H5N1

NCDC: Weekly epidemiological report

Via the Nigeria Centre for Disease Control: Weekly Epidemiological Report, week 9.

The Lassa fever outbreak in Nigeria continued in the 10th Epi-week with a total of 1386 suspected cases reported across 19 affected states. Of this, 374 cases have been classified as: 365 confirmed cases, 9 probable cases with 90 deaths (81 in Lab confirmed and 9 in probable) recorded giving a case fatality rate (CFR) of 24%.  

In the last three weeks, there has been a steady decline in the number of confirmed cases reported, from 54 in Epi-week 8 to 35 in Epi-week 9 and 12 in Epi-week 10. Historically, a steady decline in the number of cases reported is an indication of a gradual exit from the peak period of the disease. 

The decline in the number of new cases can be linked to the enhanced response activities in the last few weeks. However, it is important to note that additional efforts need to be place on actively searching for cases and ensuring they are all tested for Lassa fever. 

This has necessitated the deployment of active case teams to the three hotspot states of Edo, Ondo and Ebonyi State to support active case search and contact tracing activities in these states. The expected outcomes of these activities is to 

1. Identify and list all contacts of confirmed Lassa fever patients  

2. Monitor all listed contacts for 21 days  

3. Refer all symptomatic contacts for Lassa fever testing  

4. Follow up all symptomatic cases who become positive and refer immediately to designated treatment centres. 

5. Active search in communities for suspected cases and ensure lab investigations are carried out for them.  

It is expected that these activities will provide more information for the Lassa fever Emergency Operation Centre (LF-EOC) to work with. The deployed teams are expected to carry out these activities for 21 days and provide daily updates from the field. Updates on the outbreak and control efforts are provided on different print and electronic media platforms and on the NCDC social media platforms and website: www.ncdc.gov.ng 

SUMMARY OF REPORTS 

In the reporting week ending on March 4, 2018: 

o There were 153 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o 12 suspected cases of Cholera were reported from three LGAs in three States (Bauchi – 6, Kaduna – 4 & Kano – 2). Of these, two were laboratory confirmed and two deaths were recorded. 

o 32 suspected cases of Lassa fever were reported from 17 LGAs in 13 States (Bauchi – 1, Benue – 1, Borno – 1, Edo – 3, Ekiti – 1, Enugu – 1, FCT- 1, Gombe – 1, Kogi – 4, Nasarawa – 1, Ondo – 12, Plateau – 1 & Taraba - 4). Six were laboratory confirmed and four deaths were recorded.  

o There were 236 suspected cases of Cerebrospinal Meningitis (CSM) reported from 75 LGAs in 15 States (Adamawa – 5, Bauchi – 3, Benue – 1, Borno – 3, FCT – 1, , Gombe - 5, Jigawa – 28, Kaduna – 1, Kano – 11, Katsina - 48, Kebbi – 19, Niger – 1, Sokoto – 21, Yobe - 11 & Zamfara - 78). Of these, four were laboratory confirmed and 19 deaths were recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt and case-based surveillance commenced from 4th December 2017  

o There were 534 suspected cases of Measles reported from 34 States. None was laboratory confirmed and two deaths were recorded.  

In the reporting week, all States sent in their report. This is a remarkable improvement! Timeliness of reporting remains 85% in both previous & current weeks (week 8 & 9, 2018) while completeness also remains 100% at the same period. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak

NCDC: Epidemiological report, week 1

Via the Nigeria Centre for Disease Control, an excerpt from its Weekly Epidemiological Report for week 1:

In the reporting week ending on January 5, 2018: 

o There were 56 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o 84 suspected cases of Cholera were reported from 13 LGAs in four States (Bauchi – 9, Borno – 3, Kaduna – 2 & Kano – 70). Of these, one was laboratory confirmed and five deaths were recorded. 

o Four suspected cases of Lassa fever were reported from four LGAs in four States (Bauchi – 1, Edo – 1, FCT - 1 & Nasarawa – 1). One was laboratory confirmed and one death was recorded.  

o There were 33 suspected cases of Cerebrospinal Meningitis (CSM) reported from 20 LGAs in six States (Ebonyi – 2, FCT -1, Katsina - 9, Plateau – 2, Sokoto – 4 & Zamfara – 15). Of these, eight were laboratory confirmed and no death was recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt and case based surveillance commenced from 4th December, 2017.

o There were 144 suspected cases of Measles reported from 23 States. None was laboratory confirmed and one death was recorded. 

