NCDC ACTIVATES AN EMERGENCY OPERATIONS CENTRE FOR COORDINATION OF LASSA FEVER OUTBREAK ACTIVITIES

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Magdalen Greer
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Epi-week 3 2019, Nigeria had recorded a total of 136 confirmed cases of Lassa fever and 31 deaths, with a case fatality rate (CFR) of 22.8%.

1 Issue: Volume 9 No th January 2019 NIGERIA CENTRE FOR DISEASE CONTROL Main Highlight of the week NCDC ACTIVATES AN EMERGENCY OPERATIONS CENTRE FOR COORDINATION OF LASSA FEVER OUTBREAK ACTIVITIES At the end of Epi-week , Nigeria had recorded a total of 136 confirmed cases of Lassa fever and 31 deaths, with a case fatality rate (CFR) of 22.8%. With this, the country has exceeded the emergency threshold for Lassa fever. Consequently, the Nigeria Centre for Disease Control (NCDC) activated the Lassa fever Emergency Operations Centre (LF-EOC) as part of its operational National incident management system for outbreak response and coordination. The LF-EOC is a multi-agency, multi-partner structure with the sole mandate of coordination of the Lassa fever outbreak activities across the country. This will be carried out through collaborative efforts of its seven pillars: Surveillance/Epidemiology, Data Management, Case Management, Infection Prevention and Control (IPC)/Safe Burial, Laboratory, Logistics and Risk Communications. To achieve a One-Health approach to outbreak management, the LF-EOC will be supported by the Federal Ministries of Agriculture/Rural development and Environment. One of the immediate steps of the newly activated LF-EOC was the deployment of Rapid Response Teams (RRTs) to five states (Edo, Ondo, Ebonyi, Plateau and Bauchi) that have consistently reported confirmed cases since the

2 beginning of the year. The teams deployed will be engaging and supporting the affected states in outbreak control as well as bridge gaps in identified pillar activities. Following the Post 2018 outbreak season, the NCDC started work on a 5-year Lassa fever control strategy ( ) with core activities spread across the seven pillars. The overall goal of this strategy is to reduce CFR of Lassa fever reduced to Less than 10%. During this outbreak, the implementation of the control strategy will commence and all stakeholders will be engaged to support actual realization of the goal of the control strategy. At the beginning of the year, the NCDC sent out public health advisories to states informing them of the impending Lassa fever outbreak and urging them to commence preparedness activities. Non-affected States are encouraged to increase the scope of their preparedness activities and report cases to the NCDC promptly through approved channels. The NCDC will continue to disseminate information on the outbreak and response activities through electronic means, print and social media platforms. The weekly situational reports (SitReps) can be accessed on the NCDC website: SUMMARY OF REPORTS In the reporting week ending January 13, 2019: o There were 85 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as polio. The last reported case of polio in Nigeria was in August Active case search for AFP is being intensified with the goal to eliminate polio in Nigeria. o There were 18 suspected cases of cholera reported from three LGAs in two States (Ebonyi 9 & Kano 9). There was no laboratory confirmed case and no death. o There were 116 suspected cases of Lassa fever reported from 16 LGAs in eight States (Bauchi 12, Edo 58, Ebonyi 11, FCT 2, Ondo 27, Nasarawa 1, Plateau 3 & Taraba - 2). 35 were laboratory confirmed and eight 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.

3 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 Jigawa State. Timeliness of reporting increased from 89.0% in the previous week to 91.0% in the current week (02) while completeness increased from 97.0% to 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 , no new case of WPV was recorded 1.2. In the reporting week, 85 suspected cases of AFP were reported from 80 LGAs in 27 States 1.3. Between week 1 and 2 (2019), 137 suspected cases of AFP were reported from 112 LGAs in 35 state 2. CEREBROSPINAL MENINGITIS (CSM) 2.1 In the reporting week, 22 suspected Cerebrospinal Meningitis (CSM) cases were reported from 14 LGAs in five states(cross River 2, Katsina 10, Kwara 2, Taraba - 2 & Zamfara 6) compared with 33 suspected cases with 7 laboratory confirmed and two deaths (CFR, 6.1%) reported across 22 LGAs (nine states) at the same period in 2018 (Figure 1) 2.2 Between weeks 1 and 2 (2019), 39 suspected meningitis cases with one laboratory confirmed and three deaths (CFR, 7.69%) from 20 LGAs (ten States) were reported compared with 166 suspected cases with 28 Laboratory confirmed and 15 deaths (CFR, 9.0%) from 55 LGAs in 16 states during the same period in Timeliness/completeness of CSM case-reporting from states to the national level (2019 versus 2018): on average, 90.5% of the 26 endemic States sent CSM reports in a timely manner while 98.6% were complete in week 1-2, 2019 as against 88.5% timeliness and 88.5% completeness recorded within the same period in The CSM National Emergency Operations Centre (EOC) is on alert mode and meets weekly to review the situation

