Weekly Epidemiological Report

Issue: Volume 9 No. 3 1st February, 2019

NIGERIA CENTRE FOR DISEASE CONTROL

Weekly Epidemiological Report

Main Highlight of the week

TRAINING OF TRAINERS FOR INTEGRATED TRAINING OF SURVEILLANCE OFFICERS IN NIGERIA

The World Health Organization’s Integrated Disease Surveillance and Response

(IDSR) strategy was adopted in Nigeria in 2001, for public health surveillance in the

country. It is a strategy that promotes the rational use of resources in streamlining

and integrating disease surveillance activities. This is expected to ensure early

detection and prompt response to outbreaks of diseases and public health events.

In 2018, the Nigeria Centre for Disease Control (NCDC) adopted the Surveillance

Outbreak Response and Analysis System (SORMAS), an electronic platform for

managing surveillance and outbreak data. The use of SORMAS app in IDSR strategy

as ICT has enhanced real time surveillance and reporting of outbreaks/events at the

Local, State and Federal levels. This integration of SORMAS into IDSR strategy has

also improved the surveillance system in outbreak response management such as

case investigation, contact follow up, rumour management, laboratory sample

management and case management.

Issue: Volume 9 No. 3

1st February 2019

Weekly Epidemiological Report

Issue: Volume 9 No. 3

1st February, 2019

NCDC has recognized the need to have a single training package that addresses all

the training needs of surveillance officers that will help to avoid parallel training

programs. This harmonised training package is known as Integrated Training of

Surveillance officers in Nigeria (ITSON) which is derived from the previous training

programs – IDSR modules, Frontline FETP, and WARDS also incorporated Emergency

Operation Centres (EOC), Infection Prevention and Control (IPC), One Health and

Risk communication training.

In order to kick start and roll out the ITSON project that will train all surveillance

officers in all the States (36 + FCT) and 774 LGAs of the country over the next one

and a half year, the NCDC organized a six days training of trainers in Abuja from 28th

January to 2nd February, 2019. This will orient the facilitators at the national level

with the vision, goals, objectives, methods and the structure of the training

programme.

We are working towards strengthening disease surveillance in Nigeria, and recognise

that a well-trained workforce is an essential building block for health security.

SUMMARY OF REPORTS

In the reporting week ending January 20, 2019: o There were 110 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 with the goal to eliminate polio in Nigeria.

o There were 29 suspected cases of cholera reported from three LGAs in two States (Bayelsa – 15, Edo – 9 & Kano – 9). There was one laboratory confirmed case and one death.

o There were 206 suspected cases of Lassa fever reported from 21 LGAs in ten

States (Adamawa – 2, Bauchi –10, Edo – 104, Ebonyi – 21, FCT – 2, Ondo – 44, Nasarawa – 1, Plateau – 15, Rivers - 1 & Taraba - 6). Seventy four were laboratory confirmed and 12 deaths were recorded.

o There were 22 suspected cases of Cerebrospinal Meningitis (CSM) reported

from 14 LGAs in five States (Cross River – 2, Katsina – 10, Kwara – 2, Taraba - 2 & Zamfara – 6). Of these, none was laboratory confirmed and no death was recorded.

Weekly Epidemiological Report

Issue: Volume 9 No. 3

1st February, 2019

o There were 503 suspected cases of measles reported from 32 States. None

was laboratory confirmed and two deaths were recorded. In the reporting week, all States sent in their reports except Benue State. Timeliness of reporting remains 91.0% in both the previous and current weeks (2 & 3) while completeness also remains 99.0% at the same period. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

REPORT ANALYSIS AND INTERPRETATION

1. AFP

1.1. As at January 20 2019, no new case of WPV was recorded

1.2. In the reporting week, 110 suspected cases of AFP were reported from 99 LGAs in 33 States

1.3. Between week 1 and 3 (2019), 253 suspected cases of AFP were reported from 191 LGAs in 36 state

2. CEREBROSPINAL MENINGITIS (CSM)

2.1 In the reporting week, 29 suspected Cerebrospinal Meningitis (CSM) cases with

three laboratory confirmed and one death (CFR, 3.45%) were reported from 20

LGAs in ten States(Borno – 3, FCT – 1, Gombe – 2, Jigawa – 4, Kano – 1, Katsina –

