Cerebrospinal Meningitis (CSM) is one of the priority epidemic-prone diseases under the National Integrated Disease Surveillance and Response Strategy that is reported all year round in Nigeria. Despite its endemicity, CSM has predilection for dry season with peak between January and May. It is characterised by acute severe infection of the central nervous system causing inflammation of the meninges with associated morbidity and mortality. Highest burden occurs in the part of sub-Saharan Africa known as the “Meningitis Beltâ€. In Nigeria, the belt covers all the 19 northern states and the Federal Capital Territory (FCT).
In 2020, Nigeria recorded a total of 603 cases and 13 deaths reported from 138 Local Government Areas in 30 States of the Federation. Despite this burden, the problem of under-reporting due to low cerebrospinal fluid (CSF) collection rate still remains. This can be as low as less than 10% during outbreak. To address this, the Nigeria Centre for Disease Control (NCDC) with the support of relevant development partners is working with states to conduct a pilot study to specifically determine the prevalence of bacteraemia by quantitative polymerase chain reaction (qPCR) among suspected cases.
The study aims to develop approaches that can increase diagnostic yield of confirmed meningitis and to allow for easy detection of outbreaks with great rapidity to hasten reactive vaccination campaign. The specific objectives are to:
- Determine whether and by how much inclusion of blood testing in addition to CSF testing increases case ascertainment of meningococcal disease over case ascertainment by CSF testing alone
- Investigate if inclusion of blood testing will reduce the time between the onset of an outbreak and the activation of reactive vaccination campaign
To achieve the above objectives, the NCDC, with the support of partners, from April 12-16 2021 conducted a residential workshop for states’ actors on Blood Testing to Enhance Case Ascertainment during Meningococcal Meningitis Outbreaks in the African Meningitis Belt (BLoTIMA). A total of 27 personnel were trained (Clinicians, Biomedical Scientists, Laboratory Scientists and Disease Surveillance and Notification Officers (DSNOs)) in the five selected states- Sokoto, Zamfara, Katsina, Kebbi, and Niger.
The workshop provided an opportunity to strengthen the capacity of the states’ focal persons on CSM diagnosis using qPCR, CSM case management as well as data collection and management using Surveillance Outbreak Response Management and Analysis System (SORMAS) tool. This will promote early detection of CSMoutbreaks for appropriate public health responses.
We remain grateful to our partners- University College London, World Health Organisation and Public Health England for co-facilitating the training. The NCDC will continue to support the sub-national level to improve CSF collection, diagnostic and case management capacity for timely decision making. We are working towards reducing significantly, the morbidity and mortality associated with CSM in Nigeria.
Summary of Incidents
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
Lassa Fever
Key points
• There were 78 suspected cases, three were laboratory confirmed and no death was recorded from two LGAs in Ondo State
Actions
To date:
• Conducted 2021 Lassa fever(LF) high burden states preparedness/response engagement meeting
• Dissemination of reviewed case management and safe burial practices guidelines
• Ensured all five LF molecular laboratories in the NCDC network are working at full capacity for timely testing of samples with reduced turnaround time
Planned:
• Finalise Lassa fever five-year strategic plan
Cerebrospinal Meningitis (CSM)
Key points
• There were three suspected cases of Cerebrospinal Meningitis (CSM) reported from three LGAs in two states (Ebonyi – 2 & Katsina – 1). Two were laboratory confirmed and no death was recorded
Actions
To date:
• National CSM 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 SORMAS data
• Continue to ensure that states reporting cases send their line lists and collect CSM samples
Yellow Fever
Key points
• There were 19 suspected cases of Yellow Fever (YF) reported from 17 LGAs in 11 states. None were laboratory confirmed and no death was recorded
Actions
To date:
• National YF multi-partner Technical Working Group (TWG) continues to coordinate activities across states.
• Daily monitoring and analysis of surveillance data across the country to guide response activities
Planned:
• Continue supporting affected states across all pillars of response
• Continue harmonisation of surveillance and laboratory data ongoing
Cholera
Key points
• There were 151 suspected cases of cholera reported from five LGAs in Bayelsa State. None were laboratory confirmed and nine deaths were recorded
Actions
To date
• National Cholera Multi-Sectoral Technical Working Group (TWG) is monitoring all states and supporting affected states
• Developed the 2021 Annual Cholera Preparedness and Response Workplan
• Cholera jingles being aired in English and local languages across the country
Planned:
• Continue follow up and monitoring of non-reporting states
• Build capacity for sample collection, transportation, and laboratory diagnosis across states
Measles
Key points
• There were 163 suspected cases of measles reported from 69 LGAs in 21 states and FCT. Five were laboratory confirmed and no death was recorded
Actions
To date
• National Measles TWG is closely monitoring measles surveillance data and providing feedback to relevant agencies and development partners
• Ongoing weekly surveillance and laboratory data harmonisation
Planned:
• Intensify follow up with states to update and transmit line list
• Continue monthly measles surveillance data review
Monkeypox
Key points
• There was no suspected case of monkeypox in the reporting week
Actions
To date
• National Monkeypox Technical Working Group (TWG) is monitoring activities in all states
Planned:
• Enhance surveillance for monkeypox in high burden states
• Continue harmonisation of the national line list and SORMAS data
Acute Flaccid Paralysis (AFP)
Key points
• There were 41 suspected cases of AFP reported from 41 LGAs in 18 states. None were laboratory confirmed and no death was recorded
National Influenza Sentinel Surveillance
Avian Influenza (H5 series)
Actions
To date:
• A multi-sectoral Emergency Operations Centre (EOC) continues to coordinate the response
• So far, all confirmed seven human positive samples have been shipped to WHO coordinating centre for further lab analysis
Planned:
• Continue to intensify surveillance activities and monitor contacts across the country
• Conduct risk assessment at the national level
Coronavirus Disease (COVID-19)
To date:
• National COVID-19 multi-partner Emergency Operations Centre (EOC) continues to coordinate response activities across states
• Held a virtual strategic coordination meeting with State Incident Managers and State Epidemiologists on increasing sample collection and testing in states
• Conducted webinar on Ag-RDT policy and use
• Conducted bi-monthly meeting with state Health Educators (SHEs)
Planned:
• Deploy antigen-based rapid diagnostic test (Ag-RDT) kits and sample collection materials to the selected states
• Intensify genomic surveillance activities
• Conduct WASH (Water, Sanitation and Hygiene) assessment across all health facilities
• Finalise Local Government Area (LGA) / State transmission categorisation
Timeliness and Completeness of Reports
Timeliness and Completeness of Reports by State