INTEGRATED DISEASE SURVEILLANCE AND RESPONSE (IDSR)

Transcription

1 INTEGRATED DISEASE SURVEILLANCE AND RESPONSE (IDSR) Surveillance Report Republic Of Zambia (Ministry Of Health) Reporting Period: 11/11/218 to 17/11//218. Epidemiology Bulletin: Week 46 Issue: 46 Issue 46 WEEKLY EPIDEMIOLOGY BULLETIN Week to 17 November 218 Highlights of the week Health Facility Completeness: 9% (1,958/2,173) Health Facility Timeliness 88% (1,92/2,173) Meningitis: 2 suspected cases from Eastern (1) and Luapula (1) Province. Both tested positive Acute Flaccid Paralysis (AFP): 1 AFP case was notified from Copperbelt (1). The specimen was sent for investigation of polioviruses Measles: 2 cases of suspected measles were reported from Eastern (1) and Lusaka (1) provinces. Cases are undergoing investigations. Dysentery: A total of 1,191 suspected cases were notified from all provinces Typhoid: There were no suspected cases of typhoid reported in this week Malaria: 121,328 cases of suspected malaria were reported. Out of these cases (99.9 %) were laboratory tested, the positivity rate was 42.6% HIV: Of the 49,655 persons tested this week, 2,114 were confirmed with a positivity rate was 4.3% Maternal Deaths: 14 Maternal deaths were registered from Lusaka (1), Muchinga (2), Northern (4), North- Western (2), Luapula (2), Western (2) and Central (1) Provinces Dog Bites: A total of 296 cases of dog bites were reported nationwide. Rabies: No cases of suspected of rabies were notified. Cumulative cases reported are 2 Regional Outbreaks Ebola Virus D sease, DRC: 366 cases report, 214 deaths CFR, 59%. Rabies. DRC: 26 Cases, 26 Deaths, CFR 1% Yellow fever, Ethiopia: 35 cases, 1 deaths, CFR 28.6% Cholera, DRC: 25,378 cases, 86 deaths, CFR 3.4% Humanitarian Crisis DRC: The prevailing crisis is ongoing and is deteriorating, particularly in Ituri, South Kivu, Maniema and Tanganyika provinces National IDSR Health Facility Reporting Rates by Province, Week 46, 218 Percentage timliness/completness Timliness Completeness Target 8% Central Copperbelt Eastern Luapula Lusaka Muchinga North Western Provinces Northern Southern Western 1

2 Summary Report Priority Diseases, Conditions and Events for Weeks 1 to 46, 218 Week 46 Cumulative week 1 to 46 Disease Conditions Cases (Suspected) Cases (Tested) Cases (Confirmed) Number of Deaths Cases (Suspected) Cases (Tested) Cases (Confirmed) Number of Deaths AFP Cholera 5,936 2, Meningitis (Neisseria) Measles Neonatal Tetanus 4 Plague Rabies Dog bites ,667 Dysentery 1, ,184 3, Typhoid fever Yellow fever 7 VHF Anthrax 1 Influenza Non Bloody Diarrhea 1, , Schistosomiasis (Bilharzia) *Malaria 121,328 12,114 51,653 6,357,592 5,721,539 2,364,12 *HIV 49,655 2, ,763,55 73,447 Maternal Death ,698,227 Total 134,23 169,867 53, ,494,126 2,439, *Mortality for these conditions are currently not well captured on a weekly basis in IDSR 2

3 Early Warning Diseases Ebola Virus Disease, North Kivu DRC 218 The Ebola outbreak in North Kivu and the Ituri provinces of DRC is ongoing. 37 new cases and 9 new deaths were reported in this week. There are 366 cumulative suspected cases and 214 deaths (CFR is 59%) since beginning of outbreak. The epicentre of the outbreak is in the North Kivu Province within Mabalako 18% (67/329) and Beni 46% (163/329) health zones. 39 health care workers have been infected resulting in 11 deaths. Contact tracing was above 8% in all affected zones. New It has been observed that 5% of confirmed cases do not present fever symptoms which hinders their detection in health facilities and increase the risk of exposure for health workers. Security incidents and community resistance have continued to delay the implementation of ring vaccination around new confirmed cases. Vaccine Preventable Diseases Measles NUMBER OF SUSPECED CASES SUSPECTED M Suspected Cases IgM Positive M Chiengi D 35 Chazanga D EPIDEM Measles Reported Measles Cases by Districts, Weeks 1 to 46 3

