MINISTRY OF HEALTH Nandom in Upper West Region hits epidemic threshold for meningitis 62% of all confirmed meningitis cases were caused

Transcription

1 MINISTRY OF HEALTH Nandom in Upper West Region hits epidemic threshold for meningitis 62% of all confirmed meningitis cases were caused by Streptococcus pneumonae The overall Timeliness and Completeness of reporting by regions were 9.6% and 98.4% respectively VOLUME 3 WEEK March 2018

2 The Ghana Weekly Epidemiological Report is a publication of the Ghana Health Service and the Ministry of Health, Ghana Ghana Health Service 2018 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 11, 2018 Highlights: Nandom in Upper West Region hits epidemic threshold for meningitis. 62% of all confirmed meningitis cases were caused by Streptococcus pneumoniae The overall Timeliness and Completeness of reporting by regions were 9.6% and 98.4% 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 1,319 with three deaths; maternal death (1), meningitis (1) and Human rabies (1). Acute watery diarrhoea in persons aged > years was the highest proportion of cases reported and contributed 7.4 % of the notifiable diseases case load during Week 11 (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,831, out of which,7 (9.6%) and,73 (98.4%) were documented for Timeliness and Completeness of reporting respectively. Eastern and Northern regions both recorded 100% for both timeliness and completeness of reporting. Greater Accra region recorded the lowest score for timeliness (68.9%) as well as completeness (88.3%) [Table 1] Table 1: Timeliness and Completeness of Regions based on DHIMS reporting, Ghana, Week 11, 2018 Expected Number of Reports Actual Reports Reports on Region Received % Completeness Time Ashanti Brong-Ahafo Central Eastern Greater Accra Northern Upper East Upper West Volta Western Ghana,847, ,7 9.6 % Report on Time Regional Performance Based on Reporting During Week 11, overall performance of the regions ranged from 0.3% (Central) to 90.0% (Brong-Ahafo) [Table 2]. The expected percentage for districts reporting suspected Measles or Yellow Fever as at Week 11 was 16.9%. All regions achieved the target for both Measles and Yellow Fever surveillance except Central and Northern regions which failed to achieve for Yellow fever surveillance. Table 2: Ranking of Regional Performance, Week 11, 2018 Timeliness Completeness AFP Measles YF Average Region Week 11 A Week 11 B Cum. AFP Week 11 Annualized Non-Polio AFP Rate AFP Score C % District reporting D % District reporting E Score % (A+B+C+ D+E)/ Position Brong-Ahafo st Eastern nd Western rd Volta th Upper East th Greater Accra th Northern th Upper West th Ashanti th Central th Ghana

5 MENINGITIS In Week 11, a total of 40 cases of meningitis was recorded with 1 death [Table 3]. Nandom district in the Upper West region crossed the epidemic threshold recording an attack rate of 11.4 per 100,000 population. A total of four districts from three regions were also in alert situation for meningitis. In the Upper West region, Lambussie-Karni and Lawra districts crossed the alert threshold and recorded attack rates of 3.3 and 6.2 per 100,000 population respectively. Jaman North district in the Brong-Ahafo Region also crossed the alert threshold recording an attack rate of.0 per 100,000 population. Bole in the Northern region was in alert situation with an attack rate of 9.0 per 100,000 population. Nandom and the two other districts in the Upper West Region which were in epidemic and alert phase respectively were contiguous [Figure 1]. All cases were tested with Streptococcus pneumoniae responsible for the two cases of meningitis [Table 4]. The two positive cases were PCR confirmed and were all recorded in Brong- Ahafo (1) and Northern regions (1). [Figure 2].. Table 3: Meningitis cases and deaths by Region, Ghana, Week 11, 2018 Region Cerebrospinal Fluid (CSF) Lab Test Positive Deaths CFR District in Alert Ashanti Brong-Ahafo Central Eastern Greater Accra Northern Upper East Upper West Volta Western District in Epidemic Total (Ghana) [AR per 100,000 population] Jaman North: cases [AR=.0] Bole: 7 cases [AR=9.0] Lambussie-Karni: 2 cases [AR=3.3] Lawra: 4 cases [AR=6.2] Nandom: 6 cases [AR=11.4] Table 4: Meningitis confirmed cases by Latex, Gram stain and Culture/PCR* Week 11, 2018 Districts CSF CSF positive Deaths Causative Organism Jaman North 1 1 Streptococcus pneumoniae Bole Streptococcus pneumoniae Lambussie-Karni Nil Lawra Nil Nandom Nil * Polymerase Chain Reaction Figure 1: Districts in alert or epidemic phase for Meningitis, Week 11, 2018 Figure 2: Laboratory confirmed Meningitis pathogens, Week 11, 2018 Ghana Weekly Epidemiological Report Vol. 3 Week 11 February

