Integrated Disease Surveillance and Response Bulletin INTEGRATED DISEASE SURVEILLANCE AND RESPONSE BULLETIN

Transcription

1 Republic of Liberia INTEGRATED DISEASE SURVEILLANCE AND RESPONSE BULLETIN Week-23 June Data Source: CSOs from 15 Counties Highlights during the reporting week Six maternal deaths reported from three counties Two neonatal deaths reported from two counties EVD outbreak declared over after 42 days of heightened surveillance and sixty nine (69) days without a new confirmed case Outbreak of Measles reported in Camp Wood District, Grand Bassa County Reporting Coverage 97% (719/740) of expected health facilities reported from 92 health districts across 15 counties. Rivercess County sent late report. 1

2 Vaccine Preventable Diseases Measles Fifty six (56) suspected cases of measles were reported. Grand Bassa (49), Lofa (2), Margibi, Bong, Grand Gedeh, Maryland, and Montserrado (1) each. 10 samples have been collected and sent to the lab for testing. Cumulatively, 596 measles cases have been reported. 204 specimens have been submitted for testing out of which 93 (45.6%) tested positive, 95 (46.6%) tested negative, 6 (2.9%) equivocal and 10 (4.9%) pending. Poliomyelitis One (1) case of acute flaccid paralysis (AFP) was reported from Montserrado County. Specimens have been collected and sent pending laboratory confirmation. Since the start of 2016, 29 AFP cases have been reported and investigated out of which specimens were collected from 25 cases. 68% (17/25) tested negative and 32% (8/25) are pending laboratory confirmation. 2

3 Non-polio AFP rate/100,000 <15yrs in 2016 as of Week 23 County < 15 years pop Non- Polio AFP Rate % of stool <14days % of NPENT Expected Reported Bomi Bong Gbarpolu Grand Bassa Grand Cape Mount Grand Gedeh Grand Kru Lofa Margibi Maryland Montserrado Nimba Rivercess River-Gee Sinoe Liberia Non-Polio AFP Rate Stool adequacy Non-Polio Enterovirus <2 = 2 = <80% = 80% = <10% = 10% = 3

4 Neonatal tetanus No case of neonatal tetanus was reported. Since the start of 2016, eight (8) cases of clinically confirmed neonatal tetanus have been reported. Meningitis No case of meningitis was reported. Since the start of 2016, twelve (12) cases of suspected meningitis have been reported. Viral hemorrhagic diseases: Ebola viral disease, Yellow fever, Lassa fever Ebola Virus Disease (EVD) A total of 964 suspected cases of EVD were reported. (801 alive and 163 dead). 649 specimens were submitted for testing. 648 tested negative and 1 indeterminate. 31.1% decrease observed in samples tested from week 22 to 23. Cumulatively, 23,361 suspected EVD cases have been reported out of which three (3) were confirmed positive. Lassa fever No suspected case of Lassa fever was reported. One sample from Grand Bassa County collected in Week 22 tested negative for Lassa virus. Since the start of 2016, 51 suspected Lassa fever cases have been reported. Specimens from 34 suspected cases were sent to the laboratory for testing, 7/34 (20.6%) cases tested positive and 20/34 (58..8%) tested negative and 7/34 (20.6%) are still pending laboratory confirmation. 4

5 Yellow fever One suspected case of yellow fever was reported from Montserrado County Sample was collected and submitted for Laboratory confirmation. During 2016, seven (7) suspected cases of Yellow fever have been reported out of which 4 out of 7 (57.1%) tested negative while 3 out of 7 (42.9%) pending laboratory confirmation 5

6 Events of Public Health Importance Maternal Mortality Six (6) maternal deaths were reported. Grand Cape Mount (4) while Lofa and Sinoe reported (1) each. Primary causes of deaths were Sepsis (3), Eclampsia (1), Hypovolemic shock (1), and Renal failure (1) Since the start of 2016, 121 maternal deaths have been reported. 6

7 Table 2: Cumulative maternal deaths reported by counties, 2016 County Reported deaths Percent *Maternal Mortality Rate (Per 100,000 Live births) Bomi Bong Gbarpolu Grand Bassa Grand Cape Mount Grand Gedeh Grand Kru Lofa Margibi Maryland Montserrado Nimba River Gee Rivercess Sinoe Total * Martenal Mortality Rate is annualized to Week 23 Using EPI population data Neonatal Mortality Two (2) neonatal deaths were reported. Montserrado and Grand cape Mount (1) each. Primary causes of deaths were neonatal asphyxia (1) and neonatal sepsis (1). Since the start of 2016, 194 neonatal deaths which include one (1) attributable death from Neonatal Tetanus have been reported. 7

