Healthcare Workers (HCWs) are often vulnerable to contract diseases and in some cases lose their lives while providing care for their patients. This is particularly worrisome during outbreaks. In Nigeria, cases of HCWs infection with Lassa fever as well as other diseases have been recorded. One of the factors associated with these diseases is poor Infection Prevention and Control (IPC) practices among HCWs.
To mitigate this gap and protect the health of HCWs, the Nigeria Centre for Disease Control (NCDC) in collaboration with Robert Koch Institute (RKI), Germany developed a “MAURICE Project” aimed at promoting good IPC practices among HCWs in the Nigerian health institutions. One important output from this initial collaboration in 2018 was the development of an IPC curriculum to guide HCWs while delivering healthcare services.
As a follow up, NCDC and RKI have developed a more comprehensive project to strengthen IPC across the country. This is based on the previous MAURICE project and now developed IPC training curriculum. The project will utilise a hybrid teaching approach- on the job, classroom and field practice. Between the 18th and 21st of March 2019, NCDC convened a workshop including members of the RKI Team and Nigerian HCWs who have been identified previously as facilitators and IPC change agents based on the MAURICE project.
The major outcomes from the workshop were the adoption of the hybrid concept for learning; establishment of the selection criteria for different target groups; development of the research criteria; and development of action tracker for ongoing project activities.
As the NCDC remains committed to developing structures to protect the health of all Nigerians, HCWs are advised to continue to exercise good IPC practices while taking care of their patients.
Editors note: Do you know that the German national public health institute, Robert Koch institute (RKI) is named after the German sientistst that identified the causative agent of Tuberculosis? We join the global community to celebrate the World Tuberculosis Day on the 24th of March 2019 and commit to the End Tuberculosis goal. We are also grateful to our partners at RKI for the strong North-South collaboration
SUMMARY OF REPORTS
In the reporting week ending March 10, 2019:
o There were 131 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 five suspected cases of cholera reported from three LGAs in three States (Abia – 1, Bayelsa – 1 & Kano – 3). None was laboratory confirmed and no death recorded.
o There were 378 suspected cases of Lassa fever reported from 24 LGAs in nine States (Edo – 293, Ebonyi – 15, Ondo – 55, Bauchi -5, Nasarawa – 1, FCT – 1, Gombe – 1, Taraba – 6 & Plateau – 1). Fifty-two were laboratory confirmed and eleven deaths were recorded.
o There were 60 suspected cases of Cerebrospinal Meningitis (CSM) reported from 40 LGAs in 14 States (Anambra – 1, Bauchi – 2, Bayelsa – 1, Borno – 1, Ebonyi – 1, Gombe – 5, Jigawa – 1, Katsina – 22, Kebbi - 5, Kwara – 2, Niger – 2, Sokoto – 4, Yobe – 3 & Zamfara - 9). Of these, two were laboratory confirmed and two deaths were recorded.
o There were 1921 suspected cases of measles reported from 33 States. Eleven were laboratory confirmed and five deaths were recorded.
In the reporting week, all States sent in their reports except Delta State. Timeliness of reporting remained 93.0% in both weeks nine & ten 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
1.1 As at March 10 2019, no new case of WPV was recorded
1.2 In the reporting week, 131 suspected cases of AFP were reported from 114 LGAs in 30 States and FCT
1.3 Between week 1 and 10 (2019), 1187 suspected cases of AFP were reported from 531 LGAs in 36 states and FCT
2. CEREBROSPINAL MENINGITIS (CSM)
2.1 In the reporting week, 60 suspected Cerebrospinal Meningitis (CSM) cases, two laboratory confirmed cases and two deaths (CFR, 3.3%) were reported from 40 LGAs in 14 States (Anambra – 1, Bauchi – 2, Bayelsa – 1, Borno – 1, Ebonyi – 1, Gombe – 5, Jigawa – 1, Katsina – 22, Kebbi - 5, Kwara – 2, Niger – 2, Sokoto – 4, Yobe – 3 & Zamfara - 9) compared with 228 suspected cases with eight laboratory confirmed and 21 deaths (CFR, 9.2%) reported across 62 LGAs (14 States) at the same period in 2018 (Figure 1)
2.2 Between weeks 1 and 10 (2019), 435 suspected meningitis cases with 27 laboratory confirmed and 38 deaths (CFR, 8.74%) from 129 LGAs (23 States) were reported compared with 1635 suspected cases with 174 Laboratory confirmed and 152 deaths (CFR, 9.3%) from 180 LGAs in 25 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, 92.7% of the 26 endemic States sent CSM reports in a timely manner while 99.7% were complete in week 1 - 10, 2019 as against 88.1% timeliness and 96.5% completeness recorded within the same period in 2018
2.4 NCDC deployed Rapid Response Team (RRT) to Katsina and Niger States
2.5 NCDC and WHO conducted training on CSF collection and enhanced surveillance for clinicians and surveillance officers in Katsina State
2.6 The CSM National Emergency Operations Centre (EOC) is on alert mode and meets weekly to review the situation
2.7 CSM preparedness and response assessment checklist form sent to all States
3.1 Five suspected cases of cholera were reported from three LGAs in three States (Abia – 1, Bayelsa – 1 & Kano – 3) compared with 189 suspected cases with six laboratory confirmed and four deaths (CFR, 2.1%) reported from five LGAs in four States during the same period in 2018 (Figure 2).
3.2 Between weeks 1 and 10 (2019), 323 suspected cholera cases with four laboratory confirmed and 19 deaths (CFR, 5.88%) from 14 LGAs (seven states) were reported compared with 1476 suspected cases and 33 deaths (CFR, 2.34%) from 50 LGAs in 13 States during the same period in 2018.