12, Plateau – 1, Sokoto – 2, Taraba - 2 & Zamfara – 1) compared with 72

suspected cases with 17 laboratory confirmed and three deaths (CFR, 4.2%)

reported across 31 LGAs (11 States) at the same period in 2018 (Figure 1)

2.2 Between weeks 1 and 3 (2019), 84 suspected meningitis cases with four

laboratory confirmed and five deaths (CFR, 5.95%) from 44 LGAs (14 States) were

reported compared with 256 suspected cases with 41 Laboratory confirmed and

19 deaths (CFR, 7.42%) from 75 LGAs in 19 states during the same period in 2018

2.3 Timeliness/completeness of CSM case-reporting from states to the national level

(2019 versus 2018): on average, 91.0% of the 26 endemic States sent CSM

reports in a timely manner while 99.1% were complete in week 1 - 3, 2019 as

against 93.7% timeliness and 100.0% completeness recorded within the same

period in 2018

2.4 The CSM National Emergency Operations Centre (EOC) is on alert mode and

meets weekly to review the situation

Weekly Epidemiological Report

Issue: Volume 9 No. 3

1st February, 2019

Figure 1: Map of Nigeria showing areas affected by CSM, week 1 - 3, 2018 & 2019

3. CHOLERA

3.1 20 suspected cases of cholera with one laboratory confirmed and one death

(CFR, 11.1%) were reported from three LGAs in three states ( Bayelsa – 15, Edo –

2 & Kano – 3) in week 3, 2019 compared with 25 suspected cases and two deaths

(CFR, 8.0%) reported from 10 LGAs in Kano State during the same period in 2018

(Figure 2).

3.2 Between weeks 1 and 3 (2019), 43 suspected cholera cases with one laboratory

confirmed and three deaths (CFR, 6.98%) from six LGAs (five States) were

reported compared with 228 suspected cases and 20 deaths (CFR, 8.77%) from

31 LGAs in eight States during the same period in 2018

3.3 NCDC has disseminated cholera alert mails and line list template to all states in preparedness for dry season transmission

3.4 The cholera National Emergency Operations Centre (EOC) is on watch mode and

the Technical Working Group meets weekly to review the situation

3.5 National Preparedness and Response to Acute Watery Diarrhoea/Cholera

Guidelines. Available from

Weekly Epidemiological Report

Issue: Volume 9 No. 3

1st February, 2019

http://ncdc.gov.ng/themes/common/docs/protocols/45_1507196550.pdf

Figure 2: Status of LGAs/States that reported Cholera cases in week 1 - 3, 2018 & 2019

4 LASSA FEVER

4.1 In the reporting Week 3 (14 – 20 January, 2019), seventy-six new confirmediI cases

were reported from Edo (31), Ondo (18), Bauchi (9), Ebonyi (2), Plateau (10),

Taraba (5) and Adamawa (1) States with twelve new deaths in Ondo (3), Edo (4),

Ebonyi (1), Plateau (2), Taraba (1) and Adamawa (1) States

4.2 From 1st - 20th January 2019, a total of 377 suspectedi cases have been reported.

Of these, 136 were confirmed positive and 240 negative (not a case)

4.3 Since the onset of the 2019 outbreak, there have been 31 deaths among

confirmed cases. Case Fatality Rate in confirmed cases is 22.8%

4.4 Nine states have recorded at least one confirmed case across 29 LGAs (Edo,

Ondo, Bauchi, Nasarawa, Ebonyi, Plateau, Taraba, FCT & Adamawa) and remain

active.iv

4.5 National rapid response team deployed to Edo, Ondo, Bauchi, Ebonyi and Plateau

States

Weekly Epidemiological Report

Issue: Volume 9 No. 3

1st February, 2019

4.6 Disseminated Lassa fever alert mails to all states in preparedness for high

transmission season

4.7 NCDC prepositioned PPEs, Ribavirin (injection and tablets), beds, tents, body-

bags, thermometers, hypochlorite hand sanitizers, IEC materials, guidelines and

SOPS distributed across 36 states, FCT and treatment centres

4.8 Lassa fever international Conference conducted on 16th to 17th January 2019

4.9 The Lassa fever national multi-partner, multi-agency Technical Working Group

(TWG) continues to coordinate response activities at all levels.

