Liberia IDSR Epidemiology Bulletin

Transcription

1 Country Population: 4,373,279 l Volume 10, Issue 9 Feb. 26- Mar. 4, 2018 Data Source: CSOs from 15 Counties and Lab Highlights Figure1. Public Health Events Reported in Epi-week 9 Keynotes and Events of Public Health Significance A total of 192 suspected cases of immediately reportable diseases and events including 11 deaths was reported Completeness and timeliness of health facility reports were both 99% respectively 3 confirmed cases of Lassa fever reported from three (3) Counties Reporting Coverage Table 1. Weekly IDSR Reporting Coverage, Liberia, Epi week 9, 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 (99%) Health facilities reported IDSR data 92 (100%) Health districts reported IDSR data 754(99%) Health facilities out of 764 reported timely IDSR data Legend 80 <80 All fifteen counties submitted weekly IDSR report on time The national target for weekly IDSR reporting is 80% IDSR Weekly Epidemiology and Surveillance Bulletin Page 1

2 Vaccine Preventable Diseases Measles One hundred and forty-two suspected cases of measles were reported from the following Counties; Montserrado (43), Nimba (35), Grand Bassa (16), Margibi (14), Maryland(11), Bong (11), Bomi (3), Rivercess (2), Lofa (2), Grand Kru (1), Grand Cape Mount (1), Grand Gedeh (1), River Gee (1) and Sinoe (1) Samples were collected for 51 of the suspected cases of which 26 were tested. o positive (15), equivocal (1), negative(10),epi-linked (74), and clinically compatible (42) o Confirmed cases were reported from five counties: Margibi (8),Grand Bassa (4), Grand Cape Mount (1), Rivercess (1) and Nimba (1) Vaccination status among the suspected cases are as follow: vaccinated 24 (16%), Not vaccinated 27 (19%), and Unknown 97 (64.7%) Age distribution among suspected cases are as follow: <1 year old: 29 (20.4%), 1 4years: 81 (57%), 5 years: 32 (22.5%) Cumulatively, since Epi-week one, 1,512 suspected cases have been reported. Epi-classification among these cases are as follow: lab confirmed 84 (6%), Epi-linked: 1022 (75.5%), clinically compatible: 66 (4.8%), Equivocal 7 (0.5%), Discarded: 74 (5.4%), and pending: 259 (20.1%) Of the 74 samples tested negative for Measles, 66 have been tested for Rubella; positive 29 (44%),and negative 37 (56%) while 8 (12%) are pending testing Public Health Actions Case management initiated for all the suspected cases and community engagement ongoing Active case search is ongoing Phase two of national mass immunization campaign has commenced in five Counties Targeted age group for the campaign is 6-59 months/under five Acute Flaccid Paralysis (Suspected Polio) Zero cases of Acute Flaccid Paralysis were reported Cumulatively, since Epi week one, 1 case has been reported and is pending laboratory confirmation. Neonatal Tetanus Zero cases of Neonatal tetanus were reported Cumulatively, since Epi-week one, 4 clinically diagnosed cases has been reported Viral Hemorrhagic Diseases Ebola Virus Disease (EVD) Zero cases of EVD alerts were reported Cumulatively, since Epi-week one, 20 EVD alerts have been reported and all tested negative by RT-PCR IDSR Weekly Epidemiology and Surveillance Bulletin Page 2

3 Lassa fever Six suspected cases including three deaths were reported from the following counties; Montserrado (2), Nimba (2), Grand Bassa (1) and Bong (1) Samples were collected from all suspected cases of which (3) tested positive and (3) negative by RT- PCR Seven samples have been confirmed of Lassa fever by RT-PCR, Counties include; o Nimba (4), Montserrado (2) and Bong (1) Cumulatively, since Epi week one, 25 suspected cases including thirteen deaths have been reported Samples were collected from a total of twenty-three suspected cases out of which, 7 tested positive and 16 negative by RT-PCR. For more details see below outbreak section Yellow fever Four suspected cases of Yellow fever were reported from the following Counties; Grand Kru (2) and River Gee (2) Samples were collected for all cases, pending laboratory confirmation Cumulatively, since Epi-week one, 22 suspected cases have been reported Meningitis Five suspected cases of meningitis were reported from the following counties; Maryland (2), Nimba (2) and Grand Bassa (1) Samples were collected from all of the cases in this reporting week Cumulatively, since Epi-week one, 22 suspected cases have been reported. Eight have been tested of which two were positive by RT-PCR for Neisseria meningitides serotype w and six negatives The two positive cases are part of an outbreak of meningococcal disease in Lofa County Events of Public Health Importance Maternal Mortality Three maternal deaths were reported from two counties; Nimba (2) and Bong (1) Reported causes of death were anemia, congested heart failure and postpartum hemorrhage All deaths were reported to have occurred in the health facility Cumulatively, since Epi-week one, 55 maternal deaths have been reported (see Table 3 for causes of death) IDSR Weekly Epidemiology and Surveillance Bulletin Page 3

4 Table 2. Cumulative Maternal Deaths Reported by Counties, Liberia, Epi-week 1-9, 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 9, 2018 Causes Number Percent (%) Congestive heart failure Septicemia Raptured ectopic Post-partum hemorrhage Renal failure Anemia Obstructed labor Septic abortion Transfusion reaction Retained placenta Abrutio placenta Epileptic Eclampsia Induced Abortion Pre Eclampsia Cardio-pulmonary arrest Pulmonary embolism Total IDSR Weekly Epidemiology and Surveillance Bulletin Page 4

