Weekly Epidemiological Report Week 15: 12Th – 18Th April 2021 Highlight of the Week Nigeria Commemorates World Hand Hygiene Day

Issue: Volume 12 No. 15. 4th May 2021

Nigeria Centre for Disease Control Protecting the health of Nigerians Weekly Epidemiological Report Week 15: 12th – 18th April 2021 Highlight of the Week Nigeria Commemorates World Hand Hygiene Day

Globally, promotion of hand hygiene is one of the cost effective public health interventions for the prevention and control of infections, particularly those caused by epidemic-prone pathogens. In line with this, the World Health Organisation launched the World Hand Hygiene Day which is celebrated every year. This event is part of the global advocacy efforts to mobilise citizens around the world to imbibe a general culture of handwashing with soap and running water, and the use of alcohol-based hand sanitisers.

The theme for this year’s event is “Achieving hand hygiene at the point of care” with the slogan “Seconds Save Lives – Clean Your Hands. In recognition of the importance of public awareness of hand hygiene, Nigeria joined the global community to commemorate the World Hand Hygiene Day on the 5thof May, 2021. The national sub- theme “One Nation, One Plan: Turn Nigeria Orange” is a recognition of the “Orange Network Project” which was launched by the Nigeria Centre for Disease Control (NCDC) in 2019. This is a network of tertiary health facilities in Nigeria which aims at promoting centers of excellence in infection prevention and control.

As part of her activities to mark this year’s event, the NCDC in collaboration with the Federal Medical Centre, Abuja organised a lecture on the importance of hand hygiene in health care settings. This further highlighted the priority given to the safety of health care workers (HCWs) by the NCDC. Some of our key partners - Infection Control Africa Network, Nigeria Society for Infection Control, Dr. Ameyo Stella Adadevoh Health Trust (DRASA), Africa Centre for Disease Control (Africa CDC), the World Health Organisation (WHO)' etc. also lent their voices and encouraged all to take responsibility to promote hand hygiene with key messages as follows: 1. Health Care Workers: Now more than ever, clean your hands at the point of care! 2. Infection Prevention and Control (IPC) practitioners: Be a champion and mentor colleagues on clean hands at the point of care! 3. Facility Managers: Ensure hand hygiene supplies are available at every point of care! 4. Policymakers: Invest now to ensure hand hygiene for all! 5. Patients and families: Wash your hands regularly, clean hands save lives! 6. Vaccinators: Clean your hands with every vaccination! 7. Everyone: Make washing your hands a regular habit – it protects us all!

An important outcome from this year’s event was the strong collaboration with stakeholders particularly in the area of IPC. We strongly believe that the afore-listed key messages when implemented will also contribute to the control of the ongoing COVID-19 outbreak in Nigeria.

The NCDC remains committed to working closely with all relevant stakeholders in promoting hand hygiene- practices among HCWs and the public at large.

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Summary of Incidents

Ongoing incidents

Ongoing incidents are defined as confirmed cases where a national EOC or equivalent has been activated (EOC is currently activated for COVID-19)

Other incidents are those with confirmed cases for which EOC is not activated

Data Source: SITAware

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Summary Week 15: 12th – 18th April 2021 Note: Coronavirus Disease is from outbreak onset till week 17 2021: 2nd May, 2021) Cerebrospinal Lassa Fever1,2 Yellow Fever3,4 Meningitis (CSM) 3,4 43 6 34 Suspected case(s) Suspected case(s) Suspected case(s)

6 1 0 Confirmed case(s) Confirmed case(s) Confirmed case(s)

0 0 0 Death(s) Death(s) Death(s)

Cholera3,4 Measles3,4 Monkeypox1,4

166 629 1 Suspected case(s) Suspected case(s) Suspected case(s)

0 2 1 Confirmed case(s) Confirmed case(s) Confirmed case(s)

11 8 0 Death(s) Death(s) Death(s)

Acute Flaccid National Sentinel Coronavirus Disease

Paralysis (AFP) 3,4 influenza surveillance5 as at week 171,

56 398 1,939,165 Suspected case(s) Suspected case(s) Suspected case(s)

0 10 168,181 Confirmed case(s) Confirmed case(s) Confirmed case(s) 2,063 Death(s)

Timeliness Completeness

of reports3 of reports3 94.6% 97.3% Last 4 weeks Last 4 weeks 96.8% 98.7% Year to date Year to date Notes 1. Information for this disease was retrieved from the Technical Working Group and Situation Reports 2. Case Fatality Rate (CFR) for this disease is reported for confirmed cases only 3. Information for this disease was retrieved from IDSR 002 data 4. CFR for this disease is reported for total cases i.e. suspected + confirmed 5. Information for sentinel influenza was retrieved from the laboratory

