PUBLIC HEALTH EMERGENCIES AND RESPONSES IN WEST AND CENTRAL AFRICA

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1 PUBLIC HEALTH EMERGENCIES AND RESPONSES IN WEST AND CENTRAL AFRICA Regional Health Working Group (RHWG) Dakar, le 25 January 2018 WHO/AFRO Dakar Hub CONTENTS Public Health and emergencies in the West and Central African countries DR CONGO: Complex Humanitarian crisis NIGERIA : Protracted Humanitarian Crisis LIBERIA: Meningococcal Disease BENIN: Lassa fever Others events : Senegal/Gambia, Liberia/Guinea, CAR 2 1

2 DR CONGO: Complex Humanitarian crisis Situation as of 23 January 2018 Key figures : Cholera cases : Deaths: CFR: 2.1% Humanitarian crisis - IDPs : 4,3M; In need of humatarian assistance : 13.1 M; Severely food insecure people: 7, 7 million SITUATION UPDATE Cholera (overall situation) Week 3 of 2018: 192 suspected cases and 0 death in Kinshasa Week 2 of 2018: 763 suspected cases and 14 deaths against 1022 cases and 19 deaths in week 1 Most affected provinces: Kinshasa, Nord Kivu and Sud Kivu (76% of cases) In Kinshasa, 27 affected Health zones out of the 35 Fig : Trends of cholera suspected cases (W1_ 2017 to W2_2018) Distribution of cholera hotspots in DRC 3 DR CONGO: Complex Humanitarian crisis Situation as of 23 January 2018 Key figures : Cholera cases : Deaths: CFR: 2.1% Humanitarian crisis - IDPs : 4,3M; In need of humatarian assistance : 13.1 M; Severely food insecure people: 7, 7 million Cholera in Kinshasa (as of 23 January) Since the beginning of the outbreak : 801 cases/34 deaths (CFR: 4.2%) Since the beginning of 2018: 591 cases/16 deaths (CFR : 2.71%) 20 new cases (from 8 zones de santé) reported in Kinshasa in the Luka (10) and Pakadjuma (10) treatment units. No deaths in UTC and no new areas reporting cholera cases Fig: Geographical distribution of cholera cases in Kinshasa as of January 23,

3 DR CONGO: Complex Humanitarian crisis Situation as of 23 January 2018 Key figures : Cholera cases : Deaths: CFR: 2.1% Humanitarian crisis - IDPs : 4,3M; In need of humatarian assistance : 13.1 M; Severely food insecure people: 7, 7 million Humanitarian crisis situation Major hotspots: Nord-Kivu, Sud Kivu, Maniema, Haut-Katanga, Kasai, Tanganyika Persistent tension with a public demonstration repressed with violence: 6 deaths and 42 injured in Kinshasa over the past week end Increasing number of displaced population in some of the affected provinces Map of provinces with major insecurity concern 5 6 DR CONGO: Complex Humanitarian crisis Situation as of 23 January 2018 Key figures : Cholera cases : Deaths: CFR: 2.1% Humanitarian crisis - IDPs : 4,3M; In need of humatarian assistance : 13.1 M; Severely food insecure people: 7, 7 million Public health response Visit of WHO Regional Director: Donation of 10 tons of medicine for cholera management WHO scales-up response to cholera outbreak and humanitarian crisis Establishment of 1 full cholera response team in Kinshasa for supporting the DPS composed mainly of epidemiologist Establishment of a 2nd multidisciplinary roving team with specific WASH experts for supporting that aspect in close collaboration with UNICEF Ongoing support for preparing the OCV which target 1.2 millions persons Proposals submitted to ECHO & CERF Operation challenges and Gaps Security situation remains a concern in the country Need to have a full health cluster coordination team in 5 provinces Rapid deployment of surge team Limited involvement of partners in the response Additional resources mobilization 3

