At the just concluded 4th Nigeria Centre for Disease Control/ National Field Epidemiology Laboratory Training Programme annual conference, our keynote speaker was Dr. Faisal Shuaib, Executive Director of the National Primary Health Care Development Agency (NPHCDA). NPHCDA has been at the forefront of leading the government’s efforts towards polio elimination in Nigeria. We present five key lessons from Dr. Shuaib’s speech on the journey towards ending polio in Nigeria.
1. WHERE WE ARE: While it may be disturbing that Nigeria still remains one of the three countries (Pakistan and Afghanistan inclusive) in the world yet to eradicate the virus, the good news is that Nigeria is no longer in the endemic phase as no case has been recorded in the last thirty seven (37) months. With the end to polio virus in view, it is hoped that if no confirmed case is recorded till March 2020, Nigeria will join the list of nations to be certified polio-free.
2. PARTNERSHIPS MATTER: The fight to kick against polio in Nigeria is strong evidence of how collaboration for health security works. NPHCDA works closely with other government agencies such as NCDC, State Governors, Traditional Rulers, partners such as the World Health Organisation, Bill and Melinda Gates Foundation, United Nation Children’s Fund (UNICEF), US Centre for Disease Control, Rotary International etc. NPHCDA has made remarkable progress in the fight towards polio eradication in Nigeria especially through routine immunisation campaigns and other public health interventions.
3. OUTBREAKS AND SECURITY: While sharing Nigeria’s experience in the fight against polio, Dr Shuaib highlighted the challenges faced by immunisation officers and other health workers, in North-East Nigeria. He described some of the disruptive and highly innovative strategies that have been introduced, especially the ‘Buratai Initiative’ launched in May 2019, for the Nigerian Army and NPHCDA to work closely together to immunise children in hard to reach areas.
4. COMMAND AND CONTROL STRUCTURE: Dr. Shuaib highlighted that the establishment and activities of the Polio Emergency Operations Centre (EOC) and National Emergency Routine Immunization Coordination Centre (NERICC) has helped the agency to generate, analyse and feedback on relevant immunisation data for polio and other diseases. This is in addition to other strategies such as directly observed polio vaccinations (DOPV); the National Stop Transmission of Polio (NSTOP) program; use of GIS maps and imagery; engagement of voluntary community mobilisers; monitoring and accountability matrix at all levels etc.
5. COMMITMENT: In concluding, Dr. Shuaib Faisal reiterated that while the afore-mentioned strategies have been successful in interrupting the transmission of wild polio virus, the Federal Government of Nigeria is unrelenting and remains committed until Nigeria is certified polio-free by March 2020.
Summary of Incidents
Ongoing Incidents are defined as confirmed cases where a national EOC or equivalent has been activated (EOC is currently activated for Yellow Fever)
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 83 suspected cases of Lassa Fever (LF) reported from 15 LGAs in 13 states (Edo – 23, Ondo – 23, Ebonyi – 12, Bauchi – 13, Gombe – 1, Kaduna – 1, Delta – 3, Rivers – 2, Cross River – 1, Bayelsa – 1, Osun – 1, Lagos – 1 & Abia - 1). There were 9 confirmed cases and no death was recorded
• National LF multi-partner, multi-sectoral Technical Working Group (TWG) continues to coordinate the response activities at all levels
• Visit to the Lassa Fever treatment centres in Bauchi, Taraba and Plateau States
• Implementation of targeted risk communication and enhanced surveillance activities in affected states
• Conduct a meeting to finalise the LF psycho-social guideline in October 2019
• Review LF case management and surveillance tools and SOPs in October 2019
• Support indigent patients with treatment cost via basic health care provision funds
Cerebrospinal Meningitis (CSM)
• There were 21 suspected cases of Cerebrospinal Meningitis reported from ten (10) LGAs in seven states (Abia - 2, Bauchi – 1, Cross river – 2, Katsina – 13, Kebbi – 1 Kwara – 1 & Ondo - 1). None was laboratory confirmed and no death was recorded
• The National CSM TWG meets weekly to review reports from states and plan appropriately
• Conduct After Action Review (AAR)
• Harmonise surveillance and laboratory data
• Conduct case and data management training in Sokoto state from 26th – 28th September, 2019
There were 92 suspected cases of Yellow Fever reported from 52 LGAs in 20 states. There were three confirmed case and one death was recorded
• A multiagency YF Incident Management System (IMS) is coordinating response activities for cases with epidemiological link to Bauchi
• Rapid Response Team (RRT) deployed to Bauchi State to support outbreak response
• The Ebonyi, Katsina, Bauchi, Gombe and Borno states’ EOCs are leading the outbreak investigation with support from the national team (NCDC/NPHCDA) and WHO
• Reactive mass vaccination campaign conducted in three LGAs in Ebonyi state from 7th – 16th September, 2019
• National Reference Laboratory (NRL) now has the capacity to confirm YF cases with Polymerase Chain Reaction (PCR)
• Continue on-site and off-site support to affected states
• Follow up with ICG request for the vaccination of other affected states
• Scale up risk communication activities, advisories and press release on YF
There were 36 suspected cases of Cholera reported from five LGAs in three states (Adamawa – 25, Bayelsa – 3, Borno - 8). There were 13 laboratory confirmed cases and no death was recorded
• The national Cholera TWG continues to coordinate activities in states in collaboration with the Federal Ministry of Water Resources (FMWR) and support from partners
• Adamawa state EOC continues to coordinate response activities with support from partners
• Follow up with state with active outbreak and monitoring of non-reporting states
• Review Standard Operating Procedures (SOPs) of sample management and testing
• There were 337 suspected cases of Measles reported from 139 LGAs in 29 states. None was laboratory confirmed and no death was recorded
• The multi-agency National Measles TWG is monitoring and coordinating response activities across the states
• The TWG is working closely with NPHCDA towards Measles Supplemental Immunization Activity in Nigeria
• Continue review of Measles surveillance data across the country
• Harmonise Measles surveillance guideline
• There were 2 suspected cases of Monkeypox reported this week in Lagos and Rivers States. There was no confirmed case and no death was recorded
• The case reported from Lagos state in week 35 was confirmed for Varicella-Zoster Virus (VZV)
• The national monkeypox TWG is monitoring and coordinating response activities across the states
• Surveillance has been enhanced in all affected states
• Offsite support is given to affected states
• Conduct monkeypox sensitisation at the National Association of Resident Doctors of Nigeria’s (NARD) Annual General Meeting (AGM) holding on 26th September 2019 in Kaduna state.
• Conduct regional monkeypox case management and surveillance training in South-East, South-West and North-Central in October 2019
Acute Flaccid Paralysis (AFP)
• In the reporting week, 82 suspected cases of AFP were reported from 75 LGAs in 25 states and FCT. None was laboratory confirmed and no death was recorded
National Influenza Sentinel Surveillance
• There was a positive case of Influenza subtype A&B (0.3%)
• The subtypes A seasonal H3 and A/not subtyped account for 43(87.8%) and 6(12.2%) of the total influenza A positive sample respectively
• The B Not subtyped account for 3(100%) of the total influenza B positive sample
Timeliness and Completeness of Reports
Timeliness and Completeness of Reports by State