Weekly Epidemiological Report

June Week 22

Editoral

Risk Communication: Understanding its role in outbreak response

In this reporting week, the ongoing Cerebrospinal Meningitis (CSM) outbreak entered its 23rd week. The number of affected states increased to 25 and four (4) additional LGAs reported a suspected case, bringing the total number of affected LGAs to 230. Since onset, a total of 14,298 suspected cases have been identified, out of which 901 samples were collected for laboratory testing. 437 of samples tested were confirmed positive for Neisseria meningitidis. 75.7% (331) of tested samples showed the causative organism to be Neisseria meningitidis serogroup C. The number of deaths recorded so far is 1,148 giving a case fatality rate (CFR) of 8%.

The events during the course of this outbreak have revealed gaps in our response systems, which need to be addressed for future outbreak response activities. Improvements in the surveillance systems have been palpable, given the high number of suspected cases identified as a result of the sensitivity of the standard case definition for CSM and enhanced surveillance activities. However, the number of samples collected cumulatively as seen above is low (6.3%). Zamfara and Sokoto States recorded individual increases in lumbar puncture procedures carried out (21% and 23% increased rates respectively) in the last few weeks, which was as a result of on-site support provided by the Nigeria Centre for Disease Control (NCDC) and its partner agencies. The number of deaths recorded has progressively increased, despite recorded outbreak response activities. An identified tool for improving good outcomes in outbreaks is risk communication A key component to a preparedness plan is risk communication. Effective risk communication during an outbreak is not limited to the exchange of information between responsible authorities and the populace. It also entails taking proactive steps towards creating a bond of trust, accountability and reliability between public health authorities and the individuals in the communities. An outcome of this is creating awareness of expectations in the event of an outbreak. Others include providing guidance during an outbreak and evaluating systems for effective feedback following an outbreak

A coordinated approach is fundamental for effective risk communication. It is essential that identified key stakeholders understand the importance of effective risk communication and are able to garner and channel all available resources to implement related activities. Outbreaks and emergencies of public health concern will continue to test our response systems. Therefore, meaningful and coordinated steps should be taken to reduce morbidity and mortality from these events.

As part of activities to address gaps and strengthen our preparedness and response systems, the NCDC alongside the National Primary Health Care Development Agency (NPHCDA) and other partner agencies have carried out a week long capacity building session on effective risk communication on Meningitis for Health Educators and Directors of Public Health in all 19 Northern States of Nigeria. Future plans will be targeted at conducting these sessions in all States of the Federation. It is hoped that participants are able to use these training sessions as a tool for improving preparedness and response to outbreak and emergencies of public health concern in their respective States.


In the reporting week:

o There were 250 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has assiduously reinvigorated its efforts at eradicating Polio.

o Three suspected cases of Cholera were reported from Kaduna South LGA in Kaduna State and no death was recorded.

o There were 128 suspected cases of Cerebrospinal Meningitis (CSM) reported from 45 LGAs in 12 States. Of these, six were laboratory confirmed and four deaths were recorded. Ongoing surveillance for CSM has been intensified in the States.

o There were 422 suspected cases of Measles reported from 28 States including the FCT. Three laboratory confirmed cases were recorded with six deaths.

In the reporting week, Adamawa, Anambra and Edo States failed to report. Timeliness of reporting remains 81% in both previous and current weeks while completeness decreased from 100% in the previous week to 99% in the current week. It is very important for all States to ensure timely and complete reporting at all times.


1. Lassa fever

Please note that the data reflects the routine reports i.e. all suspected cases including the laboratory positive and negative cases

1.1. Four suspected cases of Lassa fever with one laboratory confirmed and two deaths (CFR, 50.0%) were reported from four LGAs (three States) in week 20, 2017 compared with zero during the same period in 2016.

1.2. Laboratory results of the four suspected cases were one positive for Lassa fever (Plateau – 1), three negatives (Cross River – 1, Nassarawa – 1 and Plateau - 1).

1.3. Between weeks 1 and 20 (2017), 262 suspected Lassa fever cases with 59 laboratory confirmed cases and 48 deaths (CFR, 18.32%) from 54 LGAs (20 States) were reported compared with 658 suspected cases with 63 laboratory confirmed cases and 75 deaths (CFR, 11.40%) from 122 LGAs (27 States) during the same period in 2016 (Figure 1).

1.4. Between weeks 1 and 52 2016, 921 suspected Lassa fever cases with 109 laboratory confirmed cases and 119 deaths (CFR, 12.92%) from 144 LGAs (28 States and FCT) were reported compared with 430 suspected cases with 25 laboratory confirmed cases and 40 deaths (CFR, 9.30%) from 37 LGAs (14 States and FCT) during the same period in 2015 (Figure 2).

1.5. Investigation and active case search ongoing in affected States with coordination of response activities by the NCDC with support from partners.

1.5.1. National Lassa Fever Working Group meeting and weekly National Surveillance and Outbreak Response meeting on-going at NCDC to keep abreast of the current Lassa fever situation in the country.