3.3 NCDC deployed Rapid Respose Team (RRT) to Bayelsa State to access the current situation
3.4 NCDC has disseminated cholera alert mails and line list template to all states in preparedness for dry season transmission
3.5 NPHCDA and NCDC conducted training on Oral Cholera Vaccine on February 22, 2019 in Abuja
3.6 National Preparedness and Response to Acute Watery Diarrhoea/Cholera Guidelines. Available from
4 LASSA FEVER
4.1 In the reporting Week 10 (4th – 10th March, 2019), fifty-two new confirmed I cases were reported from eight States - Edo (23), Ondo (11), Ebonyi (9), Bauchi (1), Nasarawa (2),Plateau (1), Taraba (4) and Delta (1) States with eleven new deaths in Edo (3), Ondo (3), Ebonyi (4) and Nasarawa (1) States.
4.2 From 1st January – 10th March 2019, a total of 752 suspectedi cases have been reported from 21 States including FCT. Of these, 472 were confirmed positive, 15 probable and 1265 negatives (not a case).
4.3 Since the onset of the 2019 outbreak, there have been 110* deaths among confirmed cases. Case Fatality Rate in confirmed cases is 23.3%
4.4 Twenty-one states have recorded at least one confirmed case across 73 LGAs (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Plateau, Taraba, FCT, Adamawa, Gombe, Kaduna, Kwara, Benue, Rivers, Kogi, Enugu, Imo, Delta, Oyo, Kebbi & Cross River) and remain active.iv
4.5 Mid-term Lassa fever review meeting conducted on February 15, 2019
4.6 NCDC provided an ambulance to the Infection Control Centre of Federal Medical Centre Owo
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
4.10 A National Lassa fever multi-partner, multi-sectoral Emergency Operational Centre (EOC) continues to coordinate the response activities at all levels. State EOCs have also been activated in Edo, Ondo, Plateau, Kebbi and Ebonyi
5.1 In the reporting week, 1921 suspected cases of measles with 11 laboratory confirmed cases and five deaths (CFR, 0.26%) were reported from 33 states compared with 623 suspected cases and five deaths (CFR,0.80%) reported from 34 states during the same period in 2018
5.2 Since the beginning of the year, 9359 suspected measles cases with 535 laboratory confirmed and 23 deaths (CFR, 0.25%) were reported from 36 states and FCT compared with 4139 suspected cases and 32 deaths (CFR, 0.77 %) from 36 States and FCT, during the same period in 2018
5.3 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
5.4 A National Measles multi-partner, multi-sectoral Emergency Operational Centre (EOC) activated on the 10th March, 2019 to coordinate response activities
6 Yellow fever
6.1 In the reporting week 9 (24th February – 3rd March, 2019), eight suspected yellow fever cases were recorded in Nigeria
6.2 No new confirmed case from Institute Pasteur (IP) Dakar and the last IP Dakar confirmed cases was on the 20th of February 2019
6.3 From 1st January – 3rd March 2019, 364 suspected cases have been recorded from 177 LGAs across the country with blood samples collected from all cases. Of these, five were confirmed positive with no death recorded so far.
6.4 From the onset of this outbreak on September 12, 2017 to date, 4,100 suspected cases were reported from 604 (78.0%) LGAs in all the 36 States and FCT
6.5 A total of 139 cases have been confirmed by IP Dakar from 17 states (Kwara (8), Kogi (10), Kano (1), Zamfara (19), Kebbi (7), Nasarawa (3), Niger (1), Katsina (2), Edo (69), Ekiti (2), Rivers (1), Anambra (1), FCT (10), Benue (1), Delta (1), Ondo (2) and Abia (1) States) in 46 Local Government areas (LGAs).
6.6 Since the onset of the outbreak, 80 deaths were recorded among all cases with 29 deaths among IP Dakar confirmed cases. Case Fatality Rates (CFR) in all cases (suspected, probable & confirmed) and among IP Dakar confirmed cases is 2.0% and 21. 0% respectively
6.7 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)
6.8 A multi-agency national Emergency Operations Centre is coordinating the national response
6.9 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
6.10 A multi-agency national Emergency Operations Centre is coordinating the national response
6.11 Yellow fever After Action Review (AAR) being planned and is slated for April 2019
7. Update on national Influenza sentinel surveillance, Nigeria week 1 – 11, 2019
7.1 From week 1- 11 2019, a total of 92 samples were recruited, of which 87 were Influenza like-illness (ILI) and five was Severe Acute Respiratory Infection (SARI) .
7.2 A total of 92 samples were received and 86 samples were processed. Of the processed samples, 81(94.2%) were ILI cases and 5 (5.8%) was Severe Acute Respiratory Infection (SARI).
7.3 Of the 81 processed ILI samples, 11(13.9%) were positive for Influenza A; 2(2.5%) was positive for Influenza B and 68 (83.6%) were negative.
7.4 For the processed five SARI samples, 3(60.0%) were positive for Influenza A, 0(0.0%) for Influenza B and 2(40.0%) were negative.
7.5 Of the 81 processed samples, 16 (18.4%) were positive for Influenza, with 14 (87.5%) of these positive for Influenza A and 2 (12.5%) positive for Influenza B.
7.6 The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for 14 (100.0%), 0 (0.0%) and 0 (0.0%) of the total influenza A positive samples respectively.
7.7 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 0(0.0%), 2(100.0%) and 0(0.0%) of the total influenza B positive samples respectively
7.8 The percentage of influenza positive was highest (100.0%) in week 8, 2019
7.9 In the reporting week 1- 11, six samples are undergoing laboratory process
FOR MORE INFORMATION CONTACT
Nigeria Centre for Disease Control,
801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.