4 DR CONGO: Complex Humanitarian crisis Situation as of 23 January 2018 Key figures : Cholera cases : Deaths: CFR: 2.1% Humanitarian crisis - IDPs : 4,3M; In need of humatarian assistance : 13.1 M; Severely food insecure people: 7, 7 million Situation update on Flood Heavy rain from January caused flooding and landslides - Visit of WHO/AFRO Regional Director 45 persons died; 5,100 homes flooded; 192 houses collapsed; Health facilities: 2 CTCs flooded; occurred in cholera affected districts. Electricity infrastructure damaged and at least 10 communes in Kinshasa are without power; Bridges damaged in Ndjili district 7 Nigeria: Protracted Humanitarian crisis Situation as of 23 January 2018 Key Figures: Suspected Botulism: Cases 3, Death :2 Meningitis cases: 419 Deaths: 77 (CFR: 18.4%) YF: Confirmed case: 33, Death: 9 (CFR: 27.3%) LF: Cases : Deaths: 127 CFR: 12% SITUATION UPDATE Yellow Fever : Over all trend the same 33 samples (51.6%) out of the 64 samples in Nigeria were confirmed positive by the Dakar Laboratory, 24 were negative and 4 results are being awaited A Yellow fever outbreak is currently active in Nigeria with seven states recording confirmed cases Fig. 1: Weekly YF cases in Nigeria as of January 10, 2018 Meningitis: Overall trend increasing 419 suspected cases report with 77 death as of 18 Jan samples collected and tested of which 74 confirmed for bacterial meningitis. Neisseria meningitidis C (NmC) accounted for 62.2% (46) of the positive cases. 11 states so far being affected with Zamfara (240) reporting the highest number of cases Fig. 2: Weekly meningitis Trend in Nigeria as of 18 January

5 Nigeria: Protracted Humanitarian crisis Situation as of 23 January 2018 Key Figures: Suspected Botulism: Cases 3, Death :2 Meningitis cases: 419 Deaths: 77 (CFR: 18.4%) YF: Confirmed case: 33, Death: 9 (CFR: 27.3%) LF: Cases : Deaths: 127 CFR: 12% SITUATION UPDATE (2) Weekly confirmed and probable cases of Lassa fever in Nigeria Jan wk Lassa fever: Overall trend increasing 18 new confirmed cases and 15 new suspected cases reported from 7 states with 9 new deaths 107 total cases reported so far 53 laboratory confirmed 40 currently on admission 10 health workers (3 deaths) affected in 4 states Nigerian States with active Lassa fever transmission, 1 16 January 2018 Since the resurgence of the current wave in December 2016 (week 49), a total of suspected cases including 127 deaths (case fatality rate 12%) were reported During this outbreak, 19 out of 36 states have reported at least one confirmed Lassa fever case 9 Nigeria: Protracted Humanitarian crisis Situation as of 23 January 2018 Key Figures: Suspected Botulism: Cases 3, Death :2 Meningitis cases: 419 Deaths: 77 (CFR: 18.4%) YF: Confirmed case: 33, Death: 9 (CFR: 27.3%) LF: Cases : Deaths: 127 CFR: 12% SITUATION UPDATE (3) Suspected Botulism in Abuja: 3 suspected cases so far 1 on admission and 2 deaths 3 contacts being followed up Challenges Botulism in Nigeria is of great concern because of the potential increase of the number of cases associated with contamination of the food supply. The source of the toxin needs to be identified urgently Continuation of active surveillance is also needed to facilitate rapid detection and treatment of cases 10 Public Heath response (1) WHO secured the anti-toxin, and as of 19 January 2018, it had arrived in Nigeria. Antitoxin delivered to the hospital The NCDC, WHO, US-CDC, AFENET, and other partners : laboratory diagnosis Blood and food samples awaiting shipment to CDC Atlanta Food samples collected from the house of the case patients are being analyzed at the NVRI to determine the source The case patient admitted to the Zenith Medical and Kidney Centre is being closely followed daily 5

