MINISTRY OF HEALTH
Nadowli-Kaleo District hits epidemic threshold for meningitis.
Streptococcus pneumoniae remains the predominant causative organism for VOLUME 4 meningitis. WEEK 04 th 27 January, 2019
The Ghana Weekly Epidemiological Report is a publication of the Ghana Health Service and the Ministry of Health, Ghana © Ghana Health Service 2019 ISSN - 2579-0439
Ghana Weekly Epidemiological Report Vol. 4 Week 04 27 January 2019 i
Acknowledgement
This publication has been made possible with technical and financial support from the Bloomberg Data for Health Initiative, the CDC Foundation and the World Health Organisation
Ghana Weekly Epidemiological Report Vol. 4 Week 04 27 January 2019 ii
Summary of Weekly Epidemiological Data, Week 04, 2019
Summary of Weekly Epidemiological Data for Week 04, 2019
Weekly Spotlight: Nadowli-Kaleo district in hits epidemic threshold for meningitis. Streptococcus pneumoniae remains the predominant causative organism for meningitis
SUMMARY OF PRIORITY
DISEASES AND EVENTS - Acute watery diarrhoea in persons… 649 WEEK 04, 2019 The total all-cause notifiable disease Influenza-like illness 417
morbidity for the week (as per IDSR Meningitis 53 Weekly Summary Reporting Form) Measles 41 was 1,201 cases with one death each
from meningitis and maternal death. Yellow fever (suspected) 18 Acute watery diarrhoea in persons Diarrhoea with blood 12 aged 5 years and above was the event Disease/Health highest proportion of cases reported AFP (suspected polio) 7
and contributed 54% of the notifiable Adverse events following… 4 diseases case load during Week 4 [See Figure 1 and Annex 1, summary of 0 100 200 300 400 500 600 700 reported cases/deaths] Number of Cases
Figure 1: Reported notifiable diseases/conditions, Ghana, Week 04, 2019
INFLUENZA-LIKE ILLNESS (IDSR Weekly Report) ACUTE FLACCID PARALYSIS (SUSPECTED A total of 417 cases with no deaths were reported through IDSR weekly reporting [Table 1]. Laboratory samples POLIOMYELITIS) were sent from sentinel sites to Noguchi Memorial Institute Seven cases of Acute Flaccid Paralysis (AFP) were reported for Medical Research (NMIMR) with results pending. during the Week [Table 2]. All the stool specimens tested at the Polio Laboratory at NMIMR were negative for wild polio virus. Table 1: Reported Influenza-Like Illness c ases by Region and District, Ghana, Week 04, 2019 Table 2: Suspected Poliomyelitis cases and deaths by Region Region Districts Cases Deaths and District, Ghana, Week 04, 2019 Brong-Ahafo Sunyani 10 0 Region Districts Cases Deaths Eastern New Juaben 117 0 Accra 29 0 Dormaa West 1 0 Brong-Ahafo Nkoranza North 1 0 Adentan 8 0 Ga Central 2 0 Greater-Accra Accra 2 0 Ga East 32 0 Upper West Jirapa 1 0 Western Bia West 2 0 Ga West 33 0 La-Nkwantanang-Madina 1 0 Total 7 0
Ledzokuku-Krowor 14 0 Shai Osudoku 94 0 Greater Accra Tema 67 0 CHOLERA
Volta Ketu South 5 0 No cholera case was reported during the Week. Western Sekondi-Takoradi 5 0 Total 417 0 MATERNAL DEATHS During the Week, one maternal death was recorded in
the New Juaben Municipality, in the Eastern region. HUMAN RABIES No case of Human Rabies was recorded in Week 4.
. NEONATAL TETANUS No case of Neonatal Tetanus was recorded during the
Week under review.
Ghana Weekly Epidemiological Report Vol. 4 Week 04 27 January 2019
1
.
