IDSR Epidemiology Bulletin 2017 Epi Week 08 (February 20 – 26)

Country Population: 4,373,279 l Volume 06, Issue 08, 20 – 26 Feb. 2017 l Data Source: CSOs from 15 Counties and Lab Highlights

Figure 1. Public Health Events Reported in Epi-week 8 Keynotes and Events of Public Health

Significance

 99.9% completeness in reporting

coverage.

 99% timeliness (4 facilities in

Gbarpolu and 2 facilities in

Nimba reported late).

 Annual review meeting ongoing

in .

 One attributable measles death

was reported, among 40

suspected cases.

 Ten suspected measles cases

reported from Counties

bordering Guinea.

Reporting Coverage 

Table 1. Weekly IDSR Reporting Coverage, Liberia, Epi-week 8, 2017

Number of Number Expected of Number 760 (99.9%) Report from Reports Received Completeness Timeliness Health facilities County Health Facility Received on Time (%) (%) out of 761 Bomi 23 23 23 100 100 reported IDSR Bong 55 55 55 100 100 data Gbarpolu 15 15 11 100 73 Grand Bassa 33 33 33 100 100 Grand Cape Mount 32 32 32 100 100 Grand Gedeh 24 24 24 100 100 90 (100%) Grand Kru 19 19 19 100 100 Health districts out of 90 Lofa 59 59 59 100 100 reported IDSR Margibi 44 44 43 100 100 data Maryland 25 25 25 100 100 Montserrado 284 284 284 100 100 Nimba 75 74 73 98.7 98.6 Rivercess 19 19 19 100 100 99% Health Facility River Gee 19 19 19 100 100 timeliness for Sinoe 35 35 35 100 100 weekly IDSR Liberia 761 760 754 99.9 99 reporting

Legend ≥80 ≤80

 The national target for weekly IDSR reporting is 80%.

IDSR Weekly Epidemiology and Surveillance Bulletin Page 1

Liberia IDSR Epidemiology Bulletin 2017 Epi Week 08 (February 20 – 26)

Vaccine Preventable Diseases Measles Figure 2. Comparison of Suspected Cases of Measles Figure 3. Distribution of Suspected Measles Cases Re ported, Liberia, Epi-week 1- 8, 2016 & 2017 Reported, Liberia, Epi-week 8, 2017

Heighten Surveillance due to Guinea Outbreak

 Forty (40) suspected cases were reported. Montserrado (14), Grand Cape Mount (7), Bomi (6), Bong (5), Lofa (3), Nimba (2), Grand Gedeh (1), Grand Bassa (1) and Maryland (1).

 One attributable death reported from , Bong County.

 Compared to the same week in 2016, there is an observed 6% decrease in the number of suspected

cases reported.

 All the seven (7) cases reported from came from Bo-Waterside Community, Tewor District.  Three (3) positive results received, of which two were reported for week 8 (Montserrado) and one for week 7 (Rive Gee).  Of the forty (40) cases, two (2) tested positive, nineteen (19) negative and nineteen (19) pending laboratory confirmation.  Of the forty (40) suspected cases, 16 (40%) were reported to have been previously vaccinated, 21 (52.5%) had unknown status and 3 (7.5%) were not vaccinated.

 Fifteen (37.5%) of the suspected cases were < 5 years and 25 (62.5%) were ≥ 5 years.  Cumulatively since Epi-week 1, two hundred twenty-seven (227) suspected cases have been reported, of which ten (10) tested positive, one hundred fifty-one (151) negative, seven (7) equivocal, and twelve (12) pending laboratory confirmation.

Acute Flaccid Paralysis (Polio)  Four (4) cases were reported. Nimba (2), Grand Gedeh (1) and Lofa (1).  Specimens were collected for all cases.  All samples are pending laboratory confirmation.  Cumulatively since Epi-week 1, thirty (30) cases have been reported, of which twenty-one (21) have been tested negative for poliovirus and nine (9) pending laboratory confirmation. ***Note: According to the laboratory data, 3 of the cases from had inadequate stool and one (1) case from has date of onset in 2016. This affected the cumulative result from 32 to 30.

