Liberia IDSR Epidemiology Bulletin

Transcription

1 Country Population: 4,373,279 l Volume 10, Issue 18 Apr. 30-May 6, 2018 Data Source: CSOs from 15 Counties and Lab Highlights Figure 1. Public Health Events Reported in Epi week 18 Keynotes and Events of Public Health Significance A total of 142 suspected cases of immediately reportable diseases and events including 19 deaths were reported Completeness and timeliness of health facility reports were 99% and 97% respectively One confirmed case of Lassa reported from Margibi County One confirmed case of Acute Bloody Diarrhea from Grand Bassa County Reporting Coverage Table 1. Weekly IDSR Reporting Coverage, Liberia, Epi week 18, 2018 County Number of Expected Report from Health Facility Number of Reports Received Number Received on Time Completeness (%) Timeliness (%) Bomi Bong Gbarpolu Grand Bassa Grand Cape Mount Grand Gedeh Grand Kru Lofa Margibi Maryland Montserrado Nimba Rivercess River Gee Sinoe Liberia Legend 80 <80 761(99%) Health facilities reported IDSR 90 (98%) Health districts reported IDSR 757(99%) Health facilities out of 761 reported timely Twelfth (80%) of the fifteen counties submitted weekly IDSR report on time, except Bong, Rivergee and Nimba counties The national target for weekly IDSR reporting is 80% IDSR Weekly Epidemiology and Surveillance Bulletin Page 1

2 Vaccine Preventable Diseases Measles Eighty-six suspected cases of measles were reported from the following counties; Montserrado (22), Maryland (17), Grand Bassa (8), River Gee (7), Margibi (6), Sinoe (6), Bong (4), Grand kru (4), Gparpolu (4), Nimba (4), Rivercess (3) and Grand Gedeh (1) Samples were collected for 21 of the suspected cases and sent to the National Reference Laboratory Fifty-six of the cases were Epi-Linked due to the ongoing outbreak of measles in five Counties; Maryland, Montserrado, Nimba, Margibi and Grand Bassa involving fourteen health districts Vaccination status among the suspected cases are as follow: vaccinated 14 (16%), Not vaccinated 6 (7%), and Unknown 66 (77%) Age distribution among suspected cases are as follow: <1-year-old: 6 (7%), 1 4 years: 21 (24%), 5 years: 59 (69%) Cumulatively, since Epi-week one, 2,650 suspected cases have been reported. Epi-classification among these cases are as follow: lab confirmed 177 (7%), Epi-linked: 1617 (61%), clinically compatible: 31 (1.3%), Discarded: 128 (5%) and pending: 405 (15.2%) Of the 128 samples tested negative for Measles, 113 have been tested for Rubella; positive 58 (51%), and negative 44 (39%) while 11 (10%) are pending testing Public Health Action Case management for all reported cases ongoing Active case search and community engagement are ongoing for all suspected cases IDSR Weekly Epidemiology and Surveillance Bulletin Page 2

3 Acute Flaccid Paralysis (Suspected Polio) Two cases of Acute Flaccid Paralysis were reported from Nimba (1) and Grand Kru (1) Counties with samples collected Cumulatively, since Epi week one, 15 cases have been reported and 13 tested negative while 2 pending Neonatal Tetanus Zero case of Neonatal tetanus was reported. Cumulatively, since Epi-week one, 4 clinically diagnosed cases have been reported Viral Hemorrhagic Diseases Ebola Virus Disease (EVD) Zero case of EVD alerts was reported Cumulatively, since Epi-week one, 22 EVD alerts have been reported and all tested negative by RT-PCR Lassa fever One case of suspected Lassa fever was reported from Margibi County Specimen was collected and tested positive for Lassa fever Cumulatively, since Epi week one, 78 suspected cases have been reported including 21 deaths A total of 72 suspected cases have been tested of which, 10 positive and 62 negative by RT-PCR. The CFR in confirmed cases is 90% IDSR Weekly Epidemiology and Surveillance Bulletin Page 3

