Liberia IDSR Epidemiology Bulletin 2016 Epi Week 51 (December 16 – December 22 )
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Liberia IDSR Epidemiology Bulletin 2016 Epi Week 51 (December 16 – December 22 ) Data Source: CSOs from 15 Counties and Lab Highlights Six neonatal deaths reported from three counties. Fourteen maternal deaths reported from four counties, of which ten were identified from Nimba through record review of previous weeks. Twenty-eight suspected measles cases reported from four counties with eleven of the cases from Bushrod district and six from Todee district in Montserrado County. One suspected case of monkey pox was reported from Rivercess. Thirteen laboratory results received for measles, of which two were positive from Nimba and Montserrado Counties. Reporting Coverage 100% (745/745) of expected health facilities reported from 90 health districts across 15 counties. 99% (734/745) of health facilities submitted timely reports to the district level. 98% (88/90) of health districts submitted timely reports to county level. 100% (15/15) of counties submitted timely reports to the national level. Vaccine Preventable Diseases Measles Twenty-eight (28) suspected cases reported: Montserrado (20), Lofa (6), Bomi and Sinoe (1) each. Specimens were collected from twenty-seven (27) out the twenty-eight (28) cases for laboratory confirmation. Cumulatively, 1082 suspected cases have been reported since Epi-week 1; Lab-confirmed (131), Epi-linked (503), clinically confirmed (165), and discarded (214). There are 69 suspected cases pending reclassification. Total number of death in confirmed cases is 5 (CFR 0.8%). Liberia's annualized non-measles febrile rash illness rate now stands at 5.3 per 100,000. Grand Cape Mount, Nimba, Rivercess and River Gee Counties are below the target of 2/100,000 (Table 1). Of the total reported 703 lab-confirmed, Epi-linked and suspected cases, 15% were reported to have previously been vaccinated, 36% were unvaccinated, while 49% had unknown vaccination status. 38% of the confirmed and suspected cases are below 5 years. 1 Liberia IDSR Epidemiology Bulletin 2016 Epi Week 51 (December 16 – December 22 ) Table 1. Distribution of suspected Measles Cases by County and Epi-Classification, Liberia, Week 1 - 51, 2016 Annualized Non Lab Epi- Measles Febrile County Confirmed Linked Compatible Suspected Discarded Total Rash Illness Rate Bomi 2 2 3 2 17 26 17.4 Bong 10 49 2 3 15 79 3.9 Gbarpolu 0 0 5 0 4 9 4.1 Grand Bassa 20 116 5 2 13 156 5.1 Grand Cape Mount 0 0 1 0 0 1 0.0 Grand Gedeh 0 0 18 0 7 25 4.8 Grand Kru 0 0 0 0 3 3 4.5 Lofa 4 30 81 10 28 153 8.7 Margibi 50 170 1 19 47 287 19.3 Maryland 0 0 0 0 5 5 3.2 Montserrado 44 115 42 28 62 291 4.8 Nimba 1 21 5 0 8 35 1.5 Rivercess 0 0 0 1 1 2 1.3 River Gee 0 0 1 1 0 2 0.0 Sinoe 0 0 1 3 4 8 3.4 Liberia 131 503 165 69 214 1082 5.3 Target Achieved >=2 Below Target <2 Acute Flaccid Paralysis (Polio) Zero cases reported. Cumulatively, 68 cases of AFP have been reported since Epi-week 1. Zero confirmed, 65 negative and 3 pending lab confirmation. As of week 51, the annualized non-polio AFP rate is at 3.8 per 100,000 population in less than 15 years of age. Neonatal Tetanus One (1) attributable death reported from Montserrado. Cumulatively, 25 cases have been reported with 8 deaths since Epi-week 1. CFR is 32%. Viral Hemorrhagic Diseases Ebola Virus Disease (EVD) Forty (40) suspected cases reported. (1 alive and 39 dead cases). Eleven (11) tested negative and twenty-nine (29) pending laboratory confirmation. 47 samples tested negative (7 whole blood and 40 oral swab). Overall, samples were submitted from 12 counties. Of the 47 samples tested, 11 were reported in week 51, 34 in week 50 and 2 in week 49. Cumulatively, 29,494 alerts have been reported out of which three (3) were confirmed. CFR in confirmed cases is 33%. 