Figure 1: Map of Nigeria showing areas affected by CSM, week 1-2, 2018 & 2019 3. CHOLERA 3.1 18 suspected case of cholera and two deaths (CFR, 11.

4 Figure 1: Map of Nigeria showing areas affected by CSM, week 1-2, 2018 & CHOLERA suspected case of cholera and two deaths (CFR, 11.1%) were reported from three LGAs in two states ( Ebonyi 9 & Kano 9) in week 2, 2019 compared with 40 suspected cases and four deaths (CFR, 10.0%) reported from 11 LGAs (three states) during the same period in 2018 (Figure 2). 3.2 Between weeks 1 and 2 (2019), 19 suspected cholera cases and two deaths (CFR, 10.5%) from four LGAs in three States were reported compared with 190 suspected cases and 16 deaths (CFR, 8.42%) from 29 LGAs in eight States during the same period in 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

Figure 2: Status of LGAs/States that reported Cholera cases in week 1-2, 2018 & 2019 4 LASSA FEVER 4.

5 Figure 2: Status of LGAs/States that reported Cholera cases in week 1-2, 2018 & LASSA FEVER 4.1 In the reporting Week 2 (7 13 January, 2019), thirty-five new confirmed ii cases were reported from Edo (12), Ondo (12), Bauchi (3), FCT (1), Ebonyi (5), Plateau (1) and Taraba (1) States with eight new deaths in Ondo (3), Edo (1), Ebonyi (1), FCT (1), Plateau (1) and Taraba (1) States 4.2 From 1 st - 13 th January 2019, a total of 172 suspected i cases have been reported. Of these, 60 were confirmed positive and 112 negative (not a case) 4.3 Since the onset of the 2019 outbreak, there have been 16 deaths among confirmed cases. Case Fatality Rate in confirmed cases is 26.7% 4.4 Eight states have recorded at least one confirmed case across 17 LGAs (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Plateau, Taraba & FCT) and remain active. iv 4.5 National rapid response team deployed to Edo, Ondo, Bauchi, Ebonyi and Plateau States 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, bodybags, thermometers, hypochlorite hand sanitizers, IEC materials, guidelines and SOPS distributed across 36 states, FCT

6 4.7 NCDC prepositioned PPEs, Ribavirin (injection and tablets), beds, Tents, bodybags, 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 16 th to 17 th January 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 13 th January, MEASLES 5.1 In the reporting week, 503 suspected cases of measles and two deaths (CFR, 0.4%) were reported from 32 states compared with 212 suspected cases reported from 33 states during the same period in Since the beginning of the year, 687 suspected measles cases with 1345 laboratory confirmed and two deaths (CFR, 0.29%) 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 National rapid response team to be deploy to support outbreak response in Katsina State

7 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 1-2, 2019 as at 13 th January, 2019 Attack rate per 100,000 population Borno Katsina Bauchi Ekiti Yobe Osun Adamawa Kano Sokoto Oyo Abia Anambra Bayelsa Kaduna Kogi FCT Kebbi Imo Gombe Ogun Edo Ebonyi Ondo Nasarawa Benue Lagos Niger Kwara Delta Jigawa Rivers Taraba Plateau Enugu Zamfara Akwa Ibom States 6 Yellow fever 6.1 In the reporting week 2 (7 th 13 th 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 positive 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 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.

