Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

NIGERIA CENTRE FOR DISEASE CONTROL

Weekly Epidemiological Report Main Highlight of the week

AssessingtheeconomicimpactofMeningococcalMeningitisinNigeria

The Nigeria Centre for Disease Control (NCDC) in collaboration with the WorldHealthOrganization(WHO)hasbegunastudytoassesstheeconomicimpactofacutemeningitisinNigeriafocusingonthreeStatesintheNorthwestregion.This study isexpected to enhance the knowledge and understanding of theeconomic burden of acute meningitis for households and for health systems,following themasspreventivecampaignswith theconjugate vaccine MenAfriVacagainstNeisseriameningitidisserogroupA(NmA).Untilrecently,NmAhasbeentheleading cause of meningitis epidemics in the African meningitis belt, a regionstretchingfromSenegaltoEthiopiawith500millionpeopleestimatedtobeatrisk.Since 2010, a conjugate vaccine, MenAfriVac® was gradually introduced againstNmAincountriesoftheAfricanmeningitisbelt.ThemassvaccinationcampaignwascompletedinNigeriain2015.Thecampaignshadastrongimpact,withareductionofmore than99% in thenumberofmeningitiscasescausedbyNmA.Plansare inplacetointroduceMenAfrivacintheroutinevaccinationprogrammeinJuly2019inNigeria.

Issue: Volume 8 No. 40 19th October 2018

Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

As part of the project, NCDC and WHO organised a three-day investigator andnationalleveltrainingforsupervisorsandfielddatacollectorsinAbujafrom16–18October, 2018. The goal was to introduce all field participants to the surveymethodology and ensure full understanding of the field guide. Data collection atHousehold Level, Health Facility, LGA, State and National Level is expected tocommenceimmediatelyafter.This research project presents an opportunity for Nigeria to assess the economicimpactofmeningococcalmeningitisonthehealthcaresystemandhouseholds.Theresults from this research will help inform decision-making on the control ofmeningitis, including the introduction of a pentavalent vaccine that inducesimmunityagainstNmA,NmC,NmY,NmX,NmW.SUMMARYOFREPORTSInthereportingweekendingonOctober7,2018:

o Therewere 168 new cases of Acute Flaccid Paralysis (AFP) reported. Nonewas confirmed as polio. The last reported case of polio in Nigeria was inAugust2016.ActivecasesearchforAFP isbeing intensifiedwiththegoaltoeliminatepolioinNigeria.

o Therewere2042 suspected casesof Cholera reported from54 LGAs in tenStates (Adamawa – 95, Bauchi – 1, Borno – 710, Enugu – 6, Gombe – 42,Kaduna – 4, Kano – 25, Katsina – 631, Yobe - 153 and Zamfara - 375). Ofthese,tenwerelaboratoryconfirmedand13deathswererecorded.

o Therewere23suspectedcasesofLassafeverreportedfromsevenLGAsinsixStates (Abia–1,Bauchi–1,Ebonyi–7,Edo–7,Ondo-6&Oyo-1).Ninewerelaboratoryconfirmedandonedeathwasrecorded.

o TherewereninesuspectedcasesofCerebrospinalMeningitis(CSM)reported

from seven LGAs in six States (Ebonyi – 1, Enugu – 1, Katsina – 2, Kebbi – 2,Plateau-1&Yobe–1).Ofthese,nonewaslaboratoryconfirmedandnodeathwasrecorded.

Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

o Therewere232 suspected casesofmeasles reported from29States.Nonewaslaboratoryconfirmedandnodeathwasrecorded.

Inthereportingweek,allStatessentintheirreport.Timelinessofreportingremains87%inbothpreviousandcurrentweeks(39&40)whilecompletenessalsoremains99%atsameperiod.ItisveryimportantforallStatestoensuretimelyandcompletereportingatalltimes,especiallyduringanoutbreak.REPORTANALYSISANDINTERPRETATION1. AFP1.1. AsatOctober7th2018,nonewcaseofWPVwasrecorded1.2. Inthereportingweek,168casesofAFPwerereportedfrom141LGAsin33States

1.3. Betweenweek 1 and 40 2018, 6679 suspected cases of AFP have been reported

from750LGAsin37States1.3.1. AFP Surveillance has been enhanced and outbreak response is on-going in Borno

andotherhigh-riskStates1.3.2. The 2nd NIPDs was conducted from 30th June to 3rd July, 2018 using bOPV in 36

StatesplusFCT1.3.3. The1st&2ndOutbreakresponse(OBR)tocVDPV2inJigawa&GombeStates,Polio

eventinSokoto(SLGAs)andmop-upresponsein11LGAsinBauchiStateconductedfrom10th–13th&26th–29thMay,2018usingmOPV2respectively

1.3.4. TwoSIPDsandoneNIPDswereconductedfromJanuarytoApril,2018usingbOPVin

18highriskStatesand36StatesplusFCTrespectively

Table1:2018SIAs

Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

2. CEREBROSPINALMENINGITIS(CSM)2.1 In the reporting week, nine suspected Cerebrospinal Meningitis (CSM) cases were

reported from seven LGAs (six States; Ebonyi – 1, Enugu – 1, Katsina – 2, Kebbi – 2,Plateau-1&Yobe–1)comparedwithtwosuspectedcasesreportedfromtwoLGAs(twoStates)atthesameperiodin2017(Figure1)

2.2 Betweenweeks1and40(2018),4342suspectedmeningitiscaseswith318laboratory

confirmed and 357 deaths (CFR, 8.2%) from 288 LGAs (33 States) were reportedcomparedwith9807suspectedcasesand602deaths (CFR,6.1%) from316LGAs (33States)duringthesameperiodin2017.

2.3 Timeliness/completenessofCSMcase-reportingfromStatestotheNationalLevel(2018

versus2017):onaverage,88.2%ofthe26endemicStatessentCSMreportsinatimelymannerwhile98.2%werecomplete inweek1 -40,2018asagainst76.4%timelinessand92.3%completenessrecordedwithinthesameperiodin2017

Figure1:MapofNigeriashowingareasaffectedbyCSM,week1-40,2017&2018

3. CHOLERA3.1 2042suspectedcasesofCholerawith10Lab.Confirmedand13deaths (CFR,0.64%)

were reported from 54 LGAs (ten States; Adamawa – 95, Bauchi – 1, Borno – 710,Enugu–6,Gombe–42,Kaduna–4,Kano–25,Katsina–631,Yobe-153andZamfara-375) inweek40,2018comparedwith50suspectedcasesandonedeath (CFR,2.0%)reportedfromfourLGAs(fourStates)duringthesameperiodin2017(Figure2).

Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

3.2 Betweenweeks1and40(2018),26,780suspectedCholeracaseswith490 laboratoryconfirmed and 452 deaths (CFR, 1.7%) from 177 LGAs (26 States) were reportedcompared with 3418 suspected cases and 80 deaths (CFR, 2.3%) from 64 LGAs (19States)duringthesameperiodin2017.

3.3 ANationalEmergencyOperationsCentre(EOC)forCholerahasbeenactivatedatlevel

2atNCDC.3.4 Rapid Response Teams have been deployed to respond to recent cluster of cases in

Kano,Bauchi,Plateau,Zamfara,AdamawaandKatsinaStates.3.5 NCDCandpartnersconductedthedevelopmentofmediumtermstrategiesforCholera

controlincludingmappingofthehotspotsinNigeriaonthe19thofJuly,2018.3.6 National Preparedness and Response to AcuteWateryDiarrhoea/ CholeraGuidelines

availableviahttp://ncdc.gov.ng/themes/common/docs/protocols/45_1507196550.pdfFigure2:StatusofLGAs/StatesthatreportedCholeracasesinweek1-40,2017&2018

4 LASSAFEVER4.1 In the reporting Week 40 (1 – 7 October, 2018) nine new confirmediI cases were

reportedfromEdo(5),Ondo(2)andEbonyi(2)StateswithonenewdeathinEdoState

andthreedeathsinprobablecasesfromEbonyiState.

Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

4.2 From 1st January to 7th October 2018, a total of 2648 suspectedi cases have been

reportedfrom22states.Ofthese,523wereconfirmedpositive,15areprobable,2109

negative(notacase)

4.3 Sincetheonsetofthe2018outbreak,therehavebeen135deathsinconfirmedcases

and15inprobablecases.CaseFatalityRateinconfirmedcasesis25.8%

4.4 22stateshaverecordedatleastoneconfirmedcaseacross89LocalGovernmentAreas

(Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos,

Taraba, Delta, Osun, Rivers, FCT, Gombe, Ekiti, Kaduna, Abia, Adamawa and Enugu).

seventeenstateshaveexitedtheactivephaseoftheoutbreakwhilefive–Edo,Delta,

Ondo,BauchiandEbonyiStatesremainactiveiv

4.5 NCDCandPartnersdeployedRapidResponseTeam(RRT)toDeltaState

4.6 LassafeverinternationalConferenceregistration,abstractsubmissionandsponsorship

nowopentothepublicontheconferencewebsitewww.lic.ncdc.gov.ng

4.7 The Lassa fever nationalmulti-partner,multi-agency TechnicalWorkingGroup (TWG)

continues to coordinate response activities at all levels. Response and laboratory

supplieshavebeenprovidedtopriorityStates

4.8 NationalVHFguidelines (NationalViralHaemorrhagicFeversPreparednessguidelines,

InfectionPreventionandControlofVHFandStandardOperatingProceduresforLassa

fever management) are available on the NCDC website-

http://ncdc.gov.ng/diseases/guidelines

Figure3:DistributionofconfirmedLassafevercasesinNigeriaasat7thOctober,2018

Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

Figure4.DistributionofSuspectedandConfirmedLassaFevercasesinNigeriabyLGA5 MEASLES

5.1 Inthereportingweek,232suspectedcasesofmeasleswerereportedfrom29Statescomparedwith244suspectedcasesreportedfrom34Statesduringthesameperiodin2017

LEGEND

0 Case

1- 50 Confirmed cases

>50 Confirmed cases

≥1 Suspected cases

1 dot = 1 Confirmed case

Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

5.2 Sincethebeginningoftheyear,14671suspectedmeaslescaseswith901Lab.

Confirmedand116deaths(CFR,0.8%)werereportedfrom36StatesandFCTcomparedwith18559suspectedcaseswith108laboratoryconfirmedand105deaths(CFR,0.57%)from36StatesandFCT,duringthesameperiodin2017

5.3 Responsemeasuresincludeimmunizationforallvaccine-preventablediseasesinsome

selected/affectedwards/LGAsduringSIAs,aswellascasemanagement5.4 NCDCRRTconducteddetailedinvestigationofameaslesoutbreakinOgunStateFigure5:SuspectedMeaslesattackratebyStates,week1-40,2018asat7thOctober,2018

24.0

18.818.3

15.8

14.713.7

9.7 9.4 9.28.4 8.3

7.4 7.26.6 6.4 6.1 5.8 5.7 5.6 5.2 5.0 5.0 5.0 5.0 4.8 4.4 4.1

3.6 3.6 3.62.9 2.7 2.5 2.5 2.3 1.9 1.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

KTS BOS BAS SKS YBS EKS ABS KDS NAS KNS OGS OSS KBS ADS GBS ANS ENS OYS JIS CRS BNS BYS NGS ZFS TRS ODS IMS EBS KWS PTS EDS FCT AKS KGS DTS RVS LAS

Attackrate(100,000Po

pulation

)

States

6 Yellowfever

Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

6.1 Inthisreportingweek1st–7thOctober,2018,43suspectedcaseswerereported

6.2 Six new in-country presumptive positive cases and two inconclusive cases were

reportedfromthreediagnosticslaboratoriesinthereportingweek

6.3 The six in- country presumptive cases were from Edo State (1), Kogi State (2) Kebbi

State(1)andKatsinaState(2)

6.4 LastIPDakarconfirmedcasefromNigeriawason6thJune,2018

6.5 From theonsetof thisoutbreakonSeptember12,2017, a totalof 3,162 suspected

yellowfevercaseswith47Laboratoryconfirmedand54deaths(CFR,1.7%)havebeen

reportedfrom564LGAs(36States&FCT)

6.6 Yellow fever reactive vaccination campaigns conducted in the following States

[Kebbi(7LGAs),Niger(5LGAs),Sokoto(1LGA)&Katsina(1LGA)]

6.7 YellowfevervaccinationcampaignshavebeensuccessfullycompletedinsixStates

(Nassarawa,CrossRiver,Akwa-Ibom,Kogi,Kwara&Zamfara)and57politicalwards

in25LGAsinBornoState

6.8 SurveillanceactivitieshavebeenintensifiedacrossallStates

6.9 NPHCDA,NCDCandpartnersconcludedamicroplantraininginMinna,NigerState

forthesixStates(Borno,FCT,Kebbi,Niger,Plateau&Sokoto)implementingYellow

fever Preventive Mass Vaccination Campaign (PMVC) in November/December,

2018.

6.10 The2018phase2bNovemberPMVCtobeimplementedfrom22ndNovember–

1stDecember,2018inSokoto,Kebbi,Niger,FCT,PlateauandsomeLGAsinBorno

States.Targetpopulation9monthsto44years,(85%ofthetotalpopulation)

Figure6:MapofNigeriashowingStateswithsuspected/presumptive/confirmedcasesasatweek40,2018(asat7thOctober,2018)

Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

7. UpdateonnationalInfluenzasentinelsurveillance,Nigeriaweek1–41,2018

7.1. Fromweek1-41,284-suspectedcaseswerereported,ofwhich254wereInfluenzalike-illness(ILI),30SevereAcuteRespiratoryInfection(SARI).