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Lassa Fever Week 15 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 2 43 6 0 LGA: 3

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

4386 1595 973 247 188 50 19.3% 20.2%

Figure 1: Number of suspected and confirmed Figure 2: Location of confirmed cases of cases of Lassa Fever, Nigeria, Weeks 1 – 52, Lassa Fever by State, Nigeria, week 15, 2021 2021

Key points ● There were 43 suspected cases, six were laboratory confirmed and no death was recorded from three LGAs in two states

Actions To date: ● Conducted 2021 Lassa fever (LF) high burden states preparedness/response engagement meeting ● Dissemination of reviewed case management and safe burial practices guidelines ● Ensured all five LF molecular laboratories in the NCDC network are working at full capacity for timely testing of samples with reduced turnaround time

Planned: ● Finalise LF five-year strategic plan

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Cerebrospinal Meningitis (CSM) Week 15 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 2 6 1 0 LGA: 3

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

222 93 0 6 3 0 1.4% 0%

Figure 3: Number of suspected and confirmed Figure 4: Location of suspected cases of CSM by cases of CSM, Nigeria, weeks 1 – 52, 2021 State, Nigeria, week 15, 2021

Key points ● There were six suspected cases of Cerebrospinal Meningitis (CSM) reported from three LGAs in two states (Ebonyi – 1 & Katsina – 5). One was laboratory confirmed and no death was recorded

Actions To date: ● National CSM TWG meets weekly to review reports from states and plan appropriately ● Enhanced surveillance in all states

Planned: ● Continue harmonisation of the national line list and SORMAS data ● Continue to ensure that states reporting cases send their line lists and collect CSM samples

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Yellow Fever Week 15 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 13 + FCT 34 0 0 LGA: 25

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

695 393 6 0 0 0 0% 0%

Figure 5: Number of suspected and Figure 6: Location of suspected cases of confirmed cases of Yellow Fever, Nigeria, Yellow Fever by States, Nigeria, week 15, weeks 1 – 52, 2021 2021

Key points ● There were 34 suspected cases of Yellow Fever (YF) reported from 25 LGAs in 13 states and FCT. None were laboratory confirmed and no death was recorded

Actions To date: ● National YF multi-partner Technical Working Group (TWG) continues to coordinate activities across states. ● Daily monitoring and analysis of surveillance data across the country to guide response activities

Planned: ● Continue supporting affected states across all pillars of response ● Continue harmonisation of surveillance and laboratory data ongoing

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Cholera Week 15 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 2 166 0 11 LGA: 10

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

749 *1397 0 5 31 *58 4.1% 4.2%

*Outbreak data added to routine data

Figure 7: Number of suspected and confirmed Figure 8: Location of suspected cases of cases of Cholera, Nigeria, weeks 1 – 52, 2021 Cholera by State, Nigeria, week 15, 2021

Key points ● There were 166 suspected cases of cholera reported from ten LGAs in two states (Bayelsa – 8 & Kano – 158). None were laboratory confirmed and eleven deaths were recorded

Actions To date ● National Cholera Multi-Sectoral Technical Working Group (TWG) is monitoring all states and supporting affected states ● Developed the 2021 Annual Cholera Preparedness and Response Work plan ● Cholera jingles being aired in English and local languages across the country

Planned: ● Continue follow up and monitoring of non-reporting states ● Build capacity for sample collection, transportation, and laboratory diagnosis across states

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Measles Week 15 Suspected Confirmed Number of States and Deaths cases cases LGAs affected

State: 21 + FCT 629 2 8 LGA: 92

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

11574 4679 636 64 45 17 0.4% 0.4%

Figure 9: Number of suspected and confirmed Figure 10: Location of suspected cases of cases of Measles, Nigeria, weeks 1 – 52, 2021 Measles by State, Nigeria, week 15, 2021

Key points ● There were 629 suspected cases of measles reported from 92 LGAs in 21 states and FCT. None were laboratory confirmed and one death was recorded

Actions To date ● National Measles TWG is closely monitoring measles surveillance data and providing feedback to relevant agencies and development partners ● Ongoing weekly surveillance and laboratory data harmonisation

Planned: ● Intensify follow up with states to update and transmit line list ● Continue monthly measles surveillance data review

