Integrated Disease Surveillance and Response Bulletin

Transcription

1 Republic of Liberia INTEGRATED DISEASE SURVEILLANCE AND RESPONSE BULLETIN Week-33 August 15-21, 2016 Data Source: CSOs from 15 Counties and Lab Highlights during the reporting week Eleven neonatal deaths reported from four counties Five maternal deaths reported from four counties Four positive measles results received from the National Reference Lab, samples collected in epi weeks 31 and 32 Reporting Coverage 99.5 % (737/740) of expected health facilities reported from 90 health districts across 15 counties 93% (84/90) districts submitted timely reports to national level Nationwide, 99% of health facilities submitted timely report to the district level Figure 1: Timeliness and Completeness at time of report for Health Facility reporting in Liberia, 2016 Vaccine Preventable Diseases Measles Three (3) suspected cases reported. Margibi (2) and Montserrado (1). No known link to the previous cases reported in April (Margibi) Three (3) samples have been collected and sent to the LIBR lab for testing. Positive samples were reported from cases in epi week 31 and 32. Bong and Grand Bassa (2) cases each. The positive samples had an epi-link with previous outbreak in the two counties 1

2 Cumulative total shows 758 cases: 113 lab confirmed, 449 epi-linked, 62 compatible, 39 suspected pending reclassification after lab result, and 95 discarded. CFR - 0.4% (n=2) (Figure 2). Together, Margibi, Montserrado, and Grand Bassa counties account for 90% of all confirmed and epi-linked cases. Forty-five percent (n=257) of confirmed and epi-linked cases were not immunized. Annualized non-measles febrile rash rate is at 4 per 100,000. River Gee county remain silent Figure 2: Distribution of reported Measles cases by Epi classification, Liberia, Epi week 1-33, 2016 Acute Flaccid Paralysis Two cases reported. Margibi and River Gee (1) each. Cumulative total of AFP cases recorded is 41: Zero confirmed, 34 discarded and 7 pending lab results. As of week 33, the annualized non-polio AFP rate is at 3.5 per 100,000 populations less than 15 years of age (Table 1). Note: According to field investigation,the three clusters of AFP cases reported from Grand Bassa county did not meet case definition, however samples were collected pending laboratory confirmation 2

3 Number of Cases Figure 3: Distribution of AFP cases by Epi classification, Liberia, Epi week 1-33, Pending Discarded Pending Week of Symptom Onset (Epidemiological Week) Table 1: Non-polio AFP rate/100,000 <15yrs, Liberia, Epi week 1-33, 2016 Non- Polio AFP Rate % of stool <14days County < 15 % of years pop Expected Reported NPENT 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% = Silent 3

4 Neonatal Tetanus Zero case reported. Cumulative clinically confirmed total is eight (8). CFR is 25%. Viral Hemorrhagic Diseases: Ebola Virus Disease, Yellow Fever, Lassa Fever Ebola Virus Disease (EVD) A total of 211 suspected cases reported. 77 alive and 134 dead, samples collected from all. 182 samples tested negative for EVD. Additionally backlog of 47 samples (from epi week 32) were tested. 30.5% decrease observed in samples tested in week 33 compared to week 32. Cumulative total shows 27,111 alerts reported out of which three (3) were confirmed. CFR is 33.3% (n=1). Figure 4: Number of EVD alerts reported, Liberia, Epi weeks 1-33, 2016 Lassa Fever One death in a suspected case reported from Nimba County, specimen was collected and sent to the lab cumulative total shows 58 cases have been reported, of which 12 are confirmed, 28 are not a case, 18 are suspected (4 are awaiting lab results) CFR for suspected and confirmed cases is 70% and for confirmed cases 33%. Bong County accounts for 58% of the total confirmed cases. Yellow Fever One suspected case reported from Rivercess County, with date of onset in week 32. Cumulative total shows 17 cases reported, out of which twelve (12) tested negative and five (5) pending laboratory confirmation. 4

5 Figure 5: Number of alerts investigated for Yellow Fever reported by Epi classification, Liberia, Epi week 1-33, 2016 Meningitis Zero case reported. Cumulative total suspected cases are 18 cases. Events of Public Health Importance Maternal Mortality Five (5) maternal deaths reported. Bong (2), Grand Cape Mount, Nimba and Bomi (1) each. Primary causes of deaths were septicemia (1), post partum Eclampsia (1), rapture uterus (1), Peptic ulcer (1) and diabetes keto acidosis (1) Cumulative total shows 207 maternal deaths, out of which 77% (160/207) occurred in health facility and 23% (47/207) in community. Annualized maternal mortality ratio is at 185 per 100,000 live births (Table 2). The expected MMR based on 2013 DHS is 1072 deaths per 100,000 live births. There is likely under reporting at Community, Health Facility, District and County levels. 5

6 Figure 6: Number of Maternal Deaths Reported per Epi week, Liberia, Epi week 1-33, 2016 Table 2: Cumulative Maternal Deaths Reported by Counties, Liberia, Epi week 1-33, 2016 No. of Maternal Annualized Maternal Counties Deaths Reported % of Deaths Reported Mortality Ratio Bomi Sinoe Bong GrandCapeMou GrandKru Maryland RiverGee Gbarpolu RiverCess Margibi GrandBassa Lofa Nimba Montserrado GrandGedeh Liberia *Maternal Mortality Ratio has been annualized to Week 33 using EPI population data 6

