Disease guidelines provide a country with a harmonised method of preventing, detecting and responding to diseases of public health importance. They are also essential in providing recommendations to various role players on interventions that can prevent disease or improve health.
In the last one year, officials at the Nigeria Centre for Disease Control in collaboration with partners from Ministries of Agriculture and Environment, Non-Governmental Organisations, Hospitals, Laboratories and the academia, have developed new important guidelines to guide the management of some diseases including Viral Haemmorhagic Fevers (VHF).
In the wake of the recent cases of Lassa fever in States across the country, this editorial focuses on three vital guidelines for the control of VHF in Nigeria-
• National Guidelines on Infection Prevention and Control for Viral Haemorrhagic Fevers
The Viral Haemorrhagic Fevers Preparedness and Response Plan has been developed to ensure the clarity of activities required for prevention, rapid detection, investigation, verification, and response to VHF cases and outbreaks. The implementation of this plan will minimise associated health consequences and the negative socio-economic impact of VHFs. The plan has been developed to be applied across the Federal, State and Local Government level covering several areas including surveillance and epidemiology, laboratory diagnosis, case management, risk communication etc. It covers the period before outbreaks and during outbreaks.
The National Guidelines on Infection Prevention and Control for Viral Haemorrhagic Fevers simply provides steps on preventing human to human transmission of Lassa fever, especially in clinical settings. The plan contains protocols on safe transportation of infected patients, disinfection, waste disposal of equipment used by or for an infected patient, safe burial and other related matters to prevent the transmission of the Lassa fever virus from an infected person to health workers, family members, care givers and other members of the community.
The Standard Operating Procedures (SOPs) for Lassa Fever Case Management describes standard measures for the management of patients with Lassa fever including protocol for case identification and detection, treatment, discharge procedures of a recovered patient and safe burial practices for a patient who dies from Lassa fever.
These Guidelines have been developed with the aim of co-ordinating the response to VHF outbreaks across the country, and strengthening the system across different spheres to prevent, detect and respond to these diseases. They should be used by States and other institutions to ensure Nigeria's health security. The guidelines are available on the NCDC website (http://ncdc.gov.ng/diseases/guidelines) and plans are underway to distribute hard copies of these documents across the country.
States and hospitals are encouraged to apply these guidelines, especially in the management of the current Lassa fever outbreak and preparedness for subsequent outbreaks.
In the reporting week ending on the 30th of July, 2017:
o There were 357 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 Ilorin East LGA in Kwara State with no laboratory confirmed case and no recorded deaths.
o There were 17 suspected cases of Cerebrospinal Meningitis (CSM) reported from ten LGAs in eight States. Of these, none was laboratory confirmed and no death was recorded. Ongoing surveillance for CSM has been intensified in the States.
o There were 449 suspected cases of Measles reported from 33 States. None was laboratory confirmed and one death was recorded.
In the reporting week, Lagos State failed to send in any report. Timeliness of reporting increases from 82% to 83% in the previous and current weeks (Week 29 and 30) while completeness also remains at 100%. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.
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. 12 suspected cases of Lassa fever were reported from four LGAs (three States; Edo – 10, Nasarawa – 1 & Plateau - 1) in week 30, 2017 compared with 14 suspected cases with two Laboratory confirmed cases reported from three LGAs (three States) at the same period in 2016.
1.2. Laboratory results of the 12 suspected cases are two positives for Lassa fever (Edo -2) while eight were negative for Lassa fever and other VHF (Edo – 8) while two pending (Nasarawa – 1 & Plateau – 1).
1.3. Between weeks 1 and 30 (2017), 366 suspected Lassa fever cases with 88 laboratory confirmed cases and 56 deaths (CFR, 15.30%) from 68 LGAs (22 States) were reported compared with 760 suspected cases with 74 laboratory confirmed cases and 87 deaths (CFR, 11.45%) from 128 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 (National Viral Haemorrhagic Fevers Preparedness guidelines, Infection Prevention and Control of VHF and Standard Operating Procedures for Lassa fever management) and are available on the NCDC website.
