The Ghana Weekly Epidemiological Report is a publication of the Ghana Health Service. and the Ministry of Health, Ghana. Ghana Health Service 2018

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1 MINISTRY OF HEALTH West Gonja hits the epidemic threshold for meningitis. Seven regions achieve surveillance reporting targets for both Measles and Yellow Fever The overall Timeliness and Completeness of reporting by regions were 87.6% and 93.6% respectively VOLUME 3 WEEK 7 19 February 218

2 The Ghana Weekly Epidemiological Report is a publication of the Ghana Health Service and the Ministry of Health, Ghana Ghana Health Service 218 ISSN i

3 Acknowledgement This publication has been made possible with technical and financial support from the Bloomberg Data for Health Initiative, the CDC Foundation and the World Health Organisation. ii

4 Summary of Weekly Epidemiological Data for Week 7, 218 Highlights: West Gonja hits epidemic threshold for meningitis. Seven regions achieve surveillance reporting targets for both Measles and Yellow Fever The overall Timeliness and Completeness of reporting by regions were 87.6% and 93.6% respectively Summary of Total Weekly & Deaths The total all-cause weekly notifiable disease morbidity for the week (as per IDSR Weekly Summary Reporting Form) was 2,97 with deaths attributable to meningitis. Acute watery diarrhoea in persons aged > years was the highest proportion of cases reported and contributed 6.9% of the notifiable diseases case load during Week 7 (See Annex 1, summary of reported cases/deaths) Timeliness and Completeness of Reporting The total number of expected reports based on the District Health Information Management System (DHIMS) for the Week was,819, out of which,98 (87.6%) and,446 (93.6%) represent Timeliness and Completeness of reporting respectively. Upper West region recorded the highest score for both timeliness of reports (1%) and completeness (1%). On the other hand, Central region recorded the lowest score of timeliness of report (6.%) and completeness of reporting (71.%). [Table 1] Table 1: Timeliness and Completeness of Regions based on DHIMS reporting, Ghana, Week 7, 218 Expected Number of Reports Actual Reports Received Reports on Time % Report on Time Region % Completeness Ashanti Brong-Ahafo Central Eastern Greater Accra Northern Upper East Upper West Volta Western Ghana,819, , Regional Performance Based on Reporting During Week 7, overall performance of the regions ranged from 37.6% (Central) to 82.% (Brong-Ahafo). [Table 2] The expected percentage for districts reporting suspected Measles or Yellow Fever as of Week 7 was 1.8%. Seven regions achieved target for both Measles and Yellow Fever surveillance. Upper West failed to achieve both while Northern and Central regions failed to achieve for Yellow fever surveillance. Table 2: Ranking of Regional Performance, Week 7, 218 Timeliness Completeness AFP Measles YF Average Region Week 7 A Week 7 B Cum. AFP Week 7 Annualized Non-Polio AFP Rate Average AFP Score C % District reporting D % District reporting E Score % (A+B+C+ D+E)/ Position Brong-Ahafo st Western nd Eastern rd Volta th Upper West th Greater Accra th Ashanti th Upper East th Northern th Central th Ghana

5 MENINGITIS In Week seven, a total of 2 suspected cases of meningitis were recorded with five deaths [Table 4]. West Gonja in the Northern Region crossed the Epidemic threshold recording an attack rate A total of eight districts from four regions were in alert situation for meningitis. In the Upper West region, Lambussie, Lawra, Nadowli-Kaleo, Nandom, and Wa districts were all in alert situation and recorded respective attack rates of 3.3, 4.6, 7., 3.8 and 6.. Jaman North district in the Brong-Ahafo Region also crossed the alert threshold recording an attack rate of 3.. Bole in the.. Table 4: Meningitis cases and deaths by Region, Ghana, Week 7, 218 Region Cerebrospinal Fluid (CSF) Lab Test Positive Northern Region and Bongo in the Upper East Region as well were in alert situation with respective attack rates of.2 and 4.3. All districts which were in either alert or epidemic phase in Upper West were contiguous. [Figure 1]. All cases were tested with four confirmed to be meningitis due to N. meningitidis and five of the cases confirmed to be due to S. pneumoniae [Table ]. All confirmed cases were from the Brong-Ahafo, Northern and Upper West regions. [Table 4]. Deaths CFR District in Alert Ashanti. Brong-Ahafo* Central. Eastern 3. Greater Accra. Northern* Upper East* 9. 1 Upper West* Volta 2. Western. District in Epidemic Total (Ghana) Jaman North: 3 cases [AR=3.] Bole: 4 cases [AR=.2] West Gonja: 6 cases [AR=11.6] Bongo: 4 cases [AR=4.3] Lambussie: 2 cases [AR= 3.3] Lawra: 3 cases [AR=4.6] Nadowli-Kaleo: cases [AR=7.] Nandom: 2 cases [AR=3.8] Wa: cases [AR=6.] Table 4: Meningitis cases confirmed cases by Latex, Gram stain and Culture Week 7, 218 Districts CSF CSF positive Confirmed Deaths Causative Organism Jirapa N. meningitidis Lawra Gram Positive Diplococci Bole S. pneumoniae West Gonja N. meningitidis 2-S. pneumoniae Wenchi S. pneumoniae * Polymerase Chain Reaction Figure 1: Districts in alert or epidemic phase for Meningitis, Week 7, 218 Figure 2: Laboratory confirmed Meningitis pathogens, Week 7, 218 2