7 Neonatal Mortality Eleven neonatal deaths were reported. Montserrado (5), Bong (2), Grand Kru (2), while River Gee and Sinoe (1) each. Primary causes of deaths were birth asphyxia (6), preterm (2), neonatal sepsis (2) pneumonia (1) Ten of the deaths occurred in the Health Facility while one in the community. Cumulative total shows 293 neonatal deaths with (2) attributable death due to Neonatal Tetanus. Annualized neonatal mortality rate is at 4 per 1,000 live births. The expected NNMR based on 2013 DHS is 26 deaths per 1,000 live births. There is likely under reporting at Community, Health Facility, District and County levels. Figure 7: Weekly distribution of Neonatal Deaths reported, Liberia, Epi week 1-33,

8 Table 3: Cumulative Neonatal Deaths reported by counties, Liberia, Epi week Annualized Neonatal Cummulative number of % of Deaths Mortality Rate Per 1,000 Counties neonatal deaths reported Reported Live Births Grand Kru Grand Gedeh River Gee Sinoe Bong Gbarpolu RiverCess Maryland Montserrado Grand Cape Mount Lofa Bomi Grand Bassa Margibi Nimba Liberia * Neonatal Mortality Rate has been annualized to Week 33 using EPI population data Human Exposure to Animal Bites (Rabies) Nine (9) suspected cases including one death reported. Nimba (4), Montserrado (2), Rivercess (1), River Gee (1) and Gbarpolu (1) death. Cumulative total shows 680 cases reported including (6) deaths. Laboratory confirmation of rabies is unavailable in Liberia. Figure 8: Distribution of Animal Bites reported, Liberia, Epi week 1-33,

9 Bloody Diarrhea (Shigellosis) Four (4) suspected cases reported. Margibi (2), Montserrado and Nimba (1) each Cumulative total shows 283 cases reported. Figure 9: Distribution of suspected Bloody Diarrhea reported, Liberia, Epi week 1-33, 2016 Severe Acute Watery Diarrhea(Cholera) Zero case reported Cumulative total 137 suspected cases reported, including 2 deaths. It is likely that overreporting of suspected cholera occurred in the first 7 weeks of the year, due to the application of the case definition for acute watery diarrhea instead of suspected cholera. Figure 10: Distribution of Severe Acute Watery Diarrhea (Cholera) cases reported, Liberia, Epi week 1-33,

10 Ebola Virus Disease Table 4: Count of patients samples tested for EVD by county and sample type, Liberia, Epi Weeks 31-33, 2016 Geographical Week 31 Week 32 Week 33 Distribution Whole Oral Whole Oral Whole Oral blood Swab blood Swab blood Swab 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 Note: 30.5 % decrease observed in samples tested as compared to previous weeks. All the reporting counties did not report at least 50% of expected deaths. Public Health Measure. County Level Supportive supervision and mentoring of OIC on IDSR standard case definition continues in few Counties. Lassa fever i. Twelve contacts linked to suspected case report from Nimba were listed and are undergoing 21 days follow-up ii. Specimen was collected for laboratory confirmation Diarrhea Diseases. i. Communities are sensitized not to drink from creeks and stagnant waters to avoid water borne diseases. Maternal and Neonatal deaths i. Counties continue to submit maternal and newborn death review forms to National level. Vaccine Preventable Diseases i. Specimens were collected for laboratory testing for IgM of Yellow fever. ii. Isolation and clinical management of Measles cases ongoing. Human Exposure to Animal Bite i. A 10 days observation is ongoing relating to reported animal bite. ii. Most cases of suspected exposure to rabies were treated with anti-rabies vaccine (post-exposure prophylaxis) in affected counties 10

11 Note Completeness refers to the proportion of health facilities in the country that reported during the week. Timeliness of report is based on the proportion of health facilities that submitted reports on or before 12 noon every Monday to the Division of Disease Prevention and Control (DPC), Ministry of Health (MoH). Non-polio AFP rate is calculated by dividing the number of reported non-polio AFP cases by the expected cases per 100,000 populations under 15 years of age. Non-measles febrile rash rate refers to the proportion of the total population per 100,000 Annualized maternal mortality ratio refers to the maternal mortality ratio of a given period less than one year and it is the number of maternal deaths per 100,000 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. Compatible case refers to a suspected measles case that is not epidemiologic linked to any lab confirmed case and whose specimen was not tested for laboratory confirmation Confirmed case refers to a case whose specimen has tested positive through laboratory confirmation. Case Fatality Rate (CFR) is the proportion of deaths in confirmed cases. 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 tnknue31112@gmail.com Phone: /

12 No. of Health Districts No. of Health District reported AFP Bloody Diarrhoea Cholera (severe AWD) Human Exposure to Rabies Lassa Fever Measles Meningitis Maternal Mortality Neonatal Mortality Neo-Natal Tetanus VHF (including EVD) Yellow Fever Other Diseases/Events Appendix 1: Summary of suspected cases and conditions by County during Epi week 33 and cumulative numbers, Liberia, 2016 Counties L D L D L D L D L D L D L D D D L D L D L D 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 Reported Cumulative Confirmed