Weekly Epidemiological Report

June 2019 Week 23


Learning from Nigeria’s Response to Yellow Fever Outbreaks

Posted: 25-06-2019 10:33:05 AM

In the last two years, Nigeria has experienced a resurgence of yellow fever with cases recorded in 19 states. A multi-agency, multi-partner incident management system (IMS) hosted at NCDC, has led the coordination of outbreak response activities. In line with the International Health Regulation Monitoring and Evaluation framework and to review response interventions, NCDC and partners led by WHO hosted a national YF after Action Review (AAR) meeting in Abuja, from 18-20 June 2019.

The AAR was carried out to review response activities for the 2017/2018 yellow fever outbreak, identify best practice and develop a long-term strategy for the control of yellow fever in Nigeria. The participants at the workshop included State Epidemiologists and health workers from the 19 states that have recorded cases, members of the National Yellow Fever Technical working Group (TWG) including representatives from Federal Ministry of Health, Federal Ministry of Environment, National Arbovirus and Vector Research Centre, World Health Organisation and other development partners.

Through interactive sessions and group exercises, the AAR provided an opportunity to review outbreak response around key technical areas such as coordination, surveillance, laboratory and case management, vaccines and logistics, vector control as well as risk communication. An important outcome of the meeting was the joint development of a work plan, with clear roles for every stakeholder involved in outbreak preparedness and response.

The NCDC remains committed to working with state epidemiologists, state Ministries of Health, partners and other relevant stakeholders to improving Nigeria’s preparedness and response to yellow fever outbreaks. More importantly, states are enjoined to improve ownership and ensure implementation of the preparedness work plan.

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.

Lassa Fever

Key points

• There were 63 suspected cases of Lassa fever from 19 LGAs in 11 states (Edo - 45, Ondo - 6, Ebonyi - 2, Bauchi - 2, Plateau - 1, FCT – 1, Gombe – 1, Kogi – 1, Delta – 1, Kebbi – 1, & Zamfara - 2). Six cases from Kogi, Edo and Ondo states were laboratory confirmed and one death was recorded.


To date:

• 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 carried out in Edo and Ondo states

• Response commodities were distributed across 36 States, FCT and treatment centers


• Conduct state level AAR meetings

• Support indigent patients with treatment cost through Basic Health Care Provision Funds

Cerebrospinal Meningitis (CSM)

Key points

• There were 10 suspected cases of Cerebrospinal Meningitis reported from seven LGAs in seven states (Adamawa – 1, Bayelsa – 2, Cross River – 3, Nasarawa – 1, Plateau – 1, Sokoto – 1, Taraba - 1). None was laboratory confirmed and no death was recorded


To date:

• The National CSM Techincal Working Group meets weekly to review the situation


• Intensify surveillance in all States by providing technical support

• Continue to 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 of the national data management process.

Yellow Fever


To date:

• 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

• The second draft of the YF National Guidelines on Preparedness and Response has been completed

• The YF AAR meeting held from 18th to 20th June 2019


• Follow up with the next steps on the YF Guidelines and Action plans

• Follow up with the recommendations from the YF AAR.


Key points

There were 15 suspected cases of cholera reported from four LGAs in three states (Adamawa – 12, Bayelsa – 2, Oyo - 1). None was laboratory confirmed and no death was recorded.


To date:

• 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

• Rapid Response Team deployed to support outbreak response in Adamawa state

• 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 sensitization on cholera has begun in Anambra and Benue states

• WaSH sector meeting by FMWR and partners


• Continuous monitoring of all States

• Support all States on Cholera outbreak preparedness

• Print and disseminate IEC materials to all States

• Continue collaboration with FMWR, FMEnv and partners.


Key points

• There were 740 suspected cases reported from 28 States. Nine cases were laboratory confirmed and one death was recorded


To date:

• National multi-agency measles EOC is monitoring and coordinating response activities across the States

• Conducted Risk assessment of the measles outbreak for possible de-escalation of response


• Follow up with CPHL Lagos on throat swab specimen transportation for viral isolation and genotyping

• Intensify surveillance and update measles line list.

Monkey pox

Key points

• There was no new reported case for the week.


To date:

• Surveillance has been enhanced


• Supportive supervision visits to Bayelsa, Delta and Lagos States.

Acute Flaccid Paralysis (AFP)

Key points

• In the reporting week, 78 suspected cases of AFP were reported from 72 LGAs in 25 States and FCT

• As at 9th June, 2019, no new case of WPV was recorded

• The last reported case of polio in Nigeria was in August 2016



• Submission of complete documentation for polio certification shifted to March 2020

• Outbreak response to CVDPV in the southwest states has been completed.

National Influenza Sentinel Surveillance

Key points

• 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.

Highlight of the week

  • Summary of incidents
  • Lassa Fever
  • Cerebrospinal Meningitis (CSM)
  • Yellow Fever
  • Cholera
  • Measles
  • Monkey pox
  • Acute Flaccid Paralysis (AFP)
  • National Influenza Sentinel Surveillance

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