4 A total of 2 cases of suspected measles were reported in week 46 and are undergoing laboratory investigations for measles IgM Cumulatively, out of the 482 cases reported, 261 (55.5%) have been tested for measles IgM, 19 cases have tested positive for measles IgM. There have been 5 deaths and the CFR is 1.3%. None of the cases had previous history of vaccination. 89% are cross border transmissions, originating from DRC. 3 districts have surpased the epidemic threshold for confmred cases, Lusaka District Mansa, Mwinilunga and Mpongwe districs. Response measures have included ring vaccintions in all affected areas. Silent districts (39) not reporting measles should intensify measles case based surveillance to increase the sensitivity of case detection and to attain the recommended non febrile rash rate of 2/1,. Rubella There has been a cumulative number of eight cases being positive for rubella IgM from Lusaka (2), Kasama (1), Kabwe (2), Lukulu (1), Kaoma (1) Itezhi Tezhi (1) (age range: 4 15). None have a history of vaccination. AFP Surveillance Weeks 1 to 46 Cumulative AFP Cases by Provinces for week 46 In the current reporting week, 1 case of AFP was reported from 1 province. From week 1 to 46, a total of 194 AFP cases have been reported through the IDSR platform from 77 districsts, 1% of those cases have been laboratory tested. 54 % (99) have been vaccinated. To date no wild type or vaccine derived polioviruses have been isolated from nationwide case based surveillance or environmental surveillance (Lusaka, Ndola and Kitwe Districts). 1 suspected PV3-SL (Polio Virus type 3 Sabin Like) has been isolated and 16 Non Polio Enteroviruses (Central, Copperbelt, Luapula, Northern, North Western & Southern Provinces) The annualized non polio AFP rate of week 46 is 2.4/1,. Sub-national indicators have not yet been met in 3 of the 1 provinces which are reporting below the national target of 2/1,. Silent districts not reporting AFP should intensify AFP case based surveillance to detect at least 1/1,. 4

5 Performance of AFP Surveillance, 218, Zambia (Data submitted from provinces (w eek 46, 218) 218 Annual All Only Annualized AFP cases C ompatible AFP AFP cases w ith N o n-po lio Confirmed estimates Expected Reported AFP Non-polio w ith 2 stools (viro lo gic AFP cases pending Lab entero virus <15 pop AFP Cases in cases w ithin 14 days C las s ific atio n Detection w ith results cases (million) Cases database AFP rate (-14d) % VDPV Wild system) rate results # % # % % % 4 2% % % 3 8% % % % % % 3 11% % % % % % % % % 2 22% % % 3 13% % % 1 1% % % % % % 16 8% 2. Surveillance index ap Key: 1). Non - polio AFP rate - target > 2 per 1, under 15 years children FP rate - certification level BUT surveillance gap for stool adequacy 2). AFP cases with stool samples within 14 days (stool adequacy) - target > 8% provinces w ith operational + certification-level surveillance 3). Surveillance index - target > 1.5 4). Non-polio enterovirus rate - target > 1% Environmental surveillance- AFP ENVIRONMENTAL SURVEILLANCE - COLOUR GRAPH ZAMBIA Site Name Epidemiological Week 218 Province - Lusaka Manchinchi Treatment Plant Kaunda Square Site Chelstone Treatment Plant Ngwerere Treatment Plant Province - Copperbelt New Kanini Sewer Treatment Plant Masala Sewer Line Nkana East Treatment Plant Mindolo Treatment Plant Not scheduled 6 Sabin-Like 11 WPV1+cVDPV2 16 NEV + NPEV 2 Pending 7 NPEV + Sabin-Like 12 Sent for sequencing 17 NEV + Sabin-Like 3 Negative 8 cvdpv2 13 Scheduled but not collected 4 NEV 9 WPV1 14 Sabin 2 5 NPEV 1 WPV3 15 Sabin-Like + NPEV + NEV Copperbelt: Of the 37 samples tested from the 4 sites, isolates have included 89% ( 33) poliovirus, 1 has been negative and 2 had NPEV. Mixed isolates containing both PV1 SL and PV3 SL were frequently isolated 63 % of all differentiated results Lusaka: Results from 47 samples tested from the 4 environmental sampling sites yielded 1 negative, 19 NPEV and 18 poliovirus isolates. Of the poliovirus isolates the vaccine PV3 SL has been most frequently reported accounting for 44% (8) of the suspected poliovirus. Overall the continued isolation of NPEV for Lusaka shows the ability of the system to detect any vaccine derived PV or importations. 5