4 Yellow fever One suspected case of Yellow fever was reported from Margibi County Specimen was collected and tested negative Cumulatively, since Epi-week one, 41 suspected cases have been reported and all tested negative Meningitis Two suspected cases of meningitis were reported from Nimba County Specimen was collected for one, sent to NRL for testing and pending laboratory confirmation Cumulatively, since Epi-week one, 32 suspected cases have been reported of which thirteen have been tested; two were positive by RT-PCR for Neisseria meningitides serotype w and eleven negative The two positive cases are part of an outbreak of meningococcal disease in Lofa County Events of Public Health Importance Maternal Mortality Eight maternal deaths were reported from the following Counties; Montserrado (3), Nimba (2), Bong (1) Grand Bassa (1), and Grand Gedeh (1), Reported causes of death were sepsis (3), cardiopulmonary arrest (1), postpartum hemorrhage (2), anaphylactic shock (1), and immunosuppression (1) All deaths were reported to have occurred in the health facility Cumulatively, since Epi-week one, 99 maternal deaths have been reported (see Table 3 for causes of death) IDSR Weekly Epidemiology and Surveillance Bulletin Page 4

5 Table 2. Cumulative Maternal Deaths Reported by Counties, Liberia, Epi-week 1-18, 2018 County Current week Cumulative % of Cumulative Maternal deaths Grand Bassa Maryland Bomi Grand Kru Sinoe River Gee Montserrado Bong Margibi Nimba Lofa Rivercess Gbarpolu Grand Cape Mount Grand Gedeh Liberia Table 3. Causes of reported maternal deaths, Liberia, Epi-week 1 18, 2018 Causes Number Percent (%) Congestive heart failure 3 3 Septicemia Raptured ectopic 2 2 Post-partum hemorrhage Renal failure 3 3 Anemia Obstructed labor 2 2 Septic abortion 2 2 Transfusion reaction 1 1 Retained placenta 3 3 Abrutio placenta 2 2 Epileptic 1 1 Eclampsia Induced Abortion 1 1 Pre Eclampsia 1 1 Malaria in pregnancy 1 1 Criminal Abortion 1 1 Hypertension 1 1 Cardio-pulmonary arrest 2 1 Pulmonary embolism 2 2 Anaphylactic shock 1 1 Immunosuppression 1 1 Total IDSR Weekly Epidemiology and Surveillance Bulletin Page 5

6 Neonatal Mortality Eleven neonatal deaths were reported from the following Counties; Montserrado (4), Bong (3), Nimba (2), Sinoe (1), and Maryland (1) Causes of deaths were sepsis (5), birth asphyxia (2), preterm (3) and aspiration pneumonia (1) All eleven of the deaths were reported to have occurred in the health facility Cumulatively, since Epi-week one, 251 neonatal deaths have been reported Table 4. Cumulative Neonatal Deaths Reported by Counties, Liberia, Epi-week 1-18, 2018 County Current Week Cumulative Neonatal deaths % of Cumulative Neonatal deaths River Gee Maryland Sinoe Grand Kru Montserrado Bong Rivercess Grand Gedeh Gbarpolu Grand Bassa Lofa Nimba Margibi Grand Cape Mount Bomi Total Human Exposure to Animal Bite (Suspected Human Rabies) Eighteen cases of animal bites were reported from the following Counties; Bomi (2), Nimba (2),Bong (2), Grand Bassa (2), River Gee (3), Rivercess (1), Grand Kru (1), Grand Gedeh (1), Montserrado (1), Grand Cape Mount (1), and Margibi (2) Cumulatively, since Epi-week one, 482 cases of animal bite have been reported of which zero cases were suspected for human rabies. Acute Bloody Diarrhea (Shigellosis) Ten suspected cases of acute bloody diarrhea were reported from the following Counties; Sinoe (7), Lofa (1), Montserrado (1), and Bassa (1) Six samples were collected for testing. One result tested positive, one negative while four are pending lab confirmation IDSR Weekly Epidemiology and Surveillance Bulletin Page 6