2 Liberia IDSR Epidemiology Bulletin 2016 Epi Week 51 (December 16 – December 22 ) Table 2. Count of patient samples tested for EVD by county and samples type, Liberia, Epi-week 48 - 51, 2016 Week 48 Week 49 Week 50 Week 51 Geographical Distribution Whole Oral Whole Oral Whole Oral Whole Oral Blood Swab Blood Swab Blood Swab Blood Swab All Counties 13 83 5 40 12 38 7 40 By County Bomi 2 6 0 8 0 4 0 8 Bong 3 0 4 0 1 1 0 1 Gbarpolu 0 0 0 1 0 1 1 1 Grand Bassa 0 13 0 2 0 1 0 3 Grand Cape Mount 0 0 0 0 1 0 0 2 Grand Gedeh 0 0 0 0 5 2 6 5 Grand Kru 0 2 0 0 0 1 0 0 Lofa 0 5 0 3 0 7 0 1 Margibi 1 6 1 0 3 4 0 2 Maryland 0 7 0 0 0 6 0 3 Montserrado 0 25 0 9 0 4 0 3 Nimba 1 10 0 11 1 5 0 8 Rivercess 6 0 0 0 0 0 0 0 River Gee 0 8 0 2 0 0 0 0 Sinoe 0 1 0 4 1 2 0 3 Unknown 0 0 0 0 0 0 0 0 Lassa Fever Zero cases reported. Cumulatively, 69 suspected cases have been reported since Epi-week 1, of which 14 were confirmed, 32 were classified as “not a case” due to negative test results while 23 are classified as suspected. Of the suspected cases, 7 are awaiting lab confirmation while the other 16 cases were not tested because no sample was collected for testing. CFR is 36%. Bong County accounts for 67% of the total confirmed cases. Yellow Fever Four (4) suspected cases reported. Grand Kru (2), Bomi and Grand Gedeh (1) each. Specimens were collected for laboratory confirmation Cumulatively, 55 suspected cases have been reported since Epi-week 1, of which thirty-five (35) tested negative and twenty (20) are pending laboratory confirmation. Meningitis Zero cases reported. Cumulatively, 27 suspected cases have been reported since Epi-week 1. Laboratory confirmation of meningitis is currently unavailable in Liberia. 3 Liberia IDSR Epidemiology Bulletin 2016 Epi Week 51 (December 16 – December 22 ) Events of Public Health Importance Maternal Mortality Fourteen (14) maternal deaths reported. Nimba (10)**, Bong (2), Montserrado and Margibi (1) each. Primary causes of deaths were severe anemia (6), acute renal injury (2), congestive heart failure (2), hypovolemic shock, sepsis, gastro esophageal reflux and rapture uterus. **These deaths occurred in Ganta hospital during the previous weeks (2,9,12,13,14,19,22,28,31and 43). All of the deaths occurred in health facilities. Cumulatively, 297 maternal deaths have been reported since Epi-week 1, of which 246 (83%) were reported to have occurred from health facilities and 51 (17%) from communities. Annualized maternal mortality ratio is at 172 per 100,000 live births (Table 3). The expected MMR based on 2013 Demographic Health Survey (DHS) is 1072 deaths per 100,000 live births. Table 4: Cumulative Maternal Deaths Reported by Counties, Liberia, Epi week 1-51, 2016 No. of Maternal Deaths % of Deaths Annualized Maternal Counties Reported Reported Mortality Ratio Bomi 14 5 334 Grand Kru 8 3 277 Sinoe 13 4 255 Grand Cape Mount 16 5 253 Bong 38 13 229 Gbarpolu 9 3 217 Margibi 22 7 210 Maryland 13 4 192 River Gee 6 2 180 Grand Gedeh 11 4 176 Nimba 38 13 165 Rivercess 5 2 140 Grand Bassa 15 5 136 Montserrado 73 25 131 Lofa 16 5 116 Liberia 297 100 172 4 Liberia IDSR Epidemiology Bulletin 2016 Epi Week 51 (December 16 – December 22 ) Neonatal Mortality Six (6) neonatal deaths were reported. Montserrado (4), Lofa and Bong (1) each. Primary causes of death were neonatal asphyxia (3) and neonatal sepsis (2). **One (1) of these deaths was also reported as neonatal tetanus attributable death from Montserrado. All of the deaths were reported to have occurred in health facilities. Cumulatively, 525 neonatal deaths have been reported since Epi -week 1. Annualized neonatal mortality rate is 7 per 1,000 live births. The expected NNMR based on 2013 DHS is 26 deaths per 1,000 live births. Table 5: Cumulative Neonatal Deaths Reported by Counties, Liberia, Epi week 1-51, 2016 Cumulative number of % of Deaths Annualized Neonatal Mortality Rate Counties Neonatal Deaths Reported Reported Per 1,000 Live Births Grand Kru 21 4 17 Bong 86 16 12 River Gee 17 3 12 Grand Gedeh 30 6 11 Rivercess 14 3 9 Montserrado 199 38 8 Maryland 23 4 8 Gbarpolu 14 3 8 Lofa 36 7 6 Sinoe 13 2 6 Bomi 10 2 6 Grand Cape Mount 12 2 4 Grand Bassa 20 4 4 Margibi 10 2 2 Nimba 20 4 2 Liberia 525 100 7 5 Liberia IDSR Epidemiology Bulletin 2016 Epi Week 51 (December 16 – December 22 ) Human Exposure to Animal Bites (Suspected Rabies) Twenty-seven (27) suspected cases reported. Montserrado (16), Nimba (5), Lofa (2), Maryland, Margibi, Grand Gedeh and Bomi (1) case each. Cumulatively, 1,088 suspected cases have been reported including 8 deaths since Epi-week 1. Laboratory confirmation of rabies is currently unavailable in Liberia. Bloody Diarrhea (Shigellosis) Two (2) cases reported. Montserrado and Lofa (1) case each. One (1) specimen was collected for laboratory confirmation from Lofa. Cumulatively, 345 bloody diarrhea cases have been reported since Epi-week 1. Twenty-five (25) specimens have been tested and were negative.