Figure 3: Distribution of confirmed Lassa fever cases in Nigeria as at 20th January, 2019

5 MEASLES

5.1 In the reporting week, 539 suspected cases of measles with four laboratory

confirmed and one death (CFR, 0.19%) were reported from 32 states compared

with 212 suspected cases reported from 33 states during the same period in

2018

5.2 Since the beginning of the year, 1227 suspected measles cases with four

laboratory confirmed and three deaths (CFR, 0.24%) were reported from 35

states and FCT compared with 360 suspected cases and one death (CFR, 0.28 %)

from 34 States and FCT, during the same period in 2018

Weekly Epidemiological Report

Issue: Volume 9 No. 3

1st February, 2019

5.3 National rapid response team to be deployed to support outbreak response in

Katsina State

5.4 Response measures include immunization for all vaccine-preventable diseases in

some selected/affected wards and LGAs during Supplementary Immunization

Activities (SIAs), as well as case management

Figure 5: Suspected Measles attack rate by States, week 1 - 3, 2019 as at 20th January, 2019

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6 Yellow fever

6.1 In the reporting week 2 (7th – 13th January, 2019), no new confirmed case at

WHO reference laboratory, Institute Pasteur Dakar (IP Dakar)

6.2 From the onset of this outbreak on September 12, 2017 to date, a total of 4,085

suspected yellow fever cases have been reported from 36 States & FCT. Of the

3,780 samples taken, 237 were presumptive positives in-country

6.3 A total of 95 cases have been confirmed by IP Dakar from 14 states

(Kwara, Kogi, Kano, Zamfara, Kebbi, Nasarawa, Niger, Katsina, Edo, Ekiti, Rivers,

Anambra, FCT, and Benue States)

6.4 Since the onset of the outbreak, 13 deaths among IP Dakar confirmed cases and

27 deaths among presumptive positive cases have been recorded. Case Fatality

Rate among IP Dakar confirmed cases and presumptive positives is 13.7% and

11. 4% respectively

Weekly Epidemiological Report

Issue: Volume 9 No. 3

1st February, 2019

6.5 Yellow fever reactive vaccination campaigns were conducted in the following

States: Edo (13 LGAs), Kebbi (7 LGAs), Niger (5 LGAs), Sokoto (1 LGA) & Katsina (1

LGA)

6.6 A multi-agency national Emergency Operations Centre is coordinating the

national response

6.7 Yellow fever vaccination campaigns have been successfully completed in 6

States (Nasarawa, Cross River, Akwa-Ibom, Kogi, Kwara & Zamfara) and 57

political wards in 25 LGAs in Borno State. Another campaign to commence in

Vandekeiya LGA in Benue State

6.8 The 2018 phase 2b November Preventive Mass Vaccination Campaign

(PMVC) was conducted (22nd November – 1st December, 2018) in Sokoto,

Kebbi, Niger, FCT, Plateau and some LGAs in Borno States. Target population

is 9 months to 44 years (85% of the total population)

Figure 6: Map of Nigeria showing States with suspected/presumptive/confirmed cases as at week 2, 2019 (as at 13th January, 2019)

7. Update on national Influenza sentinel surveillance, Nigeria week 1 – 52, 2018 & 1 – 4,

2019

7.1. From week 1- 52 2018, 403 suspected cases were reported, of which 363 were

Influenza like-illness (ILI), 40 were Severe Acute Respiratory Infection (SARI).

Weekly Epidemiological Report

Issue: Volume 9 No. 3

1st February, 2019

7.2. From week 1- 4 2019, a total of 25 samples were recruited and all were Influenza

like-illness (ILI). All samples were processed

7.2 A total of 403 samples were received and all samples were processed. Of the

processed samples, 363(90.1%) were ILI cases, 40 (9.9%) were Severe Acute

Respiratory Infection (SARI).

7.3 Of the 363 processed ILI samples, 40 (11.0%) were positive for Influenza A;

33(9.3%) were positive for Influenza B and 290 (79.7%) were negative.

7.4 Out of the processed 40 SARI samples, 7 (17.5%) were positive for Influenza A, 2

(5.0%) were positive for Influenza B, while the remaining 31 (77.5%) were

negative.