7 Cumulatively, since Epi-week one, 196 suspected cases of acute bloody diarrhea have been reported with stool samples collected from 152 suspected cases o Sixty-six cases were reported as part of an outbreak in Firestone District, Margibi County Of the 152 samples collected, 68 samples were tested of which 15 were tested positive for shigella dysenteriae and 49 negative. Severe Acute Watery Diarrhea (Cholera) Three suspected cases of cholera were reported from the following counties; Rivercess (2) and Grand Kru (1) No specimen was collected and sent for testing Cumulatively, since Epi-week one, 42 suspected cases of cholera have been reported of which 19 tested negative (no growth of vibro cholera isolated); samples were not collected for 15 while 4 were tested positive for shigellosis Confirmed Lassa fever Outbreak On 04 May 2018, Margibi County Health Team reported a confirmed case of Lassa fever to the national level (MoH/NPHIL). The first case for this cluster, a 56-years old male from Kakata District was admitted at CH Rennie Hospital on 03 May 2018 with symptoms of fever, decreased appetite, difficulty swallowing, diarrhea, and abdominal pain that started on 25 April He later developed respiratory distress, cough, and vomiting with blood. He died on 04 May 2018 in the isolation unit. Prior to his admission at the hospital, he sought care at a clinic in Kakata and was treated with antibiotics, quinine protocol and oral antimalarial with no improvement on 03 May A blood specimen collected tested positive for Lassa virus infection by RT-PCR at the NPHRL the same day. His body was kept in the morgue for two days before safe burial was conducted on 6 May Prior to his symptom onset, he travelled to one of the Lassa fever endemic counties for burial on 18 April A total of 84 contacts including 34 healthcare workers have been listed and follow up. The second case-patient, a 35-years old gravida 2 para 1 at 22 weeks of gestation from Kakata District was seen at CH Rennie Hospital on 07 May 2018 with symptoms of lower abdominal pain, headache, poor appetite, weakness, and difficulty in swallowing and breathing that started on 4 May She died shortly after admission to the isolation unit before Ribavirin could be administered. A blood specimen was collected and tested positive for Lassa fever infection on 7 May 2018, and a safe burial was conducted 9 May Since 04 May 2018, Margibi County has recorded a total of seven suspected cases including two deaths (2 confirmed and 5 not a case). The case fatality rate in confirmed cases is 100%. IDSR Weekly Epidemiology and Surveillance Bulletin Page 7

8 No new suspected case reported as of May 9, The suspected case -patient in isolation is planned to be transferred to the medical ward after receiving his second Lassa fever negative result from the National Public Health Reference Laboratory (NPHRL). Twenty-nine (29) new contacts were identified and listed. A total of 84 contacts including 34 health workers has been listed and are being followed-up. 55 (65%) contacts were monitored with none symptomatic. Figure 2: Geographical distribution of confirmed cases of Lassa fever, Margibi May 4 9, 2018 Public Health Measures National level: Lassa fever case management training for surveillance officers and clinicians conducted IDSR supervision in Montserrado County was completed by DIDE staff and interns County level: Case management and community engagement for all suspected cases ongoing IDSR Weekly Epidemiology and Surveillance Bulletin Page 8

9 Points of Entry-updates IDSR Weekly Epidemiology and Surveillance Bulletin Page 9

10 AFRO Public Health Events The National Public Health Institute of Liberia continues to monitor acute public health emergencies and outbreaks occurring in the African Region in order ensure to preparedness and preventive measures are implemented. During this week, 58 ongoing events are being monitored through WHO Health Emergencies Program in the African Region. Key events highlighted during the week include the following: Cholera in Congo Cholera in Zimbawe Lassa fever in Nigeria Humanitarian crisis in South Sudan Humanitarian crisis in Democratic Republic of Congo Source: WHO Notes Completeness refers to the proportion of expected weekly IDSR reports received (target: 80%) Timeliness refers to the proportion of expected weekly IDSR reports received by the next level on time (target: 80%). Time requirement for weekly IDSR reports: o o o Health facility - required on or before 5:00pm every Saturday to the district level Health district - required on or before 5:00pm every Sunday to the county level County - required on or before 5:00pm every Monday to the national level Non-polio AFP rate is the proportion of non-polio AFP cases per 100,000 among the estimated population under 15 years of age in 2017 (annual target: 2/100,000) IDSR Weekly Epidemiology and Surveillance Bulletin 10 Page

