MINISTRY OF HEALTH

• Three districts cross the alert threshold for meningitis. • Two cases of clinically confirmed human rabies in the Eastern and Upper West Regions

VOLUME 3 WEEK 16 nd 22 April 2018

The Weekly Epidemiological Report is a publication of the Ghana Health Service and the Ministry of Health, Ghana © Ghana Health Service 2018 ISