Nigeria continues to express yearly outbreaks of Lassa fever (LF), with increase in the number of cases in the last two years. Asides the commonly known symptoms such as fever, bleeding, joint pains etc., there is an epidemiological evidence that LF is also associated with psychological variables such as depression and anxiety. In addition, stigmatisation, fear, self-blame and lack of social support also contribute to the psychosocial burden of LF.
Over the years, NCDC has responded to outbreaks of LF and other epidemic prone diseases using a multisectoral, multi-agency approach in line with global best practice. Our experience in responding to these outbreaks has highlighted a critical need to strengthen the management of psychosocial burden of LF cases. To address this, NCDC has set up a group with the responsibility to integrate psychosocial support into LF case management.
On the 2nd and 3rd of May 2019, the group convened a review meeting to identify psychosocial needs for Lassa fever cases, and develop guidelines for providing psychosocial care to both patients and their families.
The participants at the meeting included psychologists and psychiatrists (including other experts providing psychosocial care for LF management) drawn from the three main treatment centres for LF in Nigeria. These are Irrua Specialist Teaching Hospital, Federal Medical Centre, Owo and Federal Teaching Hospital, Abakaliki. An important outcome of the meeting was the development of a draft guideline for psychosocial support in the management of Lassa fever.
The goal is to complete the development of this guideline, and strategically include psychosocial care for Lassa fever and other infectious diseases in outbreak response activities. Upon development, the guideline will be made available on the NCDC website and to all treatment centres and state epidemiologists.
Summary of Incidents
Ongoing Incidents are defined as confirmed cases where a national EOC or equivalent has been activated (EOC is currently activated Cerebrospinal meningitis and Measles)
Other incidents are those confirmed cases for which EOC is not activated.
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.
• There were 86 suspected cases of Lassa fever from 19 LGAs in 10 States (Edo - 45, Ondo - 19, Ebonyi - 6, Bauchi - 3, Plateau - 3, Taraba - 1, FCT - 1, Gombe - 1, Delta - 2, Kebbi - 5). Six cases from Ebonyi, Ondo and Edo States were confirmed with one death recorded.
• National Lassa fever multi-partner, multi-sectoral Technical Working Group (TWG) continues to coordinate response activities at all levels
• Psychosocial support guideline development workshop
• Support indigent patients with treatment cost through Basic Health Care Provision Funds
• Harmonisation of LF laboratory and surveillance data into one database platform is ongoing
Cerebrospinal Meningitis (CSM)
• There were 27 suspected cases of Cerebrospinal Meningitis reported from 12 LGAs in 10 States (Bauchi – 1, Bayelsa – 1, Benue – 1, Kano – 2, Katsina – 2, Kebbi – 2, Niger – 1, Osun – 1, Plateau – 1 & Sokoto - 15). There was no laboratory confirmed case(s) and no death(s) recorded
• Sabon Birni LGA, Sokoto State crossed alert threshold in week 20.
• The National CSM Emergency Operations Center meets weekly to review the situation
• Intensify surveillance in all States by providing onsite/offsite support
• Continue follow-up with the States to enhance reporting and preparedness
• Conclude the recalling process of Ceftriaxone (about to expire) from Cross River State
• Continue engagement with Sokoto State on CSM case management training for Clinicians.
• A multiagency Yellow fever TWG is coordinating the response activities
• Yellow fever surveillance is enhanced in all the States
• The second draft of the yellow fever National Guideline on Preparedness and Response has been completed
• YF Reactive vaccination campaign in Edo State (5 LGAs), Ondo State (7 LGAs) and Delta State (1 LGA) tentatively scheduled to commence on the 30th May, 2019
• Yellow fever 2019 Preventive mass vaccination campaign to take place in Katsina, Edo, Ekiti and Rivers States.
There were 17 suspected cases of cholera reported from 5 LGAs in 3 States (Bayelsa (4), Adamawa (5) & Kano (8)). None was laboratory confirmed and no death was recorded.
• NCDC cholera Technical Working Group (TWG) continues to coordinate Cholera activities in States in collaboration with FMWR and support from partners
• Routine monitoring of States through IDSR
• Assessment of level of preparedness in all States, so far only 17 States responded
• Cholera specific jingles developed and other IECs reviewed
• Cholera 2019 National preparedness and response Plan finalized.
• Continuous monitoring of all States
• Support all States on Cholera outbreak preparedness
• Print and disseminate IECs to all States
• Continuous collaboration with FMWR, FMEnv and partners.
• There were 1862 suspected cases reported from 34 States and FCT. None was laboratory confirmed and two deaths were recorded
• The multi-agency National Measles EOC is monitoring and coordinating response activities across the States
• Reactive measles vaccination conducted in Borno State
• Media messages developed and disseminated across social and conventional media
• Case management guideline developed and disseminated
• Throat swab specimen collected in Borno, Yobe, Adamawa and Kaduna for viral isolation and genotyping
• A biweekly teleconference with Borno, Yobe, Adamawa and Katsina States to follow up on outbreak response activities
• Intensify surveillance and updating of Measles line list.
• One new suspected case reported from Bayelsa State tested negative for MPX but positive for VZV.
• Surveillance has been enhanced in all affected States
• Deployment of RRT to Bayelsa, Cross River, Delta and Lagos States
• Supportive supervision to silent States (Akwa Ibom, Abia, Anambra, Imo).
Acute Flaccid Paralysis (AFP)
• In the reporting week, 153 suspected cases of AFP were reported from 135 LGAs in 33 States and FCT
• As at 19th May, 2019, no new case of WPV was recorded
• The last reported case of polio in Nigeria was in August 2016
• Complete Documentation report review mission by International Support Team (West Africa) is ongoing.
• The first round of outbreak response (OBR) targeted at the South western States has been concluded and plans are ongoing for the second round.
National Influenza Sentinel Surveillance
• There was a positive case of Influenza subtype A&B (4.43.1%)
• The predominant Influenza A subtype so far this year was A seasonal H3 19 (95%).
• The predominant Influenza B subtype so far this year was B not subtyped 2(100%).
• The percentage influenza positive was highest (100.0%) in week 8.