Summary of Weekly Epidemiological Data, Week 04, 2019
YELLOW FEVER MEASLES Eighteen (18) suspected cases of Yellow Fever were reported A total of 41 suspected cases of Measles were reported across across the country [Table 4]. Samples were sent to the National the country [Table 5]. Samples were taken and sent to the Public Health and Reference Laboratory with results pending. National Public Health and Reference Laboratory [NPHRL] for investigations with results pending. As at the end of Week 4, Table 4: Suspected Yellow Fever cases by Region, Ghana, there were three confirmed measles cases, one each from the Week 04, 2019 Ejisu Juaben, New Juaben and Ningo Prampram districts Region District Cases Deaths Ashanti Kwabre 3 0 Table 5: Reported Suspected Measles cases by Region and Tain 1 0 District, Ghana, Week 04, 2019 Brong-Ahafo Tano North 1 0 Region Districts Cases Deaths Birim Central 1 0 Asunafo North 2 0 Eastern Lower Manya Krobo 1 0 Asunafo South 2 0 Ada West 2 0 Asutifi North 2 0 Ga West 1 0 Asutifi South 1 0 Greater-Accra La-Dade-Kotopon 1 0 Berekum 2 0 Jaman South 1 0 Kassena Nankana West 1 0 Upper East Talensi 1 0 Kintampo North 1 0 Lawra 1 0 Pru 1 0 Nadowli-Kaleo 1 0 Sene East 1 0 Upper West Sissala West 1 0 Sunyani 1 0 Western Prestea-Huni Valley 2 0 Tain 1 0 Total 18 0 Tano North 1 0 Brong-Ahafo Techiman South 1 0 Afram Plains South 1 0 MENINGITIS Asuogyaman 1 0 In Week four, 53 cases of meningitis were recorded with one Ayensuano 1 0 death [Table 6]. Six districts hit the alert threshold with one Kwahu North 3 0 district in epidemic threshold for meningitis [Figure 8]. Nadowli- Nsawam Adoagyiri 2 0
Kaleo district crossed the epidemic threshold recording an attack Eastern Upper Manya Krobo 1 0 rate of 16.4 per 100,000 population. Asutifi North, Banda, Jaman Adentan 1 0
North, Zabzugu, Lawra and Nandom districts all crossed the alert Ga Central 3 0 Ga West 1 0 threshold recording attack rates of 3.1, 4.0, 3.9, 5.0, 9.1 and 7.1 Kpone Katamanso 1 0 per 100,000 population respectively. La-Dade-Kotopon 1 0
Greater Accra Ningo Prampram 1 0
Upper East Pusiga 1 0 Upper West Sissala West 2 0 Volta Ho 1 0 Bibiani-Anhwiaso-Bekwai 1 0 Ellembelle 1 0 Western Prestea-Huni Valley 1 0 Total 41 0
Table 6: Meningitis cases and deaths by Region, Ghana, Week 04, 2019
Cerebrospinal Cerebrospinal CFR District in District in Region Cases Fluid (CSF) Lab Deaths Fluid (CSF) (%) Alert Epidemic Test Positive
Ashanti 1 1 0 0 0 0 0 Brong-Ahafo† 15 13 1 0 0 3 0
Central 0 0 0 0 0 0 0
Eastern 2 2 0 0 0 0 0
Greater Accra 0 0 0 0 0 0 0
Northern† 8 8 0 0 0 1 0 Upper East 3 3 2 0 0 0 0
Upper West† 23 23 2 1 4.3 2 1
Volta 1 1 0 0 0 0 0 Western 0 0 0 0 0 0 0 Total (Ghana) 53 51 5 1 1.9 6 1 † Attack Rate per 100,000 population [Asutifi North; 2 cases (AR= 3.1), Banda; 1 case (AR= 4.0), Jaman North; 4 cases (AR= 3.9), Zabzugu; 5 cases (AR=5.0), Lawra; 6 cases (AR=9.1) Nadowli-Kaleo; 12 cases (AR=16.4) Nandom; 4 cases (AR=7.1)
Ghana Weekly Epidemiological Report Vol.4 Week 04 27 January 2019 2
Summary of Weekly Epidemiological Data, Week 04, 2019
Confirmed Pathogens from Meningitis Laboratory Results, Week 04, 2019 Lumbar Puncture was done for 51 out of the 53 cases with 8 testing positive [Table 6]. There were 10 cases of Streptococcus pneumonia confirmed by Polymerase Chain Reaction Test (PCR) [Bawku – 1, Pusiga – 1 and Nadowli-Kaleo-6] [Figure 9]. The remaining two were Gram stain positive.