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Liberia IDSR Epidemiology Bulletin 2017 Epi Week 08 (February 20 – 26)

Table 2: Non-polio AFP rate/100,000 <15yrs, Liberia, Epi weeks 1 - 8, 2017 Non- # of cases <15 % of Reported Polio <14 days # of % of County years stool AFP specimen NPENTs NPENT pop <14days Rate collected Bomi 45639 3 42.7 3 100 0 0 Bong 180932 1 3.6 1 100 0 0 Gbarpolu 45243 0 0 0 0 0 0 Grand Bassa 120281 2 10.8 2 100 2 100 Grand Cape Mount 68945 1 9.4 1 100 0 0 Grand Gedeh 67959 3 28.7 3 100 0 0 Grand Kru 31421 0 0 0 0 0 0 Lofa 150214 4 17.3 4 100 0 0 Margibi 113895 8 45.7 8 100 2 25 Maryland 73754 0 0 0 0 0 0 Montserrado 606708 0 0 0 0 0 0 Nimba 250675 5 13.0 5 100 1 20 Rivercess 36237 3 53.8 3 100 1 33 River-Gee 38798 0 0 0 0 0 0 Sinoe 55553 0 0 0 0 0 0 Liberia 1886254 30 9.3 30 100 6 20

Non-Polio AFP <2 Stool <80% Non-Polio <10% Silent Rate ≥2 Adequacy ≥80% Enterovirus ≥10%

Neonatal Tetanus  One (1) case was reported from Bong County.  Cumulatively since Epi-week 1, three (3) cases have been reported.

Viral Hemorrhagic Diseases Ebola Virus Disease (EVD)  Four (4) suspected cases were reported. Bong (1), Grand Cape Mount (1), River Gee (1) and Nimba (1).  Specimens were collected from all and samples that were pending laboratory confirmation have been tested  Cumulatively since Epi-week 1, two hundred forty-eight (248) suspected cases have been reported and all tested negative. Lassa fever  Zero suspected cases were reported.  Cumulatively since Epi-week 1, twelve (12) suspected cases have been reported, of which, three (3) tested positive, and eight (8) negative. Yellow fever  Two (2) suspected cases were reported from Grand Cape Mount (1) and Nimba (1).  Specimens were collected from all of the suspected cases and are pending laboratory confirmation.  Cumulatively since Epi-week 1, forty-two (42) suspected cases have been reported, of which, twenty- three (23) tested negative and nineteen (19) pending laboratory confirmation.

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Liberia IDSR Epidemiology Bulletin 2017 Epi Week 08 (February 20 – 26)

Meningitis  One (1) suspected case was reported from .  Cumulatively since Epi-week 1, five (5) suspected cases have been reported.

Events of Public Health Importance Maternal Mortality Figure 4. Weekly Distribution of Maternal Death Table 3. Primary Causes of Maternal Death, Reported, Liberia, Epi-week 8, 2017 Liberia, Epi-week 1 - 8, 2017 (n=40)

Maternal Death Proportion Percentage Post-partum hemorrhage 12 30 Sepsis 6 15 Congestive Heart failure 3 7.5 Anemia 5 12.5 Renal failure 2 5 Multiple organ failure (herbal ingestion-1) 2 5 Pre-eclampsia 2 5 Ruptured uterus 2 5 Dissimilated intravascular coagulation 1 2.5 Amniotic fluid embolism 1 2.5 Cardiac pulmonary failure 1 2.5 Respiratory Distress 1 2.5 Abruptio placenta 1 2.5 Umbilical Hernia (Omphalocele) 1 2.5 Total 40 100

 Six (6) maternal deaths were reported. Montserrado (2), Lofa (2), Bong (1) and River Gee (1).  Primary causes of death were postpartum hemorrhage (2), sepsis (2), anemia, and abruptio placenta.

(see Figure 4).  All of the deaths were reported to have occurred in health facilities.

 Cumulatively since Epi-week 1, forty (40) deaths have been reported.

Neonatal Mortality

 Fifteen (15) neonatal deaths were Figure 6. Primary Causes of Neonatal Death, Liberia, Epi-week 1 - 8, 2017 (n=85) reported. Montserrado (4), Nimba

(4), Bong (2), Rivercess (2), Maryland (1), Grand Bassa (1), and Lofa (1).  Reported causes of deaths were birth asphyxia (10), neonatal sepsis (4), and preterm.