In the reporting week, Imo, Kebbi, Oyo and Taraba States failed to report. Timeliness of reporting is 86% in both previous and current weeks (Week 52, 2017 and Week 1, 2018) while completeness is 100% and 89% at same period. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

NCDC: Epidemiological summary, week 51

Via the Nigeria Centre for Disease Control, an except from its latest epidemiological summary:

In the reporting week ending on December 24, 2017: 

o There were 70 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o 172 suspected cases of Cholera were reported from 16 LGAs in two States (Kaduna – 2 and Kano – 170). Of these, four were laboratory confirmed and five deaths were recorded. 

o Eight suspected cases of Lassa fever were reported from seven LGAs in six States (Bauchi – 3, FCT – 1, Gombe – 1, Kogi – 1, Lagos - 1 & Ondo - 1). One was laboratory confirmed and one death was recorded.  

o There were 17 suspected cases of Cerebrospinal Meningitis (CSM) reported from 13 LGAs in five States (Cross River – 1, Kano – 4, Katsina - 10, Oyo – 1 & Sokoto – 1). Of these, one was laboratory confirmed and one death was recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt and case based surveillance commenced from 4th December, 2017.  

o There were 183 suspected cases of Measles reported from 23 States. None was laboratory confirmed and no death was recorded. 

In the reporting week, all States sent in their report. This is a remarkable improvement! Timeliness of reporting remains 86% in both previous and current weeks (Week 50 and 51) while completeness remains at 100%. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

NCDC: Week 50 summary

Via the Nigeria Centre for Disease Control, an epidemiological summary for week 50. Excerpt:

In the reporting week ending on December 17, 2017: 

o There were 113 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o 165 suspected cases of Cholera were reported from 14 LGAs in two States (Kano – 106 and Zamfara – 59). Six were laboratory confirmed and five deaths were recorded.  

o Six suspected cases of Lassa fever were reported from four LGAs in four States (Edo – 1, FCT – 1, Ondo - 1 & Osun - 3). Two were laboratory confirmed and one death was recorded.

o There were 53-suspected cases of Cerebrospinal Meningitis (CSM) reported from 13 LGAs in four States (Katsina - 9, Oyo – 4, Sokoto - 2 & Zamfara – 38). Of these, three were laboratory confirmed and four deaths were recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt and case based surveillance commenced from 4th December, 2017.  

o There were 238 suspected cases of Measles reported from 31 States. None was laboratory confirmed and two deaths were recorded.  

In the reporting week, all States sent in their report. This is a remarkable improvement! Timeliness of reporting remains 86% in both previous and current weeks (Week 49 and 50) while completeness remains at 100%. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

WHO: Situation update on meningitis C epidemic risk

On December 21, WHO published Situation update on meningitis C epidemic risk. Excerpt:

As bacterial meningitis season begins in West Africa this year, a convergence of factors is threatening the region with large outbreaks affecting millions. A new hyper-invasive strain of meningococcal meningitis serogroup C is circulating at the same time that an acute shortage of meningitis C-containing vaccine threatens to severely limit the region’s ability to minimize the number of persons affected. 

The risk of imminent large-scale epidemics is dangerously high. Last year alone, the Nm C strain caused 18,000 cases in Nigeria and Niger. Attack rates can be very high (up to 670 cases/100,000), population immunity is low, the strain is already circulating in neighboring countries of the African meningitis belt (Burkina Faso, Mali) and it showed a potential to spread outside the belt as observed in Liberia. 

Meningitis is a severe disease that can cause 20,000 to 200,000 cases in large-scale outbreaks. Those affected die in 10% of cases, and those who survive are at risk of severe neurological consequences. Epidemics of meningococcal meningitis hit the African meningitis belt in periodic waves and are frequently associated with the spread of new epidemic strains. 