Table 7: Meningitis cases confirmed, Ghana, Week 04, 2019 Districts Cases CSF CSF positive Deaths Causative Organism Bawku 1 1 1 0 Streptococcus pneumoniae Pusiga 1 1 1 0 Streptococcus pneumoniae Lawra 6 6 1 0 Gram positive diplococci Nadowli-Kaleo 12 12 6 1 6-Streptococcus pneumoniae Jaman North 4 4 1 0 Gram positive diplococci
Figure 2: Chart showing Meningitis threshold profile of selected districts in Ghana, Week 01 - 04, 2019 District Week 1 Week 2 Week 3 Week 4 Banda 0 1 0 0 Nadowli-Kaleo 0 0 0 6
Tatale-Sanguli 0 4 1 0
0 Nandom 1 0 0 Zabzugu 0 1 1 0
* Epidemic Alert None, Data presented represents number of confirmed cases.
Districts in Meningitis Alert or Epidemic In week 4, only Nadowli-Kaleo crossed the epidemic threshold [Figure 2 & 7]. Lawra district on the other hand was in alert 8 Lawra Alert Epidemic phase for the week under review [Figure 5]. Zabzugu was in 6 epidemic phase in weeks 2 and 3 [Figure 2 & 4], however recorded only 1 confirmed case in each of the respective 4 weeks. Banda district crossed the alert threshold in weeks 3 Cases 2 and 4 recording no confirmed case in both weeks [Figure 3]. Tatale-Sanguli was in epidemic phase in week 2 having 0 40 4142 4344 454647 4849 5051 52 1 2 3 4 recorded 4 confirmed cases of meningitis [Figure 2]. Nandom district crossed the epidemic and alert thresholds in weeks 3 Epidemiological Week and 4 respectively however did not record any confirmed case for both weeks [Figure 6]. Figure 5: Meningitis threshold monitoring chart for Lawra, 4 Week 40, 2018 - 04, 2019 Banda Alert Epidemic Nandom Alert Epidemic 3 15 2
Cases 10
1 Cases 0 5 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 Epidemiological Week 0 Figure 3: Meningitis threshold monitoring chart for Banda, 40 42 44 46 48 50 52 2 4
Week 40, 2018 - 04, 2019 Epidemiological Week
Figure 6: Meningitis threshold monitoring chart for Nandom, Week 40, 2018 - 04, 2019 Zabzugu Alert Epidemic 40
30 13 Nadowli-Kaleo Alert Epidemic 12 11 20 10 9 Cases 8 10 7 6
Cases 5 4 0 3 2 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 1 Epidemiological Week 0
Figure 4: Meningitis threshold monitoring chart for 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4
Zabzugu, Week 40, 2018 - 04, 2019 Epidemiological Week
Figure 7: Meningitis threshold monitoring chart for Nadowli-Kaleo, Week 40, 2018 - 04, 2019
Ghana Weekly Epidemiological Report Vol.4 Week 04 27 January 2019 3
Summary of Weekly Epidemiological Data, Week 04, 2019
Figure 8: Districts in Alert or Epidemic phase for Meningitis, Figure 9: Distribution of PCR confirmed Meningitis pathogens Week 04, 2019 Week 04, 2019
RECOMMENDATIONS HEALTH WORKERS National Level, Regions, Districts and Health Facilities are required to:
Update their preparedness and response plans and stockpile the necessary logistics, reagents and medication for
managing meningitis
Intensify surveillance on meningitis
Enhance staff awareness on detection, notification, investigation, case management guidelines and public
education
Promote general public awareness on prevention, signs and symptoms, and reporting to the nearest health facility
upon suspicion of meningitis.
