In March 2018, the Nigeria Centre for Disease Control (NCDC) supported by the West African Health Organisation (WAHO) conducted a full scale simulation exercise (SimEx) in an urban area- Lagos State, Nigeria. The exercise was aimed at testing the mechanisms and procedures in place for the management of major public health events particularly yellow fever in Nigeria. This exercise was the first major simulation at a large scale in Nigeria, in line with the International Health Regulations (IHR) monitoring and evaluation framework and the NCDC organisational strategy plan.
Following the simulation exercise, important recommendations were made to strengthen outbreak preparedness and response. To provide feedback, NCDC and WAHO organised a two-day dissemination meeting in Lagos from 10th - 11th June 2019. The stakeholders present included representatives from the Lagos State Ministry of Health (LSMOH), representatives of the Director NCDC and WAHO. In addition, the meeting had partners including WHO, AFENET, Georgetown University, International Federation of Red Cross (IFRC), German Agency for International Cooperation (GIZ) etc. were also in attendance.
1. The main findings and lessons learnt from the SimEX were shared with stakeholders from Nigeria and the ECOWAS region
2. A consensus action plan was presented and next steps agreed upon by relevant stakeholders
3. The draft version of the national yellow fever response guidelines, a major gap during the SimEx, was presented and reviewed
With the dissemination of post SimEx lessons learnt, best practices, strengths and weaknesses, NCDC will continue to work with LSMOH, other states and other stakeholders in using evidence-based strategies for improved outbreak preparedness and response.
Summary of Incidents
Ongoing Incidents are defined as confirmed cases where a national EOC or equivalent has been activated (EOC is currently activated for 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 62 suspected cases of Lassa fever from 25 LGAs in 13 States (Edo - 40, Ondo - 7, Ebonyi - 2, Bauchi - 2, Plateau - 1, Taraba - 1, Imo – 1, Kogi – 1, Enugu - 1, Rivers – 1, Oyo – 1, Kebbi – 2 & Zamfara - 2). Three cases from Edo and Zamfara States were laboratory confirmed and no death was recorded.
• National LF multi-partner, multi-sectoral Technical Working Group (TWG) continues to coordinate the response activities at all levels
• LF National Environmental Response, coordinated by Federal Ministry of Environment (FMoEnv) in collaboration with NCDC and supported by WHO was conducted in Edo and Ondo States
• Response commodities were distributed across 36 States, FCT and treatment centers
• Conduct State specific AAR meetings
• 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 9 suspected cases of Cerebrospinal Meningitis reported from eight LGAs in six States (Cross River – 2, Enugu – 1, Katsina – 3, Niger – 1, Osun – 1 & Yobe - 1). None was laboratory confirmed and no death was recorded
• Sabon Birni and Dange Shuni LGAs of Sokoto State crossed the alert threshold.
• The National CSM Emergency Operations Centre meets weekly to review the situation. There is decline in the number of cases
• Intensify surveillance in all States by providing onsite/offsite support
• Continue follow-up with the States to enhance reporting and preparedness
• Data review and harmonization from SORMAS, national Line list and laboratory data
• Review case investigation form and add the necessary variables into SORMAS
Conduct a general review on the data management process.
• A multiagency YF TWG coordinates the response activities
• Offsite support is provided to all affected States
• YF surveillance is enhanced in all the States and harmonization of surveillance and laboratory data is on-going
• Yellow fever reactive vaccination campaigns ongoing in Edo (5 LGAs), Ondo (7 LGAs) And Delta (1 LGA) States
• The second draft of the YF National Guidelines on Preparedness and Response has been completed
• The post simulation exercise meeting held in Lagos from 10th – 11th June, 2019
• The YF AAR meeting is scheduled for 18th -20th June 2019
Follow up with the next steps on the YF Guidelines and Action plans.
There were 16 suspected cases of cholera reported from Bayelsa State in two LGAs (Ogbia – 7 and Yenogoa - 9). 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 Federal Ministry of Water Resources (FMWR) and support from partners
• Routine monitoring of States through IDSR followed by calling States with suspected cases of Acute Watery Diarrhoea (AWD) weekly
• Contact with all States on enhanced surveillance
• State-wide sensitisation on cholera has begun in Anambra and Benue States
• WaSH sector meeting by FMWR and partners
• Continuous monitoring of cholera situation in all states
• Support states in cholera outbreak preparedness activities
• Print and disseminate IECs to all states
• Continuous collaboration with FMWR, FMoEnv and partners.
• There were 1088 suspected cases reported from 30 States and FCT. Two cases were laboratory confirmed and one death was recorded
• The multi-agency National Measles EOC is monitoring and coordinating response activities across the States
• Measles reactive vaccination conducted in Borno State
• Teleconference with states with the highest burden of cases (Adamawa, Borno and Yobe)
• Media messages developed and disseminated across social and conventional media
• Case management guideline developed and disseminated
• Teleconference next week with Borno, Yobe, Adamawa and Katsina to follow up on outbreak response activities
• Intensify surveillance and updating of line-list.
• One new suspected case was reported from Ughelli North LGA in Delta state. The case was laboratory confirmed and no new death was recorded.
• Surveillance has been enhanced in all affected States
Supportive supervision visits to Bayelsa State.
Acute Flaccid Paralysis (AFP)
• In the reporting week, 105 suspected cases of AFP were reported from 91 LGAs in 28 States and FCT
• As at 2nd June, 2019, no new case of WPV was recorded
• The last reported case of polio in Nigeria was in August 2016
• Three WPV1 cases have been reported globally in week 22. Two in Pakistan and one in Afghanistan by the Global Polio Eradication Initiative.
• Submission of complete documentation for polio certification shifted to March 2020
• Outbreak response to CVDPV outbreak scheduled in south-western states from 15 - 18 June, 2019.
National Influenza Sentinel Surveillance
• There was a positive case of Influenza subtype A&B (4.15%)
• 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 (60%) in week 9.