7.5 Of the 403 processed samples, 82 (20.3%) were positive for Influenza, with 47

(57.3%) of these positive for Influenza A and 35 (42.7%) positive for Influenza B.

7.6 The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for

8(17.4%), 28 (59.6%) and 11 (23.4%) of the total influenza A positive samples

respectively.

7.7 The subtypes B VICTORIA, B Not subtyped and B Yamagata account for 24(70.6%),

8(20.6%) and 3(8.8%) of the total influenza B positive samples respectively

7.8 The percentage of influenza positive was highest (100.0%) in week 43, 2018

7.9 In the reporting week 1- 52, five samples are being processed

Figure 7: Number of Influenza Positive Specimens and Percent Positive by Epidemiological Week (Week 1- 52, 2019)

Weekly Epidemiological Report

Issue: Volume 9 No. 3

1st February, 2019

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 Table 2: Status of Reporting by the State Epidemiologists, Nigeria, Weeks 1- 3, 2019, as at 20th January, 2019

Weekly Epidemiological Report

Issue: Volume 9 No. 2 24th January, 2019

Keys: <50% Poor 3 States

T= Arrived on Time 50-79% Good 3 States

L= Arrived late N Report not received 80-100% Excellent 31 States

N = No Report (Report not received)

1 Abia SEZ T T T 3 3 0 0 100% 100%2 Adamawa NEZ T T T 3 3 0 0 100% 100%3 Akwa Ibom SSZ T T T 3 3 0 0 100% 100%4 Anambra SEZ T T T 3 3 0 0 100% 100%5 Bauchi NEZ T T T 3 3 0 0 100% 100%6 Bayelsa SSZ T T T 3 3 0 0 100% 100%7 Benue NCZ L T N 3 1 1 1 33% 67%8 Borno NEZ T T T 3 3 0 0 100% 100%9 Cross River SSZ L L L 3 0 3 0 0% 100%

10 Delta SSZ T T T 3 3 0 0 100% 100%11 Ebonyi SEZ T T T 3 3 0 0 100% 100%12 Edo SSZ T T T 3 3 0 0 100% 100%13 Ekiti SWZ T T T 3 3 0 0 100% 100%14 Enugu SEZ T T T 3 3 0 0 100% 100%15 FCT NCZ T T T 3 3 0 0 100% 100%16 Gombe NEZ T T T 3 3 0 0 100% 100%17 Imo SEZ T T T 3 3 0 0 100% 100%18 Jigawa NWZ T L L 3 1 2 0 33% 100%19 Kaduna NWZ T L T 3 2 1 0 67% 100%20 Kano NWZ T T T 3 3 0 0 100% 100%21 Katsina NWZ T T T 3 3 0 0 100% 100%22 Kebbi NWZ T T T 3 3 0 0 100% 100%23 Kogi NCZ L T T 3 2 1 0 67% 100%24 Kwara NCZ T T T 3 3 0 0 100% 100%25 Lagos SWZ T T T 3 3 0 0 100% 100%26 Nasarawa NCZ T T T 3 3 0 0 100% 100%27 Niger NCZ L T T 3 2 1 0 67% 100%28 Ogun SWZ T T T 3 3 0 0 100% 100%29 Ondo SWZ T T T 3 3 0 0 100% 100%30 Osun SWZ T T T 3 3 0 0 100% 100%31 Oyo SWZ T T T 3 3 0 0 100% 100%32 Plateau NCZ T T T 3 3 0 0 100% 100%33 Rivers SSZ T T T 3 3 0 0 100% 100%34 Sokoto NWZ T T T 3 3 0 0 100% 100%35 Taraba NEZ T T T 3 3 0 0 100% 100%36 Yobe NEZ T T T 3 3 0 0 100% 100%37 Zamfara NWZ T T T 3 3 0 0 100% 100%

Total number of reports expected (E) 37 37 37 111

Total reports sent on time (T) 33 34 34 101

Total reports sent late (L) 4 3 2 9

Total number of reports not received (N) 0 0 1 1

Timeliness of reports =100*T/E 89.2 91.9 91.9 91%

Completeness of reporting=100*(E-N)/E 100.0 100.0 97.3 99%

Latest Week 3

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Complete

Last updated 22nd January, 2019

Expected (Es)Timely Rpts

(Ts)