6 High Burden Diseases Comparison of Cumulative Incidence of HIV and Cumulative Incidence of TB Cumulative Incidence of confirmed TB weeks 1-46 Cumulative Incidence of confirmed HIV weeks 1-46 Of the 2,585 cases suspected for TB, 256 have been confirmed positive. Cumulatively Lusaka and Copperbelt Provinces have the highest mean confirmed incidence of 3.3/1, and 3.1/1, respectively from weeks 1 to 46. Lusaka and Copperbelt Provinces have reported the highest burden of disease in week 46 with the incidence of 3.7/1, and 3.1/1, respectively. Dog Bites and Rabies Rabies Countrywide 49,655 people were tested for HIV. Central province reported the highest burden of new positive cases in the week with 26.65/ 1, followed by Lusaka province with 23.5/1,. Cumulatively Central and Lusaka Province have reported the highest mean confirmed incidence of 23.97/1, and 22.6/1, from weeks 1 to 46. Dog Bites Percentage of Rabies Cases by Province 4% 15% 5% 5% 5% 5% 15% 1% Central Copperbelt Eastern Luapula Lusaka Muchinga Northern North Western There have been no new rabies case reported this week resulting in a death. Cumulatively there have been 2 rabies cases with Western having the highest burden, reporting 4 % (8/2) of the cases. Number of Dog BItes per week Number of Dog Bites from week 1 until week Epidemiological Week The total number of dog bites reported from all provinces was 296. Central province had the highest number of 66 dog bites. Since the beginning of the year there have been 14,463 dog bites have been reported nationwide through IDSR and 2 rabies deaths. The average dog bite per week to date is 314 6

7 Maternal Death Reported Weeks 1 to 46, 218 Cumulative number of Maternal Deaths weeks 1-46 Maternal Deaths per week, Week 46 Province Week 46 Cumulative Eastern 8 Lusaka Muchinga 2 43 Southern 7 Northern 4 64 NWP 2 42 Copperbelt 7 Central 1 62 Luapula 2 54 Western 2 44 Total maternal deaths were reported in week 46. Maternal death causes are not indicated. Cumulatively, 643 maternal deaths have been recorded up to the current week with Lusaka having the highest burden of 114 cumulative deaths from week 1 followed by Eastern province at 8 reported deaths. Non-bloody Diarrhea, Week 1 to 52 comparison of 215 to Trends in Non Bloody Diarrhea 215 to 218 Number of cases Week Epidemiological week The cumulative number of cases of non-bloody diarrheas cases in week 46 is 354,956 from 9 reporting provinces. The epi-curve depicts a seasonal decrease in the number of non-bloody diarrheas starting from approximately week 38 reported however in week 43 and 45, only 7 provinces reported non-bloody diarrhea cases which attributes to the large drop in suspected cases. Cumulatively Southern province has reported the highest number of non-bloody diarrheas from week 1 with 1,121 cases. District surveillance officers are urged to strengthen surveillance to ensure adequate epidemic preparedness measures are in place for possible outbreaks. 7