6 Case DISTRICTS IN MENINGITIS ALERT OR EPIDEMIC Nandom district crossed the epidemic threshold during the week under review [Figure 3]. A total of four districts namely; Jaman North, Bole, Lambussie-Karni and Lawra all crossed the alert threshold in Week 11 [Figures 4-7]. 10 Bole Alert Epidemic Nandom Alert Epidemic Epidemiological Week Figure 3: Meningitis threshold monitoring chart for Nandom, Week 01-11, Jaman North Alert Epidemic Figure : Meningitis threshold monitoring chart for Bole, Week 01-11, Epidemiological Week Lambussie-Karni Alert Epidemic Epidemiological Week Figure 6: Meningitis threshold monitoring chart for Lambussie-Karni, Week 01-11, Lawra Alert Epidemic Epidemiological Week Figure 4: Meningitis threshold monitoring chart for Jaman North, Week 1-11, Epidemiological Week Figure 7: Meningitis threshold monitoring chart for Nabdam, Week 01-11, 2018 DETAILED ANALYSIS OF MENINGITIS TESTING IN NORTHERN AND UPPER WEST REGION During the week, Nandom district in the Upper West region crossed the epidemic threshold with six recorded cases. Lumber puncture and laboratory tests (both Gram Stain and Culture/PCR) were done for all cases and none was confirmed. The situation was similar in Jirapa, Lambussie- Karni, Lawra and Wa West all in Upper West region which recorded a total of 10 cases with none confirmed for any of the tests done. On the other hand, Bole in Northern recorded seven cases and one was confirmed for Streptococcus pneumoniae by Culture/PCR. Central Gonja and Sawla- Tuna-Kalba also in Northern region during the week under review recorded a total of two cases and none was confirmed [Table ]. Table : Details of the Gram Stain and Culture/PCR tests done for districts in Northern and Upper West, Week Gram Stain Culture /PCR LP No. District Negative Neisseria Neisseria Done Tested GPD GND meningitidis meningitidis Streptococcus pneumoniae Haemophilus influenza W B Bole Central Gonja Sawla-Tuna-Kalba Lambussie Jirapa Nandom Lawra Wa West Note: Table contains data from only the Northern and Upper West regions 3

7 CUMULATIVE MENINGITIS CASES IN REGIONS, WEEK 1-11, 2018 As at the end of Week 11, a total 6 cases and 47 deaths (overall CFR=8.1%) have been recorded in all regions. This is close to the bench mark of < 10% which typifies good case management. Upper West has the highest number of cases reported with 21 and 17 deaths representing a CFR of 6.8%. Central region recorded one case with no death which was the least recorded by a region. Northern region recorded 17 deaths out of the total of 92 cases with Table 6: Cumulative Meningitis cases and deaths by Regions, Ghana, Week 1-11, 2018 Region Deaths CFR* CFR=13.0%. [Table 6]. Lumber Puncture was done for 9 (98.9%) out of the 6 cases and 93 were CSF positive with the following breakdown; Gram negative diplococci 8, Gram positive diplococci 7, Haemophilus influenzae 1, Neisseria meningitidis W 27, Neisseria meningitidis B 1 and Streptococcus pneumoniae 48 [Table 7]. In all, a total of 77 cases have been Culture/PCR confirmed nationwide with Streptococcus pneumoniae 48 (62%), Neisseria meningitidis 28 (37%) and Haemophilus influenzae 1 (1%) [Figure 8]. Cumulative Number of District in Alert (Week 1-11) Cumulative Number of District in Epidemic (Week 1-11) Ashanti Brong-Ahafo Central Eastern Greater Accra Northern Upper East Upper West Volta Western Ghana *Case Fatality Rate Table 7: Regional distribution of Meningitis pathogens, Ghana, Week 1-11, 2018 Region LP* CSF Positive GND+ GPD^ Haemophilus influenzae Neisseria meningitidis W Neisseria meningitidis B Streptococcus pneumoniae Ashanti Brong- Ahafo Central Eastern Greater Accra Northern Upper East Upper West Volta Western Grand Total *Lumbar Puncture, +Gram negative diplococci, ^Gram positive diplococci 1% Neisseria meningitidis 37% Streptococcus pneumoniae Haemophilus influenzae 62% Figure 8: Pathogens isolated for all PCR Confirmed cases of Meningitis, Ghana, Week

