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Republic of Liberia 2017 Annual Integrated Disease

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Republic of Liberia 2017 Annual Integrated Disease REPUBLIC OF LIBERIA 2017 ANNUAL INTEGRATED DISEASE SURVEILLANCE AND RESPONSE (IDSR) Preventing and Controlling BULLETIN Public Health Threats JANUARY – DECEMBER 2017 39 3 Disease Humanitarian Outbreaks Events Division of Infectious Disease and Epidemiology National Public Health Institute of Liberia Table of Contents EDITORIAL……………………………………………………………………………………………………………………………………..2 I. OVERVIEW OF IDSR IN LIBERIA………………………………………………………………………………………………... 3 II. IDSR PERFORMANCE…………………………………………………………………………………………………………….. 3 A. Reporting Coverage…………………………………………………………………………………………………………….….3 B. Selected IDSR Performance Indicators…………………………………………………………………………………………6 C. National IDSR Supervision………………………………………………………………………………………………………..7 D. IDSR Immediately Reportable Diseases/Events………………………………………………………………………………9 E. IDSR Monthly Reportable Diseases/Conditions………………………………………………………………………………10 III. OUTBREAKS AND HUMANITARIAN EVENTS………………………………………………………………………………… 11 A. Introduction……………………………………………….…………………………………………………………………………11 B. Measles……………………………………………………………………………………………………………………………….12 C. Lassa fever…………………………………………………………………………………………………………………………..14 D. Human Monkeypox……………………………………………………………………………………………………….………..17 E. Meningococcal Disease…………………………………………………………………………………………………………...21 F. Floods/Mudslides…………………………………………………………………………………………………………………...22 G. Chemical Spills………………………………………………………………………………………………………………………23 IV. DISEASES/CONDITIONS OF PUBLIC HEALTH IMPORTANCE…………………………………………………………….. 24 V. PUBLIC HEALTH DIAGNOSTICS………………………………………………………………………………………………... 30 VI. ELECTRONIC DISEASE SURVEILLANCE………………………………………………………………………………………33 VII. TRAINING AND CAPACITY BUILDING…………………………………………………………………………………………. 34 Annex 1. Summary of Outbreaks and Humanitarian Events in 2017………………………………………………………………. 36 1 |2017 Annual IDSR Bulletin o Added meningitis, Lassa fever EDITORIAL o Developed laboratory screening capacity for rabies The National Public Health Institute of Liberia (NPHIL) is pleased • Overall laboratory turn-around time improved by 15% to present the 2017 annual epidemiological bulletin. This bulletin from 35% in the first half of the year, to 50% of alerts being provides information on the progress of IDSR performance in confirmed or ruled-out by laboratory testing within 4-days 2017. It highlights the successes and the challenges. The of alert notification, by the end of 2017 information from this bulletin is important for strengthening IDSR, which not only contributes to the control of communicable 4. Electronic Disease Surveillance diseases in Liberia, but also enhances the capacity to implement • E-IDSR was launched and piloted in two counties (Grand the World Health Organization’s International Health Regulations Cape Mount and Margibi) covering all health facilities (2005), a legally-binding agreement that provides a new • AVADAR was launched and piloted in four health districts framework for coordinating and managing public health threats, in Montserrado County which came into effect in June 2007. • Use of open data kit (ODK) to conduct IDSR supervision commenced thus enhancing visualization, rapid transmission, and validity of reports 1. IDSR Performance • Completeness and timeliness of weekly IDSR reports 5. Training and Capacity Building remained well above the 80% national target at all levels • A total of six hundred twenty-two (622) national and of the health system county level staff were trained as trainers in IDSR • Immediate notification of suspected cases (within 24 o This comprised 285 local authorities trained in IDSR hours) increased from 20% in week 40, 2016 to 100% as leadership and coordination and 337 technical staff of week 52, 2017 trained (at least each county has 5 IDSR modular • We recorded an increase in reporting of IDSR diseases trainers) and events with a total of 4,729 suspected cases reported • The Liberia Field Epidemiology Training Program for 10 immediately reportable diseases and events in (LFETP) has trained 146 surveillance officers at the 2017 compared to 3,812 in 2016 national, county and district levels of the surveillance • Reporting of suspected cases with case-based forms or system in the Frontline and 14 national and county officers line list increased from 30% in week 40, 2016 to 90% as in Intermediate FETP of week 52, 2017 Many other gains have been made in areas of emergency • Over 80% of the suspected cases recorded (those medical services, points-of-entry, and epidemic preparedness requiring laboratory confirmation) were investigated by and response including the formulation of contingency plans and Laboratory the conduct of at least one simulation exercise at two points-of- • Joint national supportive