6 DISTRICTS IN MENINGITIS ALERT OR EPIDEMIC A total of eight districts namely; Bole, Wa, Lambussie, Nadowli-Kaleo, Nandom, Bongo, Lawra and Jaman North crossed the alert threshold in Week 7 [Figures 4-11]. On the other hand, West Gonja district in the Upper West region hit the epidemic threshold [Figure 3] West Gonja Alert Epidemic Figure 3: Meningitis threshold monitoring chart for West Gonja, Week, 217- Week 7, Bole Alert Epidemic Figure 4: Meningitis threshold monitoring chart for Bole, Week, 217- Week 7, Wa Alert Epidemic Figure : Meningitis threshold monitoring chart for Wa, Week, 217- Week 7, Nadowli-Kaleo Alert Epidemic Figure 7: Meningitis threshold monitoring chart for Nadowli-Kaleo, Week, 217- Week 7, Figure 8: Meningitis threshold monitoring chart for Nandom, Week, 217- Week 7, Nandom Alert Epidemic Figure 9: Meningitis threshold monitoring chart for Lawra, Week, 217- Week 7, Lawra Alert Epidemic Jaman North Alert Epidemic Figure 1: Meningitis threshold monitoring chart for Jaman North, Week, 217- Week 7, Lambussie-Karni Alert Epidemic CUMULATIVE 1MENINGITIS 2 1 2CASES, 3 4WEEK 1-6, Figure 6: Meningitis threshold monitoring chart for Lambussie-Karni, Week, 217- Week 7, 218 Figure 11: Meningitis threshold monitoring chart for Bongo Week, 217- Week 7, Bongo Alert Epidemic

7 DETAILED ANALYSIS OF MENINGITIS TESTING IN NORTHERN AND UPPER WEST REGION During the week, six districts in both regions crossed either the alert or epidemic threshold. Lumber puncture and laboratory tests (both Gram Stain and PCR) were done for all cases. West Gonja recorded six cases and was the only district which crossed the epidemic threshold. All six cases were tested and five were confirmed by Culture and PCR representing a high positivity rate of test. Three were three cases of N. meningitidis W and two cases of S. pneumoniae. On the other hand, Lambussie-Karni, Nadowli- Kaleo, Wa and Lawra all in Upper East region crossed the alert threshold but all tested negative for Gram Stain and PCR test. [Table ]. The situation in Upper West region during the week under review is similar to the previous weeks, in which the districts in the region records high number of suspected but very few were confirmed by PCR and other tests. Table : Details of the Gram Stain and PCR tests done for districts in Northern and Upper West, Week Gram Stain Culture & PCR LP No. N. N. District Negative S. Done Tested GPD GND meningitidis meningitidis pneumoniae W B H. influenza Bole West Gonja Lambussie- Karni Nadowli-Kaleo Wa Lawra CUMULATIVE MENINGITIS CASES IN REGIONS, WEEK 1-7, 218 As at the end of Week 7, a total 429 suspected cases and 43 deaths (overall CFR=1.%) have been recorded in all regions. This is close to the bench mark of < 1% which typifies good case management. Upper West has the highest number of suspected cases reported with 19 and 14 deaths representing a CFR of 7.2%. Central region recorded one suspected case with no death which was the least recorded by a region. Northern region recorded 17 deaths out of the total of 68 suspected cases with CFR=2.%. The highest CFR=% was recorded in Western which recorded four suspected cases and two deaths [Table 6]. Lumber Puncture was done for 42 (97.9%) out of the 429 suspected cases and 6 were CSF positive with the following breakdown; Gram negative diplococci, H. influenza 1, N. meningitidis W 19, N. meningitidis B 1 and S. pneumoniae 34 [Table 7]. Table 6: Cumulative Meningitis cases and deaths by Regions, Ghana, Week 1-7, 218 Region Deaths CFR* Cumulative Number of District in Alert (Week 1-7) Cumulative Number of District in Epidemic (Week 1-7) Ashanti 2. Brong-Ahafo Central 1. Eastern Greater Accra 11. Northern Upper East Upper West Volta Western 4 2. Ghana *Case Fatality Rate 3