GENERAL POPULATION
Avoid overcrowding (particularly avoid infected persons sneezing, coughing) Drink lots of water Improved ventilation (opening of windows in your rooms) Report to the nearest health facility if you have fever or headache with neck pain
Ghana Weekly Epidemiological Report Vol. 4 Week 04 27 January 2019 4
Summary of Weekly Epidemiological Data, Week 04, 2019
ANNEX 1: SUMMARY OF REPORTED CASES/ EVENT S: WEEK 04 (WEEK ENDING 27 JANUARY 2019)
Disease/Health Event Week 03 Week 04 Cumulative to Week 04 (suspected/confirmed) Cases Deaths CFR Cases Deaths CFR Cases Deaths CFR (susp) (%) (susp) (%) (susp) (%)
7 0 0 7 0 0 27 0 0 AFP (suspected polio) Acute haemorrhagic 0 0 - 0 0 - 0 0 - fever syndrome Adverse events 0 0 - 4 0 0 4 0 - following immunization Anthrax 0 0 - 0 0 - 0 0 - Acute watery diarrhoea 463 0 0 649 0 0 2,872 0 0 in persons aged >5 years Cholera 0 0 - 0 0 - 0 0 - Dengue fever 0 0 - 0 0 - 0 0 - Diarrhoea with blood 18 0 0 12 0 0 72 0 0 Dracunculiasis (Guinea 0 0 - 0 0 - 0 0 - worm) Influenza-like illness 336 0 0 417 0 0 1,554 0 0 Maternal deaths - 3 - - 1 - - 7 - Measles 36 0 0 41 0 0 113 0 0 Meningitis 94 3 3.2 53 1 192 7 3.7 Neonatal tetanus 2 1 50.0 0 0 - 2 1 50.0 Plague 0 0 - 0 0 - 0 0 - Public health event of 0 0 - 0 0 - 0 0 - international concern (PHEIC) Human rabies 0 0 - 0 0 - 0 0 - SARS 0 0 - 0 0 - 0 0 - Smallpox 0 0 - 0 0 - 0 0 - Yellow fever (suspected) 16 0 0 18 0 0 50 0 0 NATIONAL TOTAL 972 7 0.4 1,201 2 0.1 4,886 15 0.2 *CFR does not include maternal deaths
This report and subsequent ones should be shared with regional and district heads as well as heads of other agencies. A feedback addressed to the Editor-In-Chief is welcome
Ghana Weekly Epidemiological Report Vol. 4 Week 04 27 January 2019 5
District Cases Deaths Nandom 91 5 Jirapa 79 5 Nadowli-Kaleo 64 4 Bole 46 3 Lawra 46 5 New Juaben 44 1 Lambussie 43 5 Jaman North 39 5 Bongo 31 3 Wa 24 0 West Gonja 23 7 Bolgatanga 22 1 Talensi 19 1 Dafiama-Bussie-Issa 19 1 Nkoranza South 16 0 Builsa North 14 1 Wa West 14 1 Sawla-Tuna-Kalba 12 2 Builsa South 11 0
Summary of Weekly Epidemiological Data, Week 04, 2019
Editorial Board Editorial Team
Dr. Anthony Nsiah-Asare Editor Dr. Badu Sarkodie Mr. Gideon Kwarteng Acheampong Dr. Michael Adjabeng Dr. Emmanuel Kofi Dzotsi Managing Editor Dr. Kwame Amponsa-Achiano Mr. Kwame Acheampong Owusu Dr. David Opare Dr. Franklin Asiedu-Bekoe Editor-In-Chief Mr. Kwame Kodom Achempem Dr. Kenneth Ofosu-Barko Mr. Isaac Baffoe-Nyarko Prof. Kwadwo Koram Dr. Ivy Frances Osei Dr. Ernest Kenu
Dr. Phyllis Antwi Ms. Selina Ababio Dr. Dennis Laryea Dr. Sally-Ann Ohene Dr. Chastity Walker
Ghana Weekly Epidemiological Report Vol. 4 Week 04 27 January 2019 6