1.5.2. Response materials for VHFs prepositioned across the country by NCDC at the beginning of the dry season

1.5.3. New VHF guidelines have been developed by the NCDC (Interim National Viral Haemorrhagic Fevers Preparedness guidelines and Standard Operating Procedures for Lassa fever management)

1.5.4. Ongoing reclassification of reported Lassa fever cases

1.5.5. Ongoing review of the variables for case-based surveillance for VHF

1.5.6. VHF case-based forms completed by affected States are being entered into the new VHF management system. This system allows for the creation of a VHF database for the country.

1.5.7. Confirmed cases are being treated at identified treatment/isolation centres across the States with Ribavirin and necessary supportive management also instituted

1.5.8. Onsite support was earlier provided to Ogun, Nasarawa, Taraba, Ondo and Borno States by the NCDC and partners

1.5.9. Offsite support provided by NCDC/partners in all affected States

1.5.10. States are enjoined to intensify surveillance


2. MEASLES

2.1. In the reporting week, 422 suspected cases of Measles with three laboratory confirmed cases and six deaths (CFR, 1.42%) were reported from 27 States and FCT compared with 488 suspected measles cases and two deaths (CFR, 0.41%) from 30 States during the same period in 2016.

2.2. So far, 11,283 suspected Measles cases with 72 laboratory confirmed cases and 70 deaths (CFR, 0. 62%) have been reported in 2017 from 36 States and FCT (Figure 4) compared with 17,930 suspected cases and 75 deaths (CFR, 0.42%) from 36 States and FCT during the same period in 2016.

2.3. In 2016 (week 1 -52), 25,251 suspected Measles cases with 102 deaths (CFR, 0.40%) were reported from 36 States and FCT compared with 24,421 suspected cases with 127 deaths (CFR, 0.52%) during the same period in 2015 (Figure 5)

2.4. Response measures include immunization for all vaccine-preventable diseases in some selected/affected wards/LGAs during SIAs, as well as case management.

2.5. Scheduled Measles campaigns in the North East were conducted from 12th – 17th January, 2017 in Adamawa, Borno and Yobe States (Phase I) and Phase II from 21st – 25th January, 2017 in Borno State and 4th – 8th February, 2017 in Yobe State


3. POLIOMYELITIS

3.1. As at May 19th 2017, no new case of WPV was recorded

3.2. Three new cVDPV2, environmental derived and Polio compatible cases identified

3.2.1. In the reporting week, 250 cases of AFP were reported from 186 LGAs in 31 States and FCT

3.2.2. AFP Surveillance has been enhanced and outbreak response is on-going in Borno and other high risk States

3.2.3. The 1st round of SIPDs in 2017 was conducted from 28th – 31st January 2017 in the 18 high risk States. This was carried out using mOPV2 (2nd mOPV2 OBR). The schedule for other SIAs is as described in Table 2

3.2.4. The 2nd round of SIPDs completed (25th-28th February, 2017) in 14 high risk States using bOPV.

3.2.5. The 1st and 2nd rounds of NIPDs completed (from 25th – 28th March, 2017 and 22nd – 25th April, 2017) nationwide respectively.

3.2.6. Between weeks 1 and 52 in 2016, four WPVs were isolated from Borno State compared to no WPV isolated during the same period in 2015.

3.3. No circulating Vaccine Derived Polio Virus type 2 (cVDPV2) was isolated in week 1 - 52, in both 2016 and 2015.

3.4. Between weeks 1 and 52, 2016 two (2) cVDPV2 were isolated in two LGAs (two States) while one (1) cVDPV2 was isolated from Kwali, FCT during the same period in 2015.

3.5. Six confirmed WPVs were isolated in 2014.

3.6. The SIAs were strengthened with the following events:

3.6.1. Immunization for all vaccine-preventable diseases in some selected wards/LGAs.

3.6.2. Use of health camp facilities.

3.6.3. Field supportive supervision and monitoring.

3.6.4. Improved Enhanced Independent Monitoring (EIM) and Lots Quality Assessments (LQAs) in all Polio high risk States.

3.6.5. High level of accountability framework


4. CHOLERA

4.1. Three suspected cases of Cholera were reported from Kaduna South LGA (Kaduna State) in week 20 compared with zero case at the same period in 2016.

4.2. Between weeks 1 and 20 (2017), 83 suspected Cholera cases and four deaths (CFR, 4.82%) from 15 LGAs (12 States) were reported compared with 216 suspected cases and one death (CFR, 0.47%) from 24 LGAs (nine States) during the same period in 2016 (Figure 7).

4.3. Between weeks 1 and 52 (2016), 768 suspected Cholera cases with 14 laboratory confirmed cases and 32 deaths (CFR, 4.17%) from 57 LGAs (14 States) were reported compared with 5,301 cases with 29 laboratory confirmed cases and 186 deaths (CFR, 3.51%) from 101 LGAs (18 States and FCT) during the same period in 2015 (Figure 8).