8 Table 7: Regional distribution of Meningitis pathogens, Ghana, Week 1-7, 218 Region LP* CSF Positive GND+ GPD^ H. influenza N. meningitidis W N. meningitidis B S. pneumoniae Ashanti 2 2 Brong-Ahafo Central 1 1 Eastern Greater Accra Northern Upper East Upper West Volta 12 9 Western 4 3 Grand Total *Lumbar Puncture, +Gram negative diplococci, ^Gram positive diplococci INFLUENZA-LIKE ILLNESS A total of 69 cases with no deaths were reported through the IDSR weekly reporting system. [Table 8]. Samples were taken and sent to Noguchi Memorial Institute for Medical Research (NMIMR) for laboratory investigation. No test was done due to the shortage of reagents. Table 8: Reported Influenza-Like Illness cases by Region and District, Ghana, Week 7, 218 Region Districts Deaths Ashanti Adansi South 14 Bekwai 13 Ejisu-Juaben 2 Kumasi 184 Brong-Ahafo Sunyani 7 Eastern Kwaebibirem 2 New Juaben 12 Greater Accra Accra 22 Ga East 71 Ga West 23 La Dade-Kotopon 1 Ledzokuku-Krowor 37 Ningo-Prampram 6 Shai Osudoku 74 Tema 69 Upper East Bolgatanga Kassena-Nankana Volta Ketu South 8 Total 69 MEASLES During Week 7, a total of 49 suspected cases of Measles were reported from 37 districts in eight regions [Table 9]. All samples were sent to the National Public Health Reference Laboratory (NPHRL) for investigation and none was confirmed as Measles positive. Table 9: Reported Suspected Measles cases by Region and District, Ghana, Week 7, 218 Region Districts Deaths Ashanti Brong-Ahafo Eastern Ahafo-Ano North 2 Amansie West 2 Asante-Akim South 1 Kumasi 1 Asunafo North 1 Asutifi North 2 Asutifi South 1 Berekum 1 Dormaa East 1 Dormaa West 1 Jaman North 3 Nkoranza North 1 Nkoranza South 1 Sunyani 1 Sunyani West 1 Techiman South 2 Asuogyaman 1 Kwaebibirem 1 Kwahu East 1 Kwahu North 1 Kwahu West 1 Yilo-Krobo 1 Accra 1 Ga West 4 Ledzokuku-Krowor 1 Greater Accra Ningo-Prampram 1 Northern Mion 1 Upper East Volta Nabdam 1 Wa West 1 Afadzato 1 Akatsi North 1 Ketu South 1 Kpando 1 Ahanta West 2 Bodi 1 Mpohor 3 Western Sekondi-Takoradi 1 Total 49 4

