Centre for Disease Control Protecting the health of Nigerians

Role of NPHIs in Re-Emerging Infectious Diseases Lassa fever: The Nigerian Experience

Dr. Chikwe Ihekweazu Director General Mandatory disclosure slide

No conflict of interest

2 NIGERIA CENTRE FOR DISEASE CONTROL Nigeria’s health and economy

Population ~ 186 million

Annual population growth rate of 2.6%

Recent outbreaks - Lassa fever, , Monkeypox, , Meningitis

Low expenditure on health as a percentage of GDP

Multiple competing priorities for Government

3 NIGERIA CENTRE FOR DISEASE CONTROL 3 Major outbreaks in Nigeria

4 NIGERIA CENTRE FOR DISEASE CONTROL Lassa fever in Nigeria

Large outbreak in 2018 Ongoing outbreak in 2019 638 confirmed cases 420 confirmed cases 171 deaths 93 deaths 23/36 states affected 21/36 states affected Case fatality: 26% Case fatality: 22% Cases concentrated in three hotspot Cases being detected in new states states

5 NIGERIA CENTRE FOR DISEASE CONTROL Trends of Lassa fever in Nigeria (2016-2019)

6 NIGERIA CENTRE FOR DISEASE CONTROL 7 NIGERIA CENTRE FOR DISEASE CONTROL Improved digital surveillance

WHO, ECOWAS, R-CDC

Aggregated monthly

Nigeria Centre for Disease Control CDC

Aggregated weekly (by Wednesday) State/Regional Health Department

Aggregated weekly (by Tuesday) District / Local Government Area Health Dpt.

Aggregated weekly (by Monday) Local Health Care Facilities

8 NIGERIA CENTRE FOR DISEASE CONTROL Improved digital surveillance

WHO, ECOWAS, R-CDC

Aggregated monthly

Nigeria Centre for Disease Control CDC manual data entry Aggregated weekly (by Wednesday) State/Regional Health Department

Aggregated weekly weekly (by Tuesday) District / Local Government Area Health Dpt.

Aggregated weekly Laboratory (by Monday) Local Health Care Facilities IDSR Field 001A investigator

9 NIGERIA CENTRE FOR DISEASE CONTROL Cases in ‘new states’

2018 2019

LEGEND ≥1 Suspected Cases 1- 50 Confirmed Cases >50 Confirmed Cases 1 dot = 1 Confirmed Case

10 NIGERIA CENTRE FOR DISEASE CONTROL Improved diagnostics- Four new molecular laboratories

11 NIGERIA CENTRE FOR DISEASE CONTROL Improved logistics system

12 NIGERIA CENTRE FOR DISEASE CONTROL Increasing use of EOCs

13 NIGERIA CENTRE FOR DISEASE CONTROL National sample transport system

14 NIGERIA CENTRE FOR DISEASE CONTROL Improved almost real-time sequencing in Nigeria

15 NIGERIA CENTRE FOR DISEASE CONTROL Research activities

• National Lassa fever research plan developed • Research as core pillar of EOC • National Lassa Fever Research Consortium • Lassa fever- critical areas for WHO R&D, CEPI vaccines

16 NIGERIA CENTRE FOR DISEASE CONTROL Improved collaboration PANDORA-ID NET SUPPORT

17 NIGERIA CENTRE FOR DISEASE CONTROL 2019 Lassa fever preparedness

• Training of 1,000 health workers in Nigeria on Lassa fever management, diagnosis and surveillance • Prepositioning of treatment and diagnostic supplies to the 21 states that recorded cases in 2018 • Publication of Lassa fever messages in newspapers, weekly radio shows, and intensive community engagement • High level advocacy visits to State Governments • Review of case management guidelines, initiated a Lassa fever Research Consortium and hosted International Conference on Lassa Fever

18 NIGERIA CENTRE FOR DISEASE CONTROL 19 NIGERIA CENTRE FOR DISEASE CONTROL Nigeria Centre for Disease Control Mandate Prevent, detect, and control spread of communicable diseases

Coordinate surveillance systems to collect, analyse and interpret data on communicable diseases to guide action

Support States in responding to small outbreaks, and lead response to large disease outbreaks

Develop and maintain a network of laboratories

Conduct, collate, synthesise and disseminate public health research to inform policy

Coordinate the compliance with international health regulations

20 NIGERIA CENTRE FOR DISEASE CONTROL NCDC’s role in infectious diseases (Lassa fever)

• Coordination of public health surveillance, laboratory and response functions

• Coordination of partners’ support

• Building trust among Nigerians through regular communication

21 NIGERIA CENTRE FOR DISEASE CONTROL Why we need strong NPHIs

1. A public health event can go from local to global very rapidly

2. Global health security can only be assured by local health protection

3. A strong surveillance & response system, managed by a skilled public health workforce, organised in a national public health institute is needed in every country

4. Partnerships matter more than ever before, NPHIs coordinate these

5. Vulnerability for one is vulnerability for all

22 NIGERIA CENTRE FOR DISEASE CONTROL Our posters at ICREID 2019

23 NIGERIA CENTRE FOR DISEASE CONTROL THANK YOU Email: [email protected]

24 NIGERIA CENTRE FOR DISEASE CONTROL