6 Nigeria: Protracted Humanitarian crisis Situation as of 23 January 2018 Key Figures: Suspected Botulism: Cases 3, Death :2 Meningitis cases: 419 Deaths: 77 (CFR: 18.4%) YF: Confirmed case: 33, Death: 9 (CFR: 27.3%) LF: Cases : Deaths: 127 CFR: 12% Public Heath response (2) Yellow Fever RRT deployed for detail investigation in Kebbi and Kano state Preventive vaccination campaign will commence on 25 Jan in Kogi, Kwara and Zamfara states. Campaign will start in Borno on 5 Feb (subject to access) ICG request for Niger, Kebbi and Nasarawa states : 25 million people will be vaccinated throughout 2018 (from 25 th Jan.) Meningitis Coordination mechanism in place Outbreak investigation and control measures are being implemented Reactive vaccination conducted in Zamfara WCO and NCDC preposition LP kits and other supplies in 13 states Lassa fever EOC established from Monday 22 January 2018 to coordinate the response Confirmed cases are being treated at identified treatment/isolation centres Enhanced surveillance activities ongoing 11 LIBERIA: Meningococcal Disease Situation as of 21 January 2018 Key figures : cases: 9, Deaths: 4, CFR: 44.4% SITUATION UPDATE Liberia not part of the Meningitis belt WHO was notified by MOH about cluster of cases and 1 death by the Liberia MOH on 10 Jan 2018 Patients reportedly consumed fresh coconut from a street vendor on 7 Jan before presented with fever, yellow eyes, body pains weakness Samples collected ruled out EVD, LF, YF, Epidemiological update 9 cases reported (2 from contacts listed) Last case reported on 22 Jan 2 survived and 3 cases currently on admission (2 stable 1 in critical condition) Most affected age group 3 14 years Cumulative total of contact listed contacts received chemoprophylaxis 12 6

7 LIBERIA: Meningococcal Disease Situation as of 21 January 2018 Key figures : cases: 9, Deaths: 4, CFR: 44.4% Public health response Coordination Coordination mechanism in place for the response both at national and country levels WHO and US CDC providing technical and operational support Surveillance and laboratory All cases are investigated by the DRRT All contacts are being followed and monitored Active case search in done both at community and health facility levels Case definition distributed to all health facilities and to community volunteers Cross border activities in 5 PoE Case management Treatment guidelines distributed to health facilities in Lofa county and neighboring counties Ceftriaxone and ciprofloxacin sent to Lofa country to support case management IPC structures in place at health facility level 28 health workers trained and sensitized on case management protocol for Meningococcal infection Risk communication and Social Mobilization 300 communities members sensitized using community case definition Religious and traditional healers also sensitized 13 LIBERIA: Meningococcal Disease Situation as of 21 January 2018 Key figures : cases: 9, Deaths: 4, CFR: 44.4% Public health response (2) Readiness and Preparedness Alert sent to Guinea and Sierra Leone Daily situation report shared with Guinea and Sierra Leone Enhanced surveillance commenced in neighboring districts of Guinea and Sierra Leone Operation challenge and Gaps CSF collection kits not available in country Low capacity to collect CSF at county level 14 7

8 BENIN : Laser fever Situation as of 19 January 2018 Key figures : Cases : 4 Deaths: 3 CFR: 75% Geographical distribution of Lassa fever cases in Benin, 8 17 January 2018 SITUATION UPDATE As of 17 January 2018, a cumulative total of four cases including three deaths (case fatality rate 75.0%) had been reported from Boukoumbé commune (one confirmed/index and one suspected) and Toucountouna commune (one probable and one suspected). All four cases initially developed symptoms while residing in Nigeria and subsequently travelled to Benin. To date, in Benin, 144 contacts have been identified, including 47 (32%) in health facilities and 97 in t 15 BENIN : Laser fever Situation as of 19 January 2018 Key figures : Cases : 4 Deaths: 3 CFR: 75% Public health response WHO is supporting the Ministry of Health in the coordination of surveillance and response activities. A national RRT has been deployed to affected communes to support the local teams. The National Director of Public Health has briefed the media regarding Lassa fever. Contact tracing has been initiated in affected districts All health workers have been orientated in the detection and management of suspected Lassa fever cases. Personal protective equipment has been supplied to health facilities involved in Lassa fever case management. Risk communication and social mobilization activities have been intensified in the affected communities. Traditional healers and community leaders have been sensitized on Lassa fever prevention and control measures 16 8

9 OTHER EVENTS 1. Senegal/Gambie : Suspected Rift Valley Fever (1 case dead) 2. Liberia/Guinea : Confirmed Lassa Fever (1 case dead) 3. CAR : Suspected meningitis (Kemo Health District, on investigation by MoH, WHO & Institut Pasteur de Bangui). 17 Public health emergencies in the African region, 2018 Subscribe More info on the WHO AFRO website

10 THANKS! 19 10