supervision/mentorship entry. conducted in 15 (100%) counties showed appreciable level of compliance in the implementation of IDSR core Despite these strides, key system challenges/constraints functions include: Settling the newly established NPHIL as a specialized 2. Outbreaks and Humanitarian Events • institute as well as aggressively responding to over 30 • A total of 39 outbreaks and 3 humanitarian events were outbreaks is resource intense detected, investigated, and responded to • System resilience to outbreak response still need the • There were investigation reports for 85% of outbreaks desired coverage of above 90% compared to 53% in 2016 • Inadequate operational support to surveillance officers • Eighty-two (82%) of outbreaks were responded to within However, strong dedication and commitment to excellence in our 48 hours compared to 37% in 2016 work to prevent and control public health threats continue to 3. Public Health Diagnostics allow us to surmount these hurdles. • Sustained public health diagnostic capacity at three laboratories – National Public Health Reference, We are grateful to the World Health Organization (WHO), US Jackson F. Doe, and Phebe hospital laboratories Centers for Disease Control and Prevention (CDC), and all other • Improved in-country public health diagnostic capacity valuable partners that continue to provide technical and from five IDSR priority diseases in 2016 to seven IDSR operational support to facilitate our work. priority disease by week 52 in 2017 2 |2017 Annual IDSR Bulletin I. OVERVIEW OF IDSR IN LIBERIA Table 1. Priority reportable diseases, conditions, and events, Liberia, 2017 The major incidence of preventable diseases in Liberia as Immediately reportable epidemic Diseases or events of Monthly reportable prone diseases/conditions and events international concern that diseases/conditions of public recorded in 2017, ranges from endemic and re-emerging such are notifiable under IHR 2005 health importance as measles, viral hemorrhagic fevers, tuberculosis, monkeypox and cholera (Weekly Epidemiological Bulletin, 2017). Among the Acute Bloody Diarrhea (Shigella) Guinea Worm (Dracunculiasis) Acute Watery Diarrhea Acute Flaccid Paralysis (AFP) Human Influenza (due to a Acute Viral Hepatitis several strategies put in place by the health sector to address Cholera (Severe AWD) new subtype) Adverse Events Following Human Rabies Severe Acute Respiratory Immunization (AEFI) this disease burden is a functional public health surveillance Lassa fever Syndrome (SARS) Cataract Maternal Deaths Smallpox Diabetes system with an early warning system which uses the IDSR Measles Diarrhea w/dehydration (in <5 Meningitis Other Public Health Event of years) platform. Neonatal Deaths International Concern (PHEIC) Encephalitis Neonatal Tetanus Includes: infectious, zoonotic, Epilepsy Viral Hemorrhagic Fevers (including foodborne, chemical, radio HIV/AIDS (new cases) The World Health Organization (WHO) Regional Office for Africa Ebola Virus Disease) nuclear, or due to unknown Hypertension Yellow fever condition Hookworm (AFRO) proposed the IDSR approach for improving public health Unexplained cluster of health events Injuries (RTAs, domestic violence) Unexplained cluster of deaths Malaria surveillance and response in Africa linking community, health Malnutrition (<5 years) Mental Health facility, district, county, and national levels. This was widely Onchocerciasis Pertussis (Whooping Cough) adopted in Africa, including Liberia, in 2004 (1st edition) and Severe Pneumonia (<5 years) Schistosomiasis 2016 (second version of the 2010 edition). This strategy Sexual Assault STIs promotes rational use of resources by integrating and Trachoma Trypanosomiasis streamlining common surveillance activities. Tuberculosis Typhoid In the aftermath of the Ebola outbreak in 2015, Liberia began revitalization of IDSR with the adaptation of revised technical guidelines in 2016, development of the operational guide for II. IDSR PERFORMANCE health facilities (IDSR in practice), and the subsequent training of health workers at all levels of the health system. A. Reporting Coverage i. Reporting System The broad objective of IDSR in Liberia is to contribute to the Fourteen diseases, conditions, and events are designated for reduction of mortality, morbidity and disability from diseases immediate reporting under IDSR in Liberia. The data for these through accurate, complete and timely reporting and analysis of diseases and conditions are collated for weekly submission to data for public health action. the national level. Ledgers for capturing IDSR data are placed in all health facilities, at district level for summarizing health Diseases of public health importance in Liberia were identified facilities data, and at county level for summarizing health districts and categorized into 3 reporting
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