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Monkeypox Week 15 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 1 1 1 0 LGA: 1

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

14 26 3 5 0 0 0% 0%

Figure 11: Number of suspected and confirmed Figure12: Location of suspected cases cases of Monkeypox, Nigeria, weeks 1 – 52, of Monkeypox by State, Nigeria, week 2021 15, 2021

Key points ● There was one suspected case of monkeypox from Esan north east in Edo state. It is laboratory confirmed and no death was recorded

Actions To date ● National Monkeypox Technical Working Group (TWG) is monitoring activities in all states

Planned: ● Enhance surveillance for monkeypox in high burden states ● Continue harmonisation of the national line list and SORMAS data

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Acute Flaccid Paralysis (AFP) Week 15 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 20 + FCT 56 0 0 LGA: 47

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

1182 714 0 0 0 0 0% 0%

Figure 13: Number of suspected and Figure 14: Location of suspected cases of AFP confirmed cases of AFP, Nigeria, weeks 1 – by State, Nigeria, week 15, 2021 52, 2021

Key points ● There were 56 suspected cases of AFP reported from 47 LGAs in 20 states and FCT. None were laboratory confirmed and no death was recorded

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report National Influenza Sentinel Surveillance

Year to date (week 1 – 15) Suspected Suspected Suspected ILI cases SARI Number 504 433 (86%) 71 (14%) (Percentage)

Week 15 Confirmed Confirmed ILI Confirmed SARI cases Influenz Influenz Influenz Influenz Influenz Influenz a A a B a A a B a A a B Number 5 5 0 0 0 0 Positivity (%) 1.2% 1.2% 0% 0% 0% 0%

Figure 15: Number of influenza positive specimens by type and percent positive by epidemiological week, 2021.

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Coronavirus Disease (COVID-19) From outbreak onset (Feb 27 2020) to epi-week 17 2021 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 1,939,165 168,181 2,063 LGA:

Figure 16: Epidemic curve of confirmed cases of Figure 17: Location of confirmed cases of COVID-19, Nigeria, week 1, 2020 – 17, 2021 COVID-19 by State, Nigeria, as at week 17, 2021

Actions To date: ● National COVID-19 multi-partner Emergency Operations Centre (EOC) continues to coordinate response activities across states ● Continued dissemination of key safety precaution messages in Ramadan ● Activation of Umaru Shehu Ultramodern Hospital PCR Laboratory, Borno state as a public laboratory for COVID-19 testing ● Ongoing genomic sequencing of all positive samples from travellers arriving Nigeria

Planned: ● Deploy antigen-based rapid diagnostic test (Ag-RDT) kits and sample collection materials to the selected states ● Intensify genomic surveillance activities ● Conduct WASH (Water, Sanitation and Hygiene) assessment across all health facilities ● Finalise Local Government Area (LGA) / State transmission categorisation

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Timeliness and Completeness of Reports Week 14 Figure 18: A – Timeliness by State (%); B – Completeness by State (%), week 15, 2021

Number of reports received on time, late or not received, the percentage timeliness and completeness, in the last 4 weeks and year to date Last 4 Weeks Year to date Nigeria Total Reports Week 12 – 15 Week 1 – 52 Reports sent on time 140 537 Reports sent late 4 11 Reports not received 4 7 Timeliness 94.6% 96.8% Completeness 97.3% 98.7%

States with reports not received in 2021 (week 1 – 52) State Week(s) report not received Benue 7, 10, 11, 12, 13, 14 & 15

Weekly Issue: Volume 12 No. 15. 4th May 2021 Epidemiological Report Timeliness and Completeness of Reports by State Year to date (week 1 – 52) Timeliness Completeness State (%) (%) Abia 93 100 Adamawa 100 100 Akwa Ibom 100 100 Anambra 100 100 Bauchi 100 100 Bayelsa 100 100 Benue 13 53 Borno 93 100 Cross River 100 100 Delta 100 100 Ebonyi 100 100 Edo 100 100 Ekiti 100 100 Enugu 87 100 FCT 100 100 Gombe 100 100 Imo 100 100 Jigawa 100 100 Kaduna 100 100 Kano 100 100 Katsina 100 100 Kebbi 100 100 Kogi 100 100 Kwara 100 100 Lagos 100 100 Nasarawa 100 100 Niger 100 100 Ogun 100 100 Ondo 100 100 Osun 100 100 Oyo 100 100 Plateau 93 100 Rivers 100 100 Sokoto 100 100 Taraba 100 100 Yobe 100 100 Zamfara 100 100