8 INFLUENZA-LIKE ILLNESS A total of 33 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. Reagents are however, expected to arrive soon for laboratory investigations to continue. Table 8: Reported Influenza-Like Illness cases by Region and District, Ghana, Week 11, 2018 Region Districts Deaths Adansi South 16 0 Ashanti Bekwai 2 0 Asikuma-Odoben- Brakwa 21 0 Central Cape Coast 39 0 Accra 27 0 Ga East 4 0 Ga West 20 0 Kpone-Katamanso 0 La-Dadekotopon 10 0 Ledzokuku-Krowor 22 0 Ningo-Prampram 2 0 Shai-Osudoku 60 0 Greater Accra Tema 63 0 Upper East Bolgatanga 0 Volta Ketu South 7 0 Total 33 0 ACUTE FLACCID PARALYSIS (SUSPECTED POLIOMYELITIS) A total of 11 cases of Acute Flaccid Paralysis (AFP) were reported by eight districts in five regions [Table 9]. All the stool specimens tested at the Polio Laboratory (NMIMR) were negative for wild polio virus. Table 9: Suspected Poliomyelitis cases and deaths by Region and District, Ghana, Week 11, 2018 Region Districts Deaths Brong-Ahafo Nkoranza North 1 0 Eastern Kwaebibirem 2 0 Ga South 1 0 Greater-Accra Ga West 2 0 Volta Ketu North 1 0 Bibiani-Anhwiaso-Bekwai 1 0 Mpohor 1 0 Western Shama 2 0 Total 11 0 MATERNAL DEATHS During the week, one case of maternal death was reported from Shai-Osudoku district in the Greater Accra Region. MEASLES During Week 11, a total of 62 suspected cases of Measles were reported from 36 districts in eight regions [Table 10]. All samples were sent to the National Public Health Reference Laboratory (NPHRL) for investigation and none was confirmed as Measles positive. Table 10: Reported Suspected Measles cases by Region and District, Ghana, Week 11, 2018 Region Districts Deaths Asante Akim Central 3 0 Ejura-Sekyedumase 2 0 Ashanti Kwabre 1 0 Asunafo North 6 0 Asunafo South 2 0 Asutifi North 1 0 Asutifi South 2 0 Banda 2 0 Berekum 3 0 Dormaa Central 2 0 Jaman North 1 0 Jaman South 1 0 Sunyani West 1 0 Tain 4 0 Brong-Ahafo Wenchi 1 0 Central Gomoa East 1 0 Akuapim South 1 0 East Akim 1 0 Kwaebibirem 2 0 New Juaben 1 0 Nsawam Adoagyiri 1 0 Suhum 1 0 Eastern Yilo-Krobo 1 0 Ga South 1 0 Greater Accra Ga West 2 0 Ningo-Prampram 1 0 Northern Karaga 2 0 Akatsi North 1 0 Biakoye 4 0 Ho West 1 0 Volta Kadjebi 1 0 Bodi 3 0 Ellembelle 2 0 Sefwi-Akotombra 1 0 Tarkwa-Nsuem 1 0 Western Wassa-Amenfi East 1 0 Total 62 0 CHOLERA In Week 11, there was no case of cholera reported. HUMAN RABIES In Week 11, one death of Human rabies was report from Ahafo-Ano South in Ashanti region

9 YELLOW FEVER During the week, 28 suspected cases of Yellow Fever were reported in 19 districts in six 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 11, 2018 Lab Confirmed Samples Region District Suspected Taken Presumptive Positive Negative Deaths Ashanti Adansi South Asunafo North Asunafo South Asutifi South Atebubu-Amanten Dormaa West Jaman North Nkoranza North Sene East Brong-Ahafo Wenchi Kwaebibirem Eastern Lower Manya-Krobo Greater Accra Ga West Akatsi North Biakoye Volta Ketu South Aowin Tarkwa-Nsuem Western Wassa-Amenfi East Total ACTION POINTS It is recommended that all regions continue to strengthen surveillance on meningitis. Periodic meetings of Public Health Emergency Management Committees should be held even in the absence of health emergencies to be apprised of disease trends. It is requisite that the 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 (PCR) Test. A lumbar puncture should be done and cerebrospinal fluid tested with Gram stain and latex agglutination for every case of meningitis; samples should be inoculated into Trans- Isolate bottles for confirmation by culture at the respective regional laboratories. Timely feedback from the laboratory to health facilities is strongly recommended. 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. Sentinel sites are encouraged to complete epidemiological forms for FluID. The case definitions of all priority diseases/conditions are to be adhered to by all Regions before classification as a suspected or probable case. Surveillance on viral haemorrhagic fevers should be enhanced in regions, districts, health facilities and the Points of Entry (ground crossings, 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. A feedback addressed to the Editor-In-Chief is also welcome. 6

10 ANNEX 1: SUMMARY OF REPORTED CASES/ EVENTS: WEEK 11 (WEEK ENDING 11 MARCH, 2018) Disease/Health Event Week 10 Week 11 Cumulative to Week 11 (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 , Cholera Dengue fever Diarrhoea with blood Dracunculiasis (Guinea worm) Influenza-like illness , Maternal deaths Measles Meningitis Neonatal tetanus Plague Public health event of international concern (PHEIC) Human rabies SARS Smallpox Yellow fever (suspected) NATIONAL TOTAL 1, , , *CFR does not include maternal deaths Ghana Weekly Ghana Epidemiological Weekly Epidemiological Report Vol. Report 3 Week Vol. 113 Week March February

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 8