8 Typhoid cases reported from week 1 to week 46, Typhoid cases reported per week Number of cases Epidemiological cases There have been no cases of typhoid reported in this week. Cumulatively there have been 63 cases of typhoid reported Lusaka has reported the highest number of cumulative cases of typhoid at 369. Based on previous reports the provinces are urged to continue community sensitization of the risks of typhoid transmission and distribution of chlorine to affected districts. National Trend of Reported Malaria Cases, Weeks 1 to 46, Malaria Suspected Tested Positivity Rate 8,% 7,% 6,% NUmber of cases ,% 4,% 3,% Positivity Rate 2,% 5 1,% Epidemiological Week,% Suspected malaria cases notified in week 46 were 121,238 and confirmed cases was 51,653 (incidence = 3.6/1) while the positivity rate was 42.6%. The province with the highest burden of confirmed malaria in the current week was Luapula Province with an incidence rate of 1.9/1. Cumulatively, North-Western has been reporting the highest mean incidence of malaria of 12.17/1 per week, from week 1 to week 46. North Western province is encouraged to intensify vector control and case management in these high transmission provinces. 8

9 Public Health Actions NATIONAL LEVEL Zambia National Public Health Institute to continue training of front line health workers in IDSR Zambia National Public Health Institute to ensure provinces have generic and disease specific IDSR notification and reporting tools ZNPHI to distribute all EVD, Cholera Registers and other surveillance tools to all Provinces Timely submission of weekly bulletins REGIONAL LEVEL Provinces to ensure priority disease notifications are supported by appropriate laboratory investigations from specified regional or national reference laboratories to confirm presence or absence of disease. Provinces to ensure reported neonatal tetanus and rubella cases are thoroughly investigated Heighted EBV Disease Surveillance All provinces to continue to enforce Ebola preparedness measures at health facilities and points of entry (ground crossings, airports and ports) Suspected EVD cases meeting the case definition must be immediately reported to the next level and Zambia National Public Health Institute All districts, health facilities and ports of entry to ensure they have appropriate surveillance tools for Ebola Virus disease investigation Blood specimens from EVD suspected cases should be appropriately packaged and sent for laboratory investigations to UNZA Veterinary Laboratory Lusaka Heightened Surveillance of Acute Watery Diarrhea (Cholera) Ministry of Health and all key line Ministries to continue with cholera prevention activities All regions are urged to have preparedness and response measures in place for Cholera prevention and control Cholera epidemic prone regions should conduct public education on preventative measures and work with relevant stakeholders to prevent a cholera outbreaks Vaccine Preventable Disease Surveillance in Silent Districts All silent districts with no reports of measles cases are urged to strengthen measles case based surveillance especially in districts bordering DRC due to the increase in cross border transmissions, all suspected cases to have at least one sample laboratory tested for measles by the national reference laboratory AFP silent districts to ensure active surveillance of AFP cases is intensified in all districts Provincial Surveillance Officers to fully investigate rubella positive cases in women of the child bearing age Increase public awareness of Congenital Rubella syndrome prevention Ensure this bulletin is shared with other district heads, surveillance officers and health facilities All suspected cases of Neisseria meningitis to be sent to National Reference Laboratory for confirmation 9

10 eported Diseases, Conditions and Events by Province, Week Notifiable Diseases Eastern Lusaka Muchinga Southern Northern North- Western Copperbelt Central Luapula Western Total AFP 1 1 Cholera Meningitis (Neisseria) Measles Neonatal Tetanus Plague Rabies 1 1 Dog bites Dysentery ,191 Typhoid fever Yellow fever VHF Anthrax Influenza Non Bloody Diarrhea 1,111 2, ,71 1,562 1, ,839 Schistosomiasis (Bilharzia) Malaria 14,827 6,275 11,961 3,667 16,721 16,137 1,851 12,59 24,244 4,55 121,328 HIV Maternal Deaths Total 16,136 9,137 12,67 3,997 17,259 18,34 12,552 14,553 25,386 4, ,24 IDSR data on priority diseases is collected from health facility data collection tools and registers by district surveillance officers on a weekly basis Reported by: Surveillance and Disease Intelligence Unit Date: 23 rd November, 218 Zambia National Public Health Institute (ZNPHI) 1

11 IDSR BULLETIN 218 1