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. NCDC team sent to Edo State to support Lassa fever data harmonization & Updating of VHF case-based management database
1.5.8. Confirmed cases are being treated at identified treatment/isolation centres across the States with Ribavirin and necessary supportive management also instituted
1.5.9. Onsite support was earlier provided to Ogun, Nasarawa, Taraba, Ondo and Borno States by the NCDC and partners
1.5.10. Offsite support provided by NCDC/partners in all affected States
1.5.11. NCDC and partners are providing onsite support in Ondo and Plateau State
1.5.12. States are enjoined to intensify surveillance and promote Infection, Prevention and Control (IPC) measures in health facilities.
2.1. In the reporting week, 449 suspected cases of Measles and one death (CFR, 0.22%) were reported from 33 States compared with 168 suspected measles cases reported from 27 States during the same period in 2016.
2.2. So far, 15,607 suspected Measles cases with 108 laboratory confirmed cases and 89 deaths (CFR, 0. 57%) have been reported in 2017 from 36 States and FCT (Figure 4) compared with 20,964 suspected cases and 84 deaths (CFR, 0.40%) 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
2.6. Measles Surveillance Evaluation and Establishment of the burden of Congenital Rubella Syndrome (CRS) in 12 selected States in the six geopolitical zones from the 17th -21st July 2017 conducted
2.7. Harmonization of measles surveillance data with laboratory confirmed cases
3.1. As at July 23rd 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, 357 cases of AFP were reported from 271 LGAs in 34 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 and 3rd round of SIPDs completed (25th-28th February and 8th – 11th July, 2017) in 14 & 18 high risk States using bOPV respectively.
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
4.1. Two suspected cases of Cholera cases were reported from Ilorin East LGA (Kwara State) in week 30 compared with zero case at the same period in 2016.
4.2. Between weeks 1 and 30 (2017), 918 suspected Cholera cases with 19 laboratory confirmed and 23 deaths (CFR, 2.51%) from 33 LGAs (13 States) were reported compared with 331 suspected cases and four deaths (CFR, 1.21%) from 30 LGAs (ten 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. Cholera preparedness workshop held from 31st May – 1st June, 2017 in Abuja to
develop Cholera preparedness plan as the season set in.
4.5. NCDC/partners provided onsite support in Kwara State.
4.6 NCDC/partners are providing onsite support in Zamfara State.
4.7 Cholera Preparedness Checklist sent to all States to assess their level of preparedness with recommendations for prevention of and response to an outbreak.
4.8 States are enjoined to intensify surveillance, implement WASH activities and ensure early reporting.
5. CEREBROSPINAL MENINGITIS (CSM)
5.1. In the reporting week 30, 17 suspected Cerebrospinal Meningitis (CSM) cases were reported from ten LGAs (eight States) compared with 14 suspected cases from eight LGAs (seven States) at the same period in 2016.
5.2. Between weeks 1 and 30 (2017), 9740 suspected CSM cases with 108 laboratory confirmed cases and 602 deaths (CFR, 6.18%) were recorded from 303 LGAs (32 States) compared with 560 suspected cases and 29 deaths (CFR, 5.18%) from 130 LGAs (27 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, 80.9% of the 26 endemic States sent CSM reports in a timely manner while 98.1% were complete in week 1 – 30, 2017 as against 84.2% timeliness and 99.4% 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 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 provided to Zamfara, Sokoto, Katsina, Kebbi, Kano, Yobe and Niger States by NCDC and partners
5.9. Off-site support provided to other States
5.10. Intensive Surveillance 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 for people aged two to 29 years using polyvalent ACW conjugate vaccine.
5.15. Medical teams were trained and deployed 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. A Team was deployed by NCDC/WHO to support surveillance activities, laboratory data harmonization and monitoring of the implementation plan in Yobe state
5.18. National CSM EOC has been stepped down
5.19. Evaluation of the CSM outbreak response in Zamfara and Sokoto States is ongoing by NCDC and WHO
5.20. National CSM After-Action Review meeting conducted in Sokoto State from the 24th – 25th of July 2017.
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, email@example.com)
FOR MORE INFORMATION CONTACT
Nigeria Centre for Disease Control
801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.