8 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 (22 nd November 1 st 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 13 th January, 2019) 7. Update on national Influenza sentinel surveillance, Nigeria week 1 52, 2018 & 1 3, From week , 403 suspected cases were reported, of which 363 were Influenza like-illness (ILI), 40 were Severe Acute Respiratory Infection (SARI) From week , a total of ten samples were recruited and all were Influenza like-illness (ILI). These samples are currently undergoing Laboratory testing process

7.2 A total of 403 samples were received and 396 samples were processed. Of the processed samples, 356(89.8%) were ILI cases, 40 (10.1%) were Severe Acute Respiratory Infection (SARI). 7.

9 7.2 A total of 403 samples were received and 396 samples were processed. Of the processed samples, 356(89.8%) were ILI cases, 40 (10.1%) were Severe Acute Respiratory Infection (SARI). 7.3 Of the 356 processed ILI samples, 39 (11.0%) were positive for Influenza A; 33(9.3%) were positive for Influenza B and 284 (79.9%) 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 396 processed samples, 81 (21.8%) were positive for Influenza, with 46 (56.8%) of these positive for Influenza A and 35 (43.2%) positive for Influenza B. 7.6 The subtypes A seasonal H3, 2009A/H1N1 and A/not subtyped account for 8(17.4%), 28 (60.9%) and 10 (21.7%) 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, In the reporting week 1-52, five samples are undergoing Laboratory process Figure 7: Number of Influenza Positive Specimens and Percent Positive by Week (Week 1-52, 2019) FOR MORE INFORMATION CONTACT Surveillance Unit: Nigeria Centre for Disease Control, 801 Ebitu Ukiwe Street, Jabi, Abuja, Nigeria.

10 Table 2: Status of ing by the State Epidemiologists, Nigeria, Weeks 1-2, 2019, as at 13 th January, 2019

11 Keys: <50% Poor 1 States Timely T= Arrived on Time s 50-79% Good 5 States L= Arrived late N not received % Excellent 31 States N = No ( not received) State GeoZones W01 W02 Expected (Es) Timely Rpts Late Rpts Rpts Not Recvd % % (Ts) (Ls) (Ns) Timely Complete 1 Abia SEZ T T % 100% 2 Adamawa NEZ T T % 100% 3 Akwa Ibom SSZ T T % 100% 4 Anambra SEZ T T % 100% 5 Bauchi NEZ T T % 100% 6 Bayelsa SSZ T T % 100% 7 Benue NCZ L T % 100% 8 Borno NEZ T T % 100% 9 Cross River SSZ L L % 100% 10 Delta SSZ T T % 100% 11 Ebonyi SEZ T T % 100% 12 Edo SSZ T T % 100% 13 Ekiti SWZ T T % 100% 14 Enugu SEZ T T % 100% 15 FCT NCZ T T % 100% 16 Gombe NEZ T T % 100% 17 Imo SEZ T T % 100% 18 Jigawa NWZ T N % 50% 19 Kaduna NWZ T L % 100% 20 Kano NWZ T T % 100% 21 Katsina NWZ T T % 100% 22 Kebbi NWZ T T % 100% 23 Kogi NCZ L T % 100% 24 Kwara NCZ T T % 100% 25 Lagos SWZ T T % 100% 26 Nasarawa NCZ T T % 100% 27 Niger NCZ L T % 100% 28 Ogun SWZ T T % 100% 29 Ondo SWZ T T % 100% 30 Osun SWZ T T % 100% 31 Oyo SWZ T T % 100% 32 Plateau NCZ T T % 100% 33 Rivers SSZ T T % 100% 34 Sokoto NWZ T T % 100% 35 Taraba NEZ T T % 100% 36 Yobe NEZ T T % 100% 37 Zamfara NWZ T T % 100% Total number of reports expected (E) Total reports sent on time (T) Total reports sent late (L) Total number of reports not received (N) Timeliness of reports =100*T/E % Completeness of reporting=100*(e-n)/e % Latest Week 2 Last updated 18th January, 2019

Main Highlight for the Week STOPPING SPREAD OF LASSA FEVER: INSTITUTING INFECTION PREVENTION CONTROL MEASURES IN HEALTH FACILITIES

Weekly Issue: Volume 8 No. 3 Issue: Volume 8 No. 3 2nd February, 2018 2nd February, 2018 NIGERIA CENTRE FOR DISEASE CONTROL Weekly Main Highlight for the Week STOPPING SPREAD OF LASSA FEVER: INSTITUTING