8 Table 3: Cumulative neonatal deaths reported by counties, 2016 County Reported de aths Percent *Neonatal Mortality Rate (per 1,000) Bomi Bong Gbarpolu Grand Bassa Grand Cape Mount Grand Gedeh Grand Kru Lofa Margibi Maryland Montserrado Nimba River Gee Rivercess Sinoe Total *Neonatal Mortality Rate annualized to Week 23 based on EPI population data 8

9 Human Exposure to Animal Bites Twenty four (24) cases of human exposure to animal bites were reported. Montserrado (20), Grand Bassa (2), Grand Gedeh (1) and Nimba (1). All 23 live cases received anti-rabies vaccine One attributable rabies death was reported from Nimba County. Since the start of 2016, 491 cases of human exposure to animal bite have been reported including (5) deaths. Laboratory confirmation is unavailable in Liberia 9

10 Bloody Diarrhea (Shigellosis) Six (6) suspected cases of bloody diarrhea were reported. Margibi (3), Lofa (2) and Sinoe (1). Since the start of 2016, 218 cases of bloody diarrhea have been reported through the IDSR priority disease reporting. Suspected Cholera No suspected case of cholera was reported. Since the start of 2016, 115 suspected cases of cholera have been reported through the IDSR priority disease reporting system, including 2 deaths. It is likely that over-reporting of suspected cholera occurred in the first 7 weeks of the year, due to applying the case definition for acute watery diarrhea instead of suspected cholera. 30 specimens were submitted for testing out of which 25 negative for cholera culture and 3 indeterminate while 2 pending. 10

11 Current outbreaks monitored at national level Lassa fever, multiple counties In 2016, outbreaks of Lassa fever have been reported in Bong and Nimba counties in Liberia. Confirmed cases have been reported from Bong (6) and Nimba (1). Since the beginning of the year, specimens from 35 cases were received for laboratory testing. 7 (20.5%) cases tested positive, and 20 (58.8%) cases tested negative while 8 are still pending. Of the reported confirmed cases, none is health care worker. To date, 15 deaths have been reported in which 6 cases were confirmed. 11

12 Ebola Virus disease Table 4: Count of patients samples tested for EVD by county and sample type; weeks 23 Geographical Distribution Whole blood Swab Week 21 Week 22 Week 23 Post Whole Post Whole Mortem NP blood Swab Mortem NP blood Swab Post Mortem NP All Counties By County Bomi Bong Gbarpolu Grand Bassa Grand Cape Mount Grand Gedeh Grand Kru Lofa Margibi Maryland Montserrado Nimba Rivercess River Gee Sinoe Unknown

13 Public Health Measures Counties have been informed to transition from sensitive outbreak case definition to IDSR specific case definition for EVD surveillance Continuous monitoring of travelers at points of entry and border health facilities. Counties have intensified immunization outreach activities in communities affected by vaccine preventable diseases Maternal & Newborn Deaths Death review forms for thirty three reported deaths have been assessed Counties are encouraged to investigate the true magnitude of maternal deaths reported to mitigate the causes. Maternal waiting homes being utilized in some counties to enhance early detection of maternal complication for prompt response. Measles Investigation ongoing into current measles outbreak in Grand Bassa Isolation and treatment of affected cases ongoing Line listing of all cases including matching of laboratory results is ongoing Community awareness on-going. Yellow fever Specimen was collected and sent for confirmation Note Completeness of report refers to the total number of health facilities reporting to the county health offices versus the total number of health facilities in the counties. Timeliness of report is based on the proportion of health facilities that submitted reports on or before 12 noon every Monday to DPC/MOH. For comments or questions, please contact Thomas K. Nagbe, PA DIP, BSC, MPH Director, Disease Prevention and Control National IHR Focal Point Ministry of Health Republic of Liberia Phone: /

14 Health Districts District reported Ebola Viral Disease AFP Cholera Bloody Diarrhea Rabies Lassa Fever Measles Meningitis Neo-Natal Tetanus Yellow Fever Maternal Mortality Neonatal Mortality Guinea Worm Other Diseases /Eve nts Appendix 1: Summary of suspected cases and conditions by county during the current epidemiological week, and cumulative numbers, Summary of suspected cases reported from county during the reporting week Counties L D L D L D L D L D L D L D L D L D L D D D L L D Bomi Bong Gbarpolu Grand Bassa Grand Cape Mount Grand Gedeh Grand Kru Lofa Margibi Maryland Montserrado Nimba Rivercess River Gee Sinoe Total Weekly Cumulative suspected since 01/01/ Cumulative confirmed Cumulative deaths