5 Neonatal Mortality Seven neonatal deaths were reported from six counties; Montserrado (2), Lofa (1), Maryland (1), River Gee (1), Grand Bassa (1), and Bong (1) Causes of deaths were sepsis (4), birth asphyxia (2) and malaria (1) Six of the deaths were reported to have occurred at health facility and one in the community Cumulatively, since Epi-week one, 103 neonatal deaths have been reported Table 4. Cumulative Neonatal Deaths Reported by Counties, Liberia, Epi-week 1-9, 2018 Cumulative Neonatal deaths Current County Week River Gee Maryland Sinoe Grand Kru Montserrado Bong Rivercess Grand Gedeh Gbarpolu Grand Bassa Lofa Nimba Margibi Grand Cape Mount Bomi Total % of Cumulative Neonatal deaths Human Exposure to Animal Bites (Suspected Human Rabies) Twenty cases of animal bites were reported from the following Counties; Bong (7), Nimba (3), Montserrado (2), Margibi (2), Lofa (2), Grand Bassa (2), Rivercess (1) and Gbarpolu (1) Cumulatively, since Epi-week one, 170 cases of animal bites have been reported of which zero cases were suspected for human rabies. Acute Bloody Diarrhea (Shigellosis) Five suspected cases of acute bloody diarrhea were reported from the following Counties; Margibi (2), Grand Kru (1) and Lofa (1),Montserrado (1) Samples were collected from four of the five cases of which one tested positive and three negative Cumulatively, since Epi-week one, 111 suspected cases of acute bloody diarrhea have been reported with stool samples collected from 46 suspected cases Samples from 40 suspected cases have been tested of which ten cases were positive (shigella dysenteriae isolated) and 30 negative (no growth of shigella dysenteriae) Sixty-six cases were reported as part of an outbreak in Firestone District, Margibi County IDSR Weekly Epidemiology and Surveillance Bulletin Page 5

6 Severe Acute Watery Diarrhea (Cholera) One suspected case of cholera was reported from Gbarpolu County Cumulatively, since Epi-week one, 29 suspected cases of cholera have been reported of which seventeen tested negative (no growth of vibrio cholera) and two are pending testing. Monkey Pox One suspected case of monkey pox was reported from Maryland County Cumulatively, since Epi week one, 1suspected case has been reported. Outbreak-Lassa Fever The National level was notified on 2nd and 3rd of March 2018 of three new confirmed cases of Lassa fever by the National Public Health Reference Laboratory (NPHRL). No epidemiological linked has been established among the three new confirmed cases. The first confirmed case is a 57 years old female from Ballah community, Commonwealth district, Montserrado County with symptom onset on 20 February The patient was admitted at a hospital in Monrovia March 1 st, 2018 having presented with fever, fatigue, loss of appetite, chest pain, bleeding from injection site. She died on March 3 rd, Whole blood tested positive for Lassa virus on the same day (March 3 rd, 2018). The second case is a 44 years old male from Gio Quarter community, Kakata City, Margibi County with onset of symptoms on 18 February 2018.The case-patient was admitted at a hospital in Monrovia on March 1 st, 2018 having presented with hiccup, fever, abdominal pain, bloody stool, loss of appetite, vomiting and later bleeding from injections sites. He also died on March 3 rd, Post-mortem cardiac blood tested positive for Lassa virus on the same day (March 3 rd, 2018). The third case is a 30 years old female, from Gladay community, Sanniquelle Mah district, Nimba County with symptoms onset on 23 February The case-patient sought care at a health care facility in Ganta City on 1 March 2018 and was admitted having presented with persistent fever, cough, sore throat, rashes, abdominal pain, diarrhea and poor urine output and died the same day (March 1 st, 2018). A total of 152 contacts have been identified 106 in Montserrado County, 25 in Margibi County and 21 in Nimba county. Sixty-five (65) of the contacts are health care workers. IDSR Weekly Epidemiology and Surveillance Bulletin Page 6

7 Distribution of Confirmed Lassa Fever cases reported in Liberia Epi week 1-8, 2018 Public Health Measures National level: Implementation of phase two measles campaign in five Counties (Grand Bassa, Bong, Nimba, Lofa and Grand Gedeh) is ongoing Provision of technical and operational support to counties to support response activities County level: Case management initiated for all suspected cases and community engagement ongoing on Active case search and contact tracing have been initiated in affected Counties for Lassa fever and measles IDSR Weekly Epidemiology and Surveillance Bulletin Page 7

8 Cross Border Surveillance-updates Type of ports Point of Entries Cumulative Arrival Departure Airport Sea port Ground crossing Nationality Received Vaccine against Yellow Fever An alert of neonatal death was reported from James Springgs Field Airport in Montserrado County and one from the Bo waterside ground crossing in Grand Cape Mount County Liberian Alien IDSR Alerts Arrival Departure Arrival Departure Liberian Alien Roberts International Airport James Spriggs Paynes Freeport of Monrovia Bo Water Side Buchanan Port Ganta N/A N/A N/A N/A N/A N/A N/A N/A Yekepa N/A N/A N/A N/A N/A N/A N/A N/A Loguatuo N/A N/A N/A N/A N/A N/A N/A N/A Total Traveller for the Week Alerts Verified IDSR Weekly Epidemiology and Surveillance Bulletin Page 8

9 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 preparedness and preventive measures are implemented. During this week, 48 events are being monitored through WHO Health Emergencies Program in the African Region. Key events highlighted during the week include the following: Cholera in Tanzania Lassa fever in Nigeria Cholera in Uganda Rift Valley fever in South Sudan Cholera in Malawi Source: WHO Afro week 8 outbreak bulletin 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) 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 Page 9

10 IDSR Weekly Epidemiology and Surveillance Bulletin 10 Page

11 Appendix 1: Summary of immediately reportable diseases, conditions, and events by County during Epi week 9 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, 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 IDSR Weekly Epidemiology and Surveillance Bulletin Page 11

12 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 12