REPUBLIC OF LIBERIA MINISTRY OF HEALTH & SOCIAL WELFARE RIVER GEE COUNTY HEALTH TEAM FISH TOWN CITY RIVER GEE COUNTY

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1 Date: 23 rd October 2015 REPUBLIC OF LIBERIA MINISTRY OF HEALTH & SOCIAL WELFARE RIVER GEE COUNTY HEALTH TEAM FISH TOWN CITY RIVER GEE COUNTY Report Number: Week Week ending: 18 th October, 2015 CSO: Benjamin Gbuah Summary River Gee County is located in the south eastern part of Liberia with six health districts and nineteen health facilities. There are ninety two general community health volunteers who are responsible to report all immediately reportable diseases and events within 24hours from the community level to the health facility. High priority is being attached to timeliness and completeness of reporting for all immediately reportable diseases and events. The trend of all priority disease is being monitored for public health action. For the period under review, epi-week 31-epi-week42 a total of 275 immediately reportable diseases were reported with 20 deaths. Case reported were; Suspected Ebola virus disease (225 cases and 19 death), acute watery diarrhea (42 cases no death), suspected measles (6 cases no death). Maternal Death (1 case) and suspected human rabies (1 case no death). During the period under review (epi-week31 epi-week42) there was no confirmed case of EVD. Four of the six health districts obtained 100 timeliness report; one had 91 timeliness and the other 83 timeliness reporting. All the six health districts reports were complete. Activities carried out during this period One suspected measles case was investigated and reported in Tienpo district. One suspected human rabies and one maternal death investigated and reported. IDSR roll out training conducted for health facilities staff. Two surveillance review meetings held with partners. Routine surveillance supervision was done in all nineteen health facilities. 1

2 Reporting Quality Timelines and completeness of report contribute significantly to disease surveillance. It helps decision makers to plan and respond timely to situation. Figure 1: Completeness and timeliness of reporting by districts, River Gee County, 2015 Districts Before FETP After FETP YTD Timeliness Completeness Timeliness Completeness YTD Timeliness YTD Completeness Chedep o Tienpo Gbeapo Potupo Sarbo Webbo Means Legend This Week T Late L No Report Received NR Cumulative >=80 >= <50 Disease Reports Figure 3: Summary of Key Notifiable Diseases reported, Bomi County,

3 Two hundred and five (225) suspected cases of Ebola virus disease (EVD) and nineteen (19) suspected EVD deaths swabs were laboratory confirmed negative and reclassified as non-cases. Five (5) of six suspected measles cases sent to lab were negative except for one result that is still pending. One human rabies case and maternal death was investigated and reported. Figure 4: Suspected Ebola Virus Disease cases and deaths in River Gee County, Week 31-42, 2015 Figure 5: Trend of suspected cases of Measles, River Gee County, week 31-42,

4 Public health action Conducted vaccination in cheboken community and other surrounding towns and villages where more than thirty five (35) children under five were vaccinated against measles and other vaccine preventable diseases. Made follow up visits on suspected measles case and contacts in cehboken town. Challenges The availability of motor cycle and vehicle for use by investigation team was a serious problem. Bad road condition was another challenge to the team. 4

5 Introduction Case Investigation Report Measles case investigation, Tienpo district, River Gee County, September, 2015 Measles is a vaccine preventable infectious disease that affects mostly children under five years of age and can causes blindness in severe cases. It is one of the immediately reportable priority diseases in Liberia and should be reported within 24 hours of detection. On September 16, 2015 a suspected case of measles of a 2 year old female was reported by a general community health volunteer (gchv) to the officer in charge (OIC) of cheboken clinic in Tienpo district. The OIC immediately reported the case to the district health officer (DHO) on September who also reported the case to the county surveillance officer on the same day. As county surveillance officer, I alerted my community health department director (CHDD), the county health officer (CHO) and reported the suspected measles case to Disease Prevention and control department (DPC) of Ministry of Health (MoH). A four man response team headed by the county surveillance officer (CSO) went to investigate the case on September 17, 2015 with the objectives of, confirming the infection, determining the source of the infection and to put in place control and preventive measure to avoid the spread of the disease. Methods To confirm the case, we reviewed the medical records of the patients including the child road to health medical record card, assessed if the patient meets the definition of a suspected measles case and collected blood specimen for laboratory confirmation. To determine the source of the infection, we interviewed the guardian of the patient and assessed the travel history of the patient. We conducted an active case search in the community to identify any additional cases. A case was defined as a resident of cheboken town with generalized rash and fever plus one of the following cough, coryza (running nose) or conjunctivitis (red eyes). Based on our findings, we implemented public health actions to avoid the possible spread of the disease. Results The patient s medical records showed that the two year old female had fever, skin rash and running nose for the past three days which meets the suspected case definition of measles. The medical record also shows that the child was not vaccinated against measles and yellow fever. Lab results for the suspected case is still pending. Information from the guardian of the child indicated that, she is a permanent resident of Monrovia but came to visit them on holidays. She arrived from Monrovia on the September and started showing symptoms on September 15, The guardian admitted that there were children presenting with similar condition in the community they came from in Monrovia. No additional cases were identified from the 5

6 active case search. The child was isolated and contacts were followed up for 12 days. Contacts did not show any sign of measles over the 12 days follow up. All contacts were vaccinated against measles. The suspected case was treated with vitamin-a, calamine lotion and tetracycline eye ointment. Discussion From the results we concluded that a suspected case of Measles was identified in cheboken town in River Gee County. The probable source of infection was Monrovia. Isolation of the case and vaccinated contacts contributed to the control of the spread of the infection. The case was followed through visits and showed a positive response to treatment. We recommended that, a measles vaccination outreach should be conducted in the communities and its surrounding towns. Following our recommendation, children under five in the community and its surrounding towns who have not yet been vaccinated were vaccinated against measles after parental consent has been given. 6