This year, there has been an increase in the number of Lassa fever (LF) cases reported across the country. As of the 24th of January 2020, 195 confirmed cases and 29 deaths had been reported in 11 states including Ondo and Kano. Given the tropical climate in Nigeria and abundance of the disease vector in our environment, we are at a high risk of infectious diseases like Lassa fever. This is also the case for other African countries with this context.
Despite this increase, the overall Case Fatality Rate (CFR) for 2020 is lower at 14.7% compared to the same period in 2019 which was 23.4%. We are gradually moving towards achieving our target of having a single digit CFR. We continue to support the response activities of affected states through various means including the deployment of Rapid Response Teams (RRTs) for better case management and outcome.
Last week, on the 24th of January 2020, the Nigeria Centre for Disease Control (NCDC) activated a National Emergency Operations Centre (EOC). This is an inter-disciplinary Technical Working Group (TWG) for Lassa fever. They have the mandate to ensure a well-coordinated response, case management and swift control of Lassa fever outbreaks.
Within this structure, public health measures are being instituted across the following pillars:
1. Coordination: National LF TWG is working closely with states and relevant development partners to coordinate emergency response activities
2. Surveillance: continuous monitoring of outbreak reports, case investigation and contact tracing through enhanced surveillance
3. Laboratory: prompt diagnosis of all case samples across the five laboratories for Lassa fever testing in the country
4. Infection Prevention and Control: dissemination of IPC advisory and safe burial guidelines for hospitals and health workers
5. Case management: treatment of confirmed cases, in-depth mortality review and dissemination of reviewed case management
6. Risk communication: scale up the implementation of targeted risk communication activities in the affected states. Dissemination of Lassa fever public health advisory for members of the public and healthcare workers, respectively.
7. Logistics: distribution of response commodities to the affected states e.g. personal protective equipment, Ribavirin (injection and tablets), beds, tents, body-bags, thermometers, hypochlorite hand sanitizers, IEC materials, guidelines and SOPS
The National EOC activation meeting had in attendance representatives from the Federal Ministry of Health, National Primary Health Care Development Agency (NPHCDA), World Health Organization (WHO), US Centers for Disease Control (US-CDC), United Nations Children Fund (UNICEF), African Field Epidemiology Network (AFENET), Georgetown University etc.
Lassa fever is preventable and can be treated especially if patients present early to a health care facility. It is important that Nigerians maintain good personal hygiene, keep their environments clean, store their food properly to avoid contact with rodents and avoid self-medication. It is also important for health workers to maintain a high index of suspicion and practise universal care precautions to protect themselves from infection. For more information on prevention of Lassa fever, see our public health advisory here.
Notes
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
Key points
• There were 158 suspected cases of Lassa fever (LF) reported from 14 LGAs in 10 states (Edo – 34, Ondo – 77, Ebonyi – 12, Bauchi – 3, Taraba – 17, Plateau – 8, Gombe - 1, Akwa Ibom – 1, Ogun – 3 & Abia – 2). There were 64 confirmed cases (Ondo – 32, Edo – 18, Ebonyi – 5, Taraba – 5, Plateau – 2, Bauchi – 1 & Ogun - 1) and 12 deaths were recorded (Ondo-6, Taraba- 4, Edo -1 & Ebonyi -1)
• One health care worker was infected in the reporting week
Actions
To date:
• Activated National Emergency Operations Centres (epi-week 4)
• Confirmed cases are being treated at designated treatment centres with Ribavirin and other necessary supportive management measures
• Enhanced surveillance (contact tracing and active case finding) in affected states
Planned:
• Pilot indigent patient treatment scheme through the Basic Healthcare Provision Funds
• Conduct LF mortality review
• Conduct an in-depth investigation of LF infection in healthcare workers
Key points
There were seven suspected cases of Cerebrospinal Meningitis (CSM) reported from seven LGAs in six states (Akwa Ibom – 1, Borno – 1, Katsina – 2, Ondo – 1, Osun – 1 & Sokoto - 1). None was laboratory confirmed and no death was recorded
Actions
To date:
• National CSM Technical Working Group (TWG) meets weekly to review reports from states and plan appropriately
• Enhanced surveillance in all states
Planned:
• Continue harmonisation of the national line list and data from the SORMAS platform
Key points
• There were 44 suspected cases of yellow fever (YF) reported from 36 LGAs in 16 states. None was laboratory confirmed and no death was recorded
Actions
To date:
• National multiagency YF TWG is coordinating response activities
Planned:
• Finalise National Yellow Fever Preparedness and Response Guidelines. To be published on January 31, 2020
Key points
• There were 19 suspected cases of cholera reported from three LGAs in three states (Bayelsa – 3, Ebonyi - 5 & Kebbi – 11). None was laboratory confirmed and four deaths were recorded
Actions
To date
• National cholera multi-sectoral TWG continues monitoring all states and supporting affected states
Planned:
• Ensure that reporting states conduct rapid diagnostic test/culture test and send line list of all reported cases to the national level
Key points
• There were 370 suspected cases of measles reported from 132 LGAs in 30 states. There was one laboratory confirmed case and no death was recorded
Actions
To date
• National measles Technical Working Group (TWG) is closely monitoring surveillance data and response activities across the country
Planned:
• Continue the review of measles surveillance data across the country
• Continue harmonisation of the national line list and SORMAS data
Key points
• There were four suspected cases of Monkeypox reported from four LGAs in three states (Lagos – 2, Edo – 1 & Ondo - 1) this week. None was laboratory confirmed and no death was recorded
• All suspected cases were confirmed for Chickenpox
Actions
• National monkeypox TWG is monitoring activities in all states
• Off-site support to affected states
Planned:
• Enhance surveillance for monkeypox in high burden states, working with the animal health colleagues.
Key points
• There were 69 suspected cases of AFP reported from 64 LGAs in 27 states and FCT. None was laboratory confirmed and no death was recorded
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