11 Non-measles febrile rash illness rate refers to the proportion of discarded measles cases per 100,000 population Annualized maternal mortality rate refers to the maternal mortality rate of a given period less than one year and it is the number of maternal deaths per 100,000 live births Annualized neonatal mortality rate refers to the neonatal mortality ratio of a given period less than one year and it is the number of maternal deaths per 1,000 live births Epi-linked refers to any suspected case that has not had a specimen taken for serologic confirmation but is linked to a laboratory confirmed case Confirmed case refers to a case whose specimen has tested positive or reactive upon laboratory testing, or has been classified as confirmed by either epidemiologic linkage with a confirmed case, or clinical compatibility with the disease or condition Case Fatality Rate (CFR) is the proportion of deaths among confirmed cases IDSR Weekly Epidemiology and Surveillance Bulletin 11 Page

12 Immediately reportable diseases, conditions, and events by County during Epi week 18 and cumulative reports, Liberia, 2018 No. of Health Districts No. of Health District reported Acute Flaccid Paralysis (Polio) Diarrhoea (Shigellosis) Severe Acute Watery Diarrhoea (Cholera) Human Exposure to Animal bites (Suspected Rabies) Lassa Fever Counties A D A D A D A D A D A D A D D D A D A D A D A D Bomi Bong Gbarpolu Grand Bassa Grand Cape Mount Grand Gedeh Grand Kru Lofa Margibi Maryland Montserrado Nimba Rivercess River Gee Sinoe Total Weekly Measles Meningitis Maternal Mortality Neonatal Mortality Neonatal Tetanus VHF (including EVD) Yellow Fever Other Diseases/Events Cumulative Reported Cumulative Laboratory Confirmed D = Dead Note: A = Alive Editorial Team - NPHIL: Roseline N. George ; Advertus N. Mianah Surveillance Coordinator/DIDE; Himiede W. Wilson & Irene Pewu Epidemiologist/DIDE; Sumo Nuwolo, Godwina B. Williams, Musand Kromah, Lasee W. Colee, T. Lafayette Hall, Alberta B. Corvah, Sumor Lomax Flomo & Samuel Zayzay Disease Investigators/DIDE; Trokon O. Yeabah Data Manager/DIDE; Partners: CDC & WHO Kwuakuan D.M. Yealue, Jeremy Sesay Page IDSR Weekly Epidemiology and Surveillance Bulletin 12

13 National Public Health Institute of Liberia (NPHIL) PURPOSE In collaboration with the Ministry of Health, NPHIL strengthens existing infection prevention and control efforts, laboratories, surveillance, infectious disease control, public health capacity building, response to outbreaks, and monitoring of diseases with epidemic potential. OUR MISSION To prevent and control public health threats by promoting healthy outcomes and serving as a source of knowledge and expertise. GOALS Contribute to the development and sustainability of the public health workforce Develop, enhance, and expand the surveillance and response platform Develop and strengthen the laboratory system and public health diagnostics Develop, enhance, and expand process and structures to protect environmental and occupation health Expand, conduct, and coordinate public health and medical research to inform Liberian public health policies Ensure sustainable financing and operations of the NPHIL Epidemiological bulletin published with support of WHO and CDC For comments or questions, please contact Thomas K. Nagbe, PA Dip., BSc, MPH Director, Infectious Disease and Epidemiology Division National IHR Focal Person National Public Health Institute of Liberia Republic of Liberia tnknue31112@gmail.com Phone: / Website: Ralph W. Jetoh, MD Deputy director Infectious Disease and Epidemiology Division National Public Health Insttute of Liberia Republic of Liberia ralphica2000@gmail.com Phone: / Website: IDSR Weekly Epidemiology and Surveillance Bulletin Page 13