 Cumulatively, since Epi-week 1,

eighty-five (85) neonatal deaths have been reported. (see Figure 6)

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Liberia IDSR Epidemiology Bulletin 2017 Epi Week 08 (February 20 – 26)

Table 4. Counties Reporting Neonatal Death in Liberia, Epi-week 8, 2017 County(n=31) Number of Deaths Rate of deaths/100,000 live births Montserrado 4 7 Nimba 4 17 Bong 2 12 Rivercess 2 58 Maryland 1 14 Grand Bassa 1 9 Lofa 1 7 Total 15 100

Human Exposure to Animal Bites (Suspected Rabies)  Forty-nine (49) reports of animal bites were reported. Montserrado (26), Nimba (7), Rivercess (4), Grand Bassa (4), Margibi (2), Grand Gedeh (2), Bomi (2), Bong (1) and Lofa (1).  Two specimens were collected from Rivercess County.  All of the persons bitten were given anti-rabies vaccine.  Cumulatively since Epi-week 1, three hundred (300) reports of animal bites have been documented.

Bloody Diarrhea (Shigellosis)  Nine (9) cases were reported from Sinoe (2), Bomi (1), Grand Kru (1), Nimba (1), Grand Gedeh (1), Margibi (1), Rivercess (1) and Grand Bassa (1).  Specimens were collected from all cases.  Five (5) of the cases were reported during week 8, of which one (1) case from District #4, was confirmed for shigellosis while eight (8) tested negative (some of these samples were collected during previous weeks).  Cumulatively since Epi-week 1, forty-nine (49) cases of bloody diarrhea have been reported.

Severe Acute Watery Diarrhea (Cholera)  Three (3) suspected cases were reported from Grand Bassa (1), Grand Gedeh (1) and Sinoe (1) Counties.  Specimens were collected from all three (3) cases and pending laboratory confirmation.  Cumulatively since Epi-week 1, fifteen (15) suspected cases of cholera have been reported.

Public Health Measures

National level Nineteen suspected measles cases reported from six i. Follow up with Counties to verify received reports/data. counties. ii. Laboratory testing of IDSR priority specimens ongoing at the National Reference Laboratory.  Ten neonatal deaths reported from six counties. iii. Follow Six upmaternal with counties deaths reported to conduct from maternalfour counties. deaths investigation, audit and recommendations made. iv. Ongoing polio campaign in all the 15 Counties v. Ongoing plan for annual IDSR Data Quality Assessment. vi. Ongoing IDSR data reclassification, validation and harmonization. vii. Planning is ongoing to conduct IDSR training rollout in all the 15 counties. viii. Revision of the data reporting tools for 2017 is ongoing. ix. Counties are encouraged to conduct health education for all public health diseases based on risk.

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Liberia IDSR Epidemiology Bulletin 2017 Epi Week 08 (February 20 – 26)

County Level Maternal and Neonatal Deaths  Montserrado, Lofa, Bong and River Gee review of the reported maternal deaths are ongoing. Viral Hemorrhagic Diseases (Yellow Fever & Lassa Fever)  Specimen was collected for all suspected Yellow Fever cases. Investigation ongoing in Grand Cape Mount and Nimba Counties. Vaccine Preventable Diseases  Cases management of reported cases with follow up investigation ongoing in all Counties.  VPD surveillance awareness along Liberia-Guinea border health facilities in Bong, Lofa and Nimba.  Assessment of border health facilities preparedness to manage measles cases.  CHT teams conducted sensitization of Joint Security/Immigration Officers and communities at PoE on active case finding. Human Exposure to Animal Bite  Cases of animal bites (suspected human rabies) received post-exposure prophylaxis (anti-rabies vaccine) in Montserrado, Nimba, Rivercess, Grand Bassa, Margibi, Grand Gedeh, Bomi, Bong and Lofa Counties.