4.4. States are enjoined to intensify surveillance.

4.5. Cholera preparedness workshop held from 31st May – 1st June, 2017 in Abuja to developed Cholera preparedness plan as the set in.


5. CEREBROSPINAL MENINGITIS (CSM)

5.1. In the reporting week 20, 128 suspected Cerebrospinal Meningitis (CSM) cases with six laboratory confirmed cases and four deaths (CFR, 3.13%) were reported from 45 LGAs (12 States) compared with three suspected cases with two laboratory confirmed cases from two LGAs (two States) during the same period in 2016.

5.2. Between weeks 1 and 20 (2017), 9477 suspected CSM cases with 99 laboratory confirmed cases and 596 deaths (CFR, 6.29%) were recorded from 288 LGAs (31 States) compared with 487 suspected cases and 25 deaths (CFR, 5.13%) from 115 LGAs (25 States) during the same period in 2016 (Figure 9).

5.3. Between weeks 1 and 52, 2016, 831 suspected CSM cases with 43 laboratory confirmed cases and 33 deaths (CFR, 3.97%) were recorded from 154 LGAs (30 States and FCT) compared with 2,711 suspected cases and 131 deaths (CFR, 4.83%) from 170 LGAs (28 States and FCT) during the same period in 2015 (Figure 10)

5.4. Timeliness/completeness of CSM case-reporting from States to the National Level (2017 versus 2016): on average, 79.6% of the 26 endemic States sent CSM reports in a timely manner while 96.0% were complete in week 1 – 20, 2017 as against 82.3% timeliness and 96.2% completeness recorded within the same period in 2016

5.5. CSM preparedness checklist sent to 36 States and FCT ahead of 2017 meningitis season

5.6. Confirmed cases are being treated at identified treatment centres in affected States (Zamfara, Sokoto, Katsina, Kebbi, Niger, Kano, Yobe and Jigawa) and necessary supportive management also instituted

5.7. CSM National Emergency Operations Centre constituted at the Nigeria Centre for Disease Control

5.8. Onsite support was earlier provided to Zamfara State and still ongoing.

5.9. Ongoing onsite support to Sokoto, Katsina, Kebbi, Kano and Niger States by NCDC and partners

5.10. Intensive Surveillance is on-going in high risk States.

5.11. Reactive vaccination completed in Zamfara State for people aged one to 29 years using polysaccharide meningococcal A & C vaccine.

5.12. Reactive vaccination completed in two wards (Gada and Kaffe) in Gada LGA in Sokoto State using polysaccharide meningococcal A & C vaccine for people aged two to 29 years.

5.13. Reactive vaccination completed in nine LGAs in Sokoto State using monosaccharide meningococcal conjugate C vaccine for aged one to 20 years.

5.14. Reactive vaccination campaign completed in Yobe State and the second phase of the campaign in Zamfara State also completed.

5.15. Training and deployment of first batch of medical teams to support case management in Sokoto and Zamfara States completed (from Friday 5th - 26th May, 2017).

5.16. Deployed mobile testing laboratory to Zamfara State to aid diagnosis

5.17. Deployed additional team of three NCDC staff to support surveillance activities, laboratory data harmonization and monitoring of implementation plan in Yobe state


6. GUINEA WORM DISEASE

6.1. In the reporting week, no rumour report of Guinea Worm disease was received from any State.

6.2. Nigeria has celebrated eight consecutive years of zero reporting of Guinea worm disease in the country. The Country has been officially certified free of Dracunculiasis transmission by the International Commission for the Certification of Dracunculiasis Eradication (ICCDE).

(For further information, contact NIGEP NC/Director: Mrs. I, Anagbogu: +2348034085607, ifechuba@yahoo.co.uk)

FOR MORE INFORMATION CONTACT

Surveillance Unit:

Nigeria Centre for Disease Control

801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.

epidreport@ncdc.gov.ng

www.ncdc.gov.ng/reports

0800-970000-10


In the reporting week:

o There were 250 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has assiduously reinvigorated its efforts at eradicating Polio.

o Two suspected cases of Cholera were reported from Kaduna South LGA in Kaduna State and no death was recorded.

o There were 49 suspected cases of Cerebrospinal Meningitis (CSM) reported from 23 LGAs in 13 States. Of these, seven were laboratory confirmed and two deaths were recorded. Ongoing surveillance for CSM has been intensified in the States.

o There were 386 suspected cases of Measles reported from 27 States. None was laboratory confirmed and four deaths were recorded.

In the reporting week, Adamawa, Akwa-Ibom, Cross River and Edo States failed to report. Timeliness of reporting remains 81% in both previous and current weeks while completeness also remains at 99% in both previous and current weeks. It is very important for all States to ensure timely and complete reporting at all times.

Highlight of the week

  • In the reporting week:
  • 1. Lassa fever
  • 2. MEASLES
  • 3. POLIOMYELITIS
  • 4. CHOLERA
  • 5. CEREBROSPINAL MENINGITIS (CSM)
  • 6. GUINEA WORM DISEASE
  • In the reporting week:

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