9 ACUTE FLACCID PARALYSIS (SUSPECTED POLIOMYELITIS) Seven suspected cases of Acute Flaccid Paralysis (AFP) were reported by seven districts in five regions [Table 1]. All the stool specimens tested at the National Public Health and Reference Laboratory were negative for wild polio virus. Table 1: Suspected Poliomyelitis cases and deaths by Region and District, Ghana, Week 7, 218 Region Districts Deaths Ashanti Atwima-Kwanwoma 1 Central Upper Denkyira West 1 Accra 1 Kpone-Katamanso 1 CHOLERA In week 7, there was no case of cholera reported. MATERNAL DEATHS During the week, there were no maternal death reported La-Dade-Kotopon 1 Greater Accra Northern Mion 1 Upper West Sissala West 1 Total 7 YELLOW FEVER During the week, 19 suspected cases of Yellow Fever were reported in 18 districts in eight regions. [Table 11]. All cases tested negative for yellow fever IgM at the National Public Health and Reference Laboratory, Korle-Bu, Accra Table 11: Laboratory investigation of suspected Yellow Fever cases, Ghana, Week 7, 218 Lab Confirmed Samples Region District Suspected Taken Presumptive Positive Negative Deaths Asokore-Mampong Ashanti Kumasi Asunafo South Asutifi South Jaman South Sene West Brong-Ahafo Sunyani Abura-Asebu- Central Kwamankese Eastern Akuapim South Accra Ga South Greater Accra Ningo-Prampram Upper West Jirapa Afadzato Kadjebi Volta Ketu South Jomoro Western Tarkwa-Nsuem Total

10 ACTION POINTS All regions and districts are requested to update their preparedness and response plans for Meningitis, Viral Haemorrhagic Fever and influenza. Regions are as well urged to continue surveillance on meningitis. For every case of meningitis, a lumbar puncture should be done and cerebrospinal fluid tested with Gram stain and latex agglutination; samples should be inoculated into Trans-Isolate bottles for confirmation by culture at the respective regional laboratory. It is mandatory that Brong-Ahafo, Northern, Upper East and Upper West regions send samples frozen in cryotubes to Tamale Zonal Public Health Laboratory (PHL) for Polymerase Chain Reaction Test (PCR) All regions are to ensure that influenza sentinel sites pick samples from the first five influenza-like illnesses (ILI) each week and send to Noguchi for testing. For all hospitalized ILI (e.g., pneumonia), nasal and oropharyngeal swabs are to be sent to the National Influenza Center. All SARI and ILI patients seen by sentinel and non-sentinel sites should be entered on the weekly summary form in the DHIMS. Regions are to adhere to the case definition of all priority diseases/conditions before putting cases on the line list. Surveillance on viral haemorrhagic fevers should be enhanced in regions, districts, health facilities and the Points of Entry (ground crossing, airport and ports). Blood samples from suspected cases should be taken, placed in viral transport medium and sent to NMIMR for laboratory investigations. This report and subsequent ones should be shared with other regional, district and other heads. You are encouraged to disseminate to other agencies as well. The DSD, NPHRL and the National Influenza Center should work towards procuring reagents for investigating acute respiratory infections. ANNEX 1: SUMMARY OF REPORTED CASES/ EVENTS: WEEK 7 (WEEK ENDING 18 FEBRUARY, 218) Disease/Health Event Week 6 Week 7 Cumulative to Week 7 (suspected/confirmed) (susp) Deaths CFR (susp) Deaths CFR (susp) Deaths CFR AFP (suspected polio) Acute haemorrhagic fever syndrome Adverse events following immunization Anthrax Acute watery diarrhoea in persons aged > years 1,7. 1,194. 7,7. Cholera Dengue fever Diarrhoea with blood Dracunculiasis (Guinea worm) Influenza-like illness ,61. Maternal deaths Measles Meningitis Neonatal tetanus Plague Public health event of international concern (PHEIC) Human rabies SARS Smallpox Yellow fever (suspected) NATIONAL TOTAL 1, , ,946.3 *CFR does not include maternal deaths 6

11 Editorial Board Dr. Anthony Nsiah-Asare Dr. Badu Sarkodie Mr. Michael Adjabeng Mr. James Addo Dr. Emmanuel Kofi Dzotsi Dr. Kwame Amponsa-Achiano Dr. David Opare Dr. Franklin Asiedu-Bekoe Mr. Kwame Kodom Achempem Mr. Isaac Baffoe-Nyarko Prof. Kwadwo Koram Dr. Ivy Frances Osei Dr. Ernest Kenu Dr. Phyllis Antwi Ms. Selina Ababio Dr. Dennis Laryea Dr. Sally-Ann Ohene Dr. Chastity Walker Editorial Team Editor Mr. Gideon Kwarteng Acheampong Managing Editor Mr. Kwame Acheampong Owusu Editor-In-Chief Dr. Kenneth Ofosu-Barko 7