Note  Completeness refers to the proportion of expected weekly IDSR reports received (target: ≥80%).  Timeliness refers to the proportion of expected weekly IDSR reports received by the next level on time (target: ≥80%). Time requirement for weekly IDSR reports: o Health facility - required on or before 5:00pm every Saturday to the district level o Health district - required on or before 5:00pm every Sunday to the county level o County - required on or before 5:00pm every Monday to the national level  Non-polio AFP rate is calculated by dividing the number of reported non-polio AFP cases by the expected cases per 100,000 populations under 15 years of age (annual target: ≥2/100,000).  Non-measles febrile rash illness rate refers to the proportion of discarded measles cases per 100,000 population.  Annualized maternal mortality ratio refers to the maternal mortality ratio of a given period less than one year and it is the number of maternal deaths per 100,000 live births.  Epi-linked refers to any suspected case that has not had a specimen taken for serologic confirmation but is linked to a laboratory confirmed case.  Confirmed case refers to a case whose specimen has tested positive on laboratory testing.  Case Fatality Rate (CFR) is the proportion of deaths among confirmed cases.

Epidemiological bulletin published with support of WHO and CDC

For comments or questions, please contact

Thomas K. Nagbe, PA Dip., BSc, MPH

Director, Disease Prevention and Control National IHR Focal Person

Ministry of Health Republic of Liberia Email: [email protected] Phone: 0886 937386/0777442444 Website: www.moh.gov.lr

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Liberia IDSR Epidemiology Bulletin 2017 Epi Week 08 (February 20 – 26)

Appendix 1: Summary of immediately reportable diseases, conditions, and events by County during Epi week 08 and cumulative reports, Liberia, 2017

sure to

VHF

Lassa Lassa

Fever

Other

(Polio)

Tetanus

Measles

Paralysis

Neonatal (Cholera)

Meningitis

Districts

reported

(Shigellosis)

Animal bites Animal

Yellow Fever

Severe Acute

Acute Flaccid Acute Flaccid

EVD) (including

Diseases/Events

No. of Health ofNo. Health

Bloody Diarrhoea Bloody

Watery Diarrhoea Diarrhoea Watery

(Suspected Rabies)

Maternal Mortality Maternal

Neonatal Mortality Neonatal Expo Human

Counties District ofNo. Health A D A D A D A D A D A D A D D D A D A D A D A D Bomi 4 4 0 0 1 0 0 0 2 0 0 0 6 0 1 0 0 0 0 0 0 0 0 0 0 0 Bong 8 8 0 0 0 0 0 0 1 0 0 0 4 1 0 0 1 2 1 0 0 1 0 0 0 0 Gbarpolu 5 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Grand Bassa 8 8 0 0 1 0 3 0 4 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 Grand Cape Mount 5 5 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 1 1 0 0 0 Grand Gedeh 6 6 1 0 1 0 0 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 Grand Kru 5 5 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Lofa 6 6 1 0 0 0 0 0 1 0 0 0 3 0 0 0 2 1 0 0 0 0 0 0 0 0 Margibi 4 4 0 0 1 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Maryland 6 6 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 Montserrado 7 7 0 0 0 0 0 0 26 0 0 0 14 0 0 0 2 4 0 0 0 0 0 0 0 0 Nimba 6 6 2 0 1 0 0 0 7 0 0 0 2 0 0 0 0 4 0 0 0 1 1 0 0 0 Rivercess 6 6 0 0 1 0 0 0 4 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 River Gee 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 Sinoe 10 10 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total Weekly 90 90 4 0 9 0 3 0 49 0 0 0 40 1 1 0 6 15 1 0 0 4 2 0 0 0

Cumulative Reported 30 0 49 0 15 0 300 0 10 2 227 1 5 1 40 84 3 0 19 248 42 0 149 10

Cumulative Confirmed 0 0 1 0 0 0 0 0 0 1 10 0 0 0 0 0 0 0 0 0 0 0

Note: A = Alive, Acknowledgments-MoH: Roseline George – Deputy Director/DPC; Advertus N. Mianah – Surveillance Coordinator/DPC; Irene Pewu – Epidemiologist/DPC; Lasee W. Cole, Musand M. Kromah, T. Lafayette Hall & Samuel Zayzay – Disease Investigators/DPC; Trokon O. Yeabah – Data Manager/DPC; D = Dead Partners: Cheryl L. Williams – Epidemiologist/CDC; Esther N. Muwanguzi, George S. Williams & Kwuakuan D.M. Yealue – Epidemiologists/WHO

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