Of the 6 serogroups (A, B, C, W, X and Y) known to cause epidemics, serogroup A was responsible for the most devastating large-scale outbreaks in this region. However, since the successful roll-out of the Men A conjugate vaccine since 2010, cases of serogroup A have fallen by 99%. 

The new serogroup C strain now represents the major risk of meningitis outbreaks in the region. According to WHO estimates validated by international meningitis experts, the worst-case expansion scenario could result in as many as 70,000 cases in the next two years. 

Urgent action is needed to prepare for the worst and minimize the potentially devastating impact of outbreaks in the region. But stocks of C-containing vaccine are alarmingly inadequate WHO calls on technical and operational partners, vaccine manufacturers, and donors to act now to increase the availability of meningococcal vaccines that protect against serogroup C. 

The 2018 emergency international stockpile has just 2.5 million doses of C containing vaccine. The immediate need is for an additional 10 million doses to complement the current stockpile for 2018-2019. The priority is for conjugate vaccines. Despite the high cost, they offer the best prospects for disease control by offering a long-lasting immune response.

Nigeria: NCDC weekly epidemiological report, week 47

Via the Nigeria Centre for Disease Control:

In the reporting week ending on the 26th of November, 2017: 

o There were 166 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o Seven suspected cases of Cholera were reported from three LGAs in three States (Anambra – 2, Bauchi – 1 and Kaduna – 4). None was laboratory confirmed and no death was recorded.  

o 25 suspected cases of Lassa fever were reported from four LGAs in (three States: Edo – 23, Nasarawa – 1 & Ondo - 1). Four were laboratory confirmed and no death was recorded.  

o There were 23 suspected cases of Cerebrospinal Meningitis (CSM) reported from nine LGAs in five States (Cross River – 1, Ebonyi – 1, Katsina -8, Sokoto – 3 & Zamfara - 10). Of these, none was laboratory confirmed and no death was recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt and case-based surveillance commenced from 4th December 2017.  

o There were 282 suspected cases of Measles reported from 30 States. One was laboratory confirmed and no death was recorded.  

In the reporting week, all States sent in their report. This is a remarkable improvement! Timeliness of reporting remains 85% in both previous and current weeks (Week 46 and 47) while completeness remains at 100%. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

Nigeria: Epidemiological report, week 44

Via the Nigeria Centre for Disease Control, an excerpt from the weekly epidemiological report for week 44:

In the reporting week ending on the 5th of November, 2017: 

o There were 192 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o 14 suspected cases of Cholera were reported from three LGAs in three States (Borno - 9, Cross River – 1 and Kaduna – 4). None was laboratory confirmed and three deaths were recorded. 

o Four suspected cases of Lassa fever were reported from four LGAs in (two States: Bauchi – 2 & Ondo -2). One was laboratory confirmed (Ondo) and no death was recorded. 

o There were 16 suspected cases of Cerebrospinal Meningitis (CSM) reported from eight LGAs in eight States (Abia -1, Adamawa – 1, Borno -1, FCT – 6, Osun – 1, Oyo – 3, Sokoto -2 & Taraba -1). Of these, none was laboratory confirmed and no death was recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt. 

o There were 362 suspected cases of Measles reported from 34 States. None was laboratory confirmed and one death was recorded. 

In the reporting week, Edo State failed to send in their report. Timeliness of reporting remains 85% in both previous and current weeks (Week 43 and 44) while completeness remains at 100%. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

The catastrophe of Saudi Arabia’s Trump-backed intervention in Yemen

Via The New Yorker, a concise and appalling report: The Catastrophe of Saudi Arabia’s Trump-Backed Intervention in Yemen. Excerpt:

In the main hospital in the Yemeni port city of Hudaydah this August, the malnutrition ward overflowed with patients. In the corridor, a man sat on the floor, with two children beside him whose ribs protruded under their pale skin. Inside the makeshift ward, every bed held two skeletal children. 

Saleha, a mother in her thirties, sat on the corner of a bed with her nine-year-old daughter, Fateena, on her lap. The child appeared thin and weak, and gasped for air. She urgently needed tests, according to doctors, but the hospital’s labs were overwhelmed. 