7.2 A total of 284 samples were received and all samples were processed. Of the

processed samples, 254(89.4%) were ILI cases, 30 (10.6%) were Severe AcuteRespiratoryInfection(SARI).

7.3 Ofthe254processedILIsamples,16(6.3%)waspositiveforInfluenzaA;29(11.4%)positiveforInfluenzaBand209(82.3%)werenegative.

7.4 Fortheprocessed30SARIsamples,seven(23.3%)werepositiveforInfluenzaA,two(6.7%)waspositiveforInfluenzaB,whiletheremaining21(70.0%)werenegative.

7.5 Of the 284 processed samples, 54 (19.0%) were positive for Influenza, with 23(42.6%)ofthesepositiveforInfluenzaAand31(57.4%)positiveforInfluenzaB.

7.6 ThesubtypesAseasonalH3,2009A/H1N1andA/notsubtypedaccountfor(0.0%),19(82.6%)and4(17.4%)ofthetotalinfluenzaApositivesamplesrespectively.

7.7 The subtypesBVICTORIA,BNot subtypedandBYamagataaccount for23(74.2%),7(22.6%)and1(3.2%)ofthetotalinfluenzaBpositivesamplesrespectively

7.8 Thepercentageinfluenzapositivewashighest(75.0%)inweek6,2018

Weekly Epidemiological Report

Issue: Volume 8 No. 40

19th October 2018

7.9 Inthereportingweek1-41,allsampleswereprocessedintheLaboratory

Figure7:NumberofInfluenzaPositiveSpecimensandPercentPositivebyEpidemiologicalWeek(Week1-41,2018)FORMOREINFORMATIONCONTACTSurveillanceUnit:NigeriaCentreforDiseaseControl,801EbituUkiweStreet,Jabi,Abuja,Nigeria.epidreport@ncdc.gov.ngwww.ncdc.gov.ng/reports0800-970000-10Table2:StatusofReportingbytheStateEpidemiologists,Nigeria,Weeks1-40,2018,asat7thOctober,2018

Weekly Epidemiological Report

Issue: Volume 8 No. 40 19th October, 2018

Keys: <50% Poor 1 States

T= Arrived on Time 50-79% Good 7 States

L= Arrived late N Report not received 80-100% Excellent 29 States

N = No Report (Report not received)

1 Abia SEZ T T T T T L L L T L T T T T T T T L T T T T T L T T T T T L L T T L T L L T L T 40 28 12 0 70% 100%2 Adamawa NEZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T L L T T T T T T 40 38 2 0 95% 100%3 Akwa Ibom SSZ T T T T T T T T T T T T T T T T T T T T T T T L T N N N T T T T T T N T T L T T 40 34 2 4 85% 90%4 Anambra SEZ T T T T T T L T T T T T T T T T T T T T T T T T T T T T T T T T T T T L T T T L 40 37 3 0 93% 100%5 Bauchi NEZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T L L T T T T T T T 40 38 2 0 95% 100%6 Bayelsa SSZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 40 40 0 0 100% 100%7 Benue NCZ L T L T T T L L L L T T T l L L T T T T T T T T L T T L T T T T L T T L T T T T 40 27 13 0 68% 100%8 Borno NEZ T T T T T L T T T T T T T T T T T T T T T T T T T T T T T T T T L L T T T L L T 40 35 5 0 88% 100%9 Cross River SSZ T T T T T L L L L L T T T T T T T T T T T T T L T T L T T L L L L T T T T T L T 40 28 12 0 70% 100%

10 Delta SSZ T T T T L T L L T T T T T T T T T T N N N N T N T T N T T T T T T T N N T T T T 40 29 3 8 73% 80%11 Ebonyi SEZ T L L T T L T L T T T T L T T T T T T T T L T L T T T T T T T T T T T T T T T T 40 33 7 0 83% 100%12 Edo SSZ T T T T L L L L T T T T T T T T L T T T T T L T T L T T T T T T L T T L T T T T 40 31 9 0 78% 100%13 Ekiti SWZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T L T T T T T T T 40 39 1 0 98% 100%14 Enugu SEZ T T T T T T L T T T T T T T T T T T T T T T T T T T L T T T T T T T L T T T T T 40 37 3 0 93% 100%15 FCT NCZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T L T T T T T T T 40 39 1 0 98% 100%16 Gombe NEZ T T T L T T T L T T L T T T T T T T T T T T T T L L T T T T T T T L L T T T T T 40 33 7 0 83% 100%17 Imo SEZ L T T T T T T T T T T L T T T T T T T T L L T L T T L T T T T T T T T T T T T T 40 34 6 0 85% 100%18 Jigawa NWZ T T T L T L L T L L T L T T T L T L T T L T L L T L L L L T L T L T L L L L L L 40 17 23 0 43% 100%19 Kaduna NWZ T T T T T T T T T T L T T T T T T T L L T T L T T T L T L T T T T T T T T T T T 40 34 6 0 85% 100%20 Kano NWZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 40 40 0 0 100% 100%21 Katsina NWZ T T T T T T T T T T T T T T T T L T L L T T L T T T T L T T T T L L L T T L L T 40 30 10 0 75% 100%22 Kebbi NWZ L L L T L T L T T T T T T T L T T L T T T T T T T T T T T T T T T T T T T T T T 40 33 7 0 83% 100%23 Kogi NCZ T T T T T L T T T T T T T T T T T T L L T T T T T T T T T T T T T T T T T T T T 40 37 3 0 93% 100%24 Kwara NCZ T T T T T L T T T T T T T T T T T T T T T T T T T T T T T T T T T T L L T T L T 40 36 4 0 90% 100%25 Lagos SWZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T L T T T T T T L T 40 38 2 0 95% 100%26 Nasarawa NCZ T T T T T T L L T T T T T T T T T T T T T T T L T T T T T T T T T T L T T T T T 40 36 4 0 90% 100%27 Niger NCZ T T T T T T T T T T T T T T T T T T L L L T T T L L T T T T T T L T L T T T T T 40 33 7 0 83% 100%28 Ogun SWZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 40 40 0 0 100% 100%29 Ondo SWZ T T T T T T L L L T T T T T T T T L T T T T T T T T T T L T T T T T T T T T T T 40 35 5 0 88% 100%30 Osun SWZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 40 40 0 0 100% 100%31 Oyo SWZ L T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 40 39 1 0 98% 100%32 Plateau NCZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 40 40 0 0 100% 100%33 Rivers SSZ T T T T T T T L T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 40 39 1 0 98% 100%34 Sokoto NWZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 40 40 0 0 100% 100%35 Taraba NEZ L T T T T T T T T T T T T T T T T T T T T T T T T L L L L T L L L L L L L L T T 40 27 13 0 68% 100%36 Yobe NEZ T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 40 40 0 0 100% 100%37 Zamfara NWZ T T T T T T L T T T T L T T T T T T T T T L T T T L T T L T T T L T T T T L L T 40 32 8 0 80% 100%

Total number of reports expected (E) 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 1480Total reports sent on time (T) 32 35 34 35 34 29 25 27 33 33 35 34 36 36 35 35 35 33 32 32 33 33 33 29 34 30 29 32 32 35 33 33 24 31 27 29 34 31 29 35 1286

Total reports sent late (L) 5 2 3 2 3 8 12 10 4 4 2 3 1 1 2 2 2 4 4 4 3 3 4 7 3 6 6 4 5 2 4 4 13 6 8 7 3 6 8 2 182Total number of reports not received (N) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 1 2 1 0 0 0 0 0 0 2 1 0 0 0 0 12

Timeliness of reports =100*T/E 86.5 94.6 91.9 94.6 91.9 78.4 67.6 73.0 89.2 89.2 94.6 91.9 97.3 97.3 94.6 94.6 94.6 89.2 86.5 86.5 89.2 89.2 89.2 78.4 91.9 81.1 78.4 86.5 86.5 94.6 89.2 89.2 64.9 83.8 73.0 78.4 91.9 83.8 78.4 94.6 87%Completeness of reporting=100*(E-N)/E 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 97.3 97.3 97.3 97.3 100.0 97.3 100.0 97.3 94.6 97.3 100.0 100.0 100.0 100.0 100.0 100.0 94.6 97.3 100.0 100.0 100.0 100.0 99%

Latest Week 39

W11

Timely Reports

State GeoZones W01 W02 W03 W04 W05 W06 W07 W08 W09 W10 W23W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W35W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W36 W37 W38 W39 W40Late Rpts

(Ls)Rpts Not Recvd

(Ns)%

Timely%

Complete

Last updated 5th October, 2018

Expected (Es)Timely Rpts

(Ts)