal Meningitis (CSM)
Key points
There were 15 suspected cases of Cerebrospinal Meningitis (CSM) reported from six LGAs in three states (Ebonyi – 1, Kaduna – 1 & Katsina – 13). None was laboratory confirmed and no death was recorded
Actions
To date:
• National CSM Technical Working Group (TWG) meets weekly to review reports from states and plan appropriately
• Ongoing After Action Review meeting (AAR) with five states (Katsina, Sokoto, Zamfara, Ebonyi and Cross river)
Planned:
• Continue harmonisation of the national line list and SORMAS data
Yellow Fever
Key points
• There were 61 suspected cases of Yellow Fever (YF) reported from 40 LGAs in 18 states and FCT. None was laboratory confirmed and three deaths was recorded
Actions
To date:
• National multiagency YF EOC is coordinating response activities
• National Rapid Response Team (RRT) deployed to Bauchi, Benue and Katsina states
• International Coordinating Group (ICG) request for vaccines developed for Bauchi state (Ningi LGA) and Benue state (Gwer west and Makurdi LGAs) with NPHCDA
• Accreditation visit to NCDC National Reference Lab (NRL) by WHO AFRO laboratory team
Planned:
• Follow up on outcome of ICG request
Cholera
Key points
• There were fourteen suspected cases of cholera reported from five LGAs in three states (Adamawa – 5, Borno – 2 & Ogun – 7). There were five laboratory confirmed cases and one death was recorded
Actions
To date
• National cholera multi-sectoral Technical Working Group (TWG) is monitoring all states and supporting affected states
• Development of flood advisory by the communication team working with relevant TWGs
Planned:
• Follow up with states with active outbreaks and monitor non-reporting states
Measles
Key points
• There were 346 suspected cases of measles reported from 152 LGAs in 30 states. None was laboratory confirmed and one death was recorded
Actions
To date
• National measles Technical Working Group (TWG) is closely monitoring surveillance data and response activities across the country
• Conducted measles guideline review meeting
Planned:
• Continue the review of measles surveillance data across the country
• Finalise measles surveillance guideline
• Review implementation of sentinel sites for Congenital Rubella Syndrome in Nigeria
Monkeypox
Key points
• There were three suspected cases of monkeypox reported from two LGAs in two states (Oyo – 1 & Rivers – 2)
Actions
• National Monkeypox Technical Working Group (TWG) is monitoring activities in all states
• Follow up with Laboratory and Tranex courier service for prompt sample delivery
Planned:
• Enhance surveillance for monkeypox in high burden states, working with the animal health colleagues.
• Conduct regional monkeypox surveillance training in South East and North Central in January 2020
• Follow up to ensure all contacts are line listed and monitored for 21 days
Acute Flaccid Paralysis (AFP)
Key points
• There were 116 suspected cases of AFP reported from 86 LGAs in 30 states and FCT. None was laboratory confirmed and no death was recorded
National Influenza Sentinel Surveillance
Key points
There were 82 processed samples positive for influenza, with 68 for influenza A, 13 for influenza B and 1 for influenza A & B
Timeliness and Completeness of Reports
Timeliness and Completeness of Reports by State