Saleha told me that the local hospital in her village was closed. It took the family three days of hitchhiking with strangers most of the way to reach the city, on the west coast of Yemen, and its hospital. 

“The war has really taken its toll on her,” Saleha told me, pointing to her daughter. “Now she just lays there until her body seizes again.” 

The staff of the government-run hospital said that they hadn’t been paid for months. “We are hungry, but we might as well come to work than starve to death at home,” one doctor told me. “We can’t go to war on the frontline but this is our way of fighting against the aggression, by saving people.” 

On Thursday, the heads of three United Nations relief agencies called on a nine-nation military coalition led by Saudi Arabia to end a tightened blockade it imposed on Yemen after Houthi rebels fired a ballistic missile into Riyadh, the Saudi capital, last weekend. 

“Closure of much of the country’s air, sea and land ports is making an already catastrophic situation far worse,” a joint statement issued by the United Nations Children’s Fund, World Food Program, and World Health Organization, said. “The space and access we need to deliver humanitarian assistance is being choked off, threatening the lives of millions of vulnerable children and families.” 

The U.N. officials said that more than twenty million people, including more than eleven million children, are in need of urgent humanitarian assistance; at least 14.8 million lack basic medical care, and a cholera outbreak has infected more than nine hundred thousand. 

Yemenis are caught in a nearly three-year conflict that began as a domestic power struggle and evolved into a brutal proxy war between Iran and Saudi Arabia, killing more than ten thousand people and shuttering more than half of the country’s medical facilities. 

Saudi armed forces, backed by more than forty billion dollars in American arms shipments authorized by the Trump and Obama Administrations, have killed thousands of civilians in air strikes. They have also blockaded the country to varying degrees for two years and intermittently prevented journalists and human-rights researchers from flying into the country.

NCDC: Epidemiological report, week 40

The Nigeria Centre for Disease Control has published the epidemiological summary for week 40. Its key feature is a report on monkeypox, but the overview gives a good sense of what the Nigerian healthcare system has to deal with:

In the reporting week ending on the 8th of October, 2017: 

o There were 204 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has assiduously reinvigorated its efforts at eradicating Polio. 

o 50 suspected cases of Cholera were reported from four LGAs (four States; Bauchi – 3, Borno – 35, Kaduna – 4 and Zamfara – 8). None was laboratory confirmed and one death was recorded.

o 11 suspected cases of Lassa fever were reported from eight LGAs in (eight State: Bauchi – 1, Benue – 2, FCT – 1, Katsina – 2, Kogi – 1, Kwara – 2, Ogun – 1 & Plateau -1). One was laboratory confirmed (Plateau) and no death was recorded. 

o There were two suspected cases of Cerebrospinal Meningitis (CSM) reported from two LGAs in two States (Ebonyi – 1 and Plateau - 1). Of these, none was laboratory confirmed and no death was recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt. 

o There were 244 suspected cases of Measles reported from 34 States. None was laboratory confirmed and no death was recorded. 

In the reporting week, Kaduna State failed to send in their report. Timeliness of reporting remains 84% in both previous and current weeks (Week 39 and 40) while completeness remains at 100%. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

Nigeria: NCDC weekly epidemiological report, week 32

Via the Nigeria Centre for Disease Control: Weekly Epidemiological Report, Week 32. NCDC's reports are a bit late, but very detailed—and not just on Lassa fever. Excerpt:

In the reporting week ending on the 13th of August, 2017: 

o There were 252 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has assiduously reinvigorated its efforts at eradicating Polio. 

o 92 suspected cases of Cholera were reported from eight LGAs (four States) with ten (10) laboratory confirmed case and four (4) recorded deaths. 

o There were 11 suspected cases of Cerebrospinal Meningitis (CSM) reported from six LGAs in six States. Of these, none was laboratory confirmed and no death was recorded. Ongoing surveillance for CSM has been intensified in the States. 

o There were 375 suspected cases of Measles reported from 30 States. None was laboratory confirmed and six deaths were recorded. 

In the reporting week, all States sent in their report. This is a remarkable improvement! Timeliness of reporting remains 83% in the previous and current weeks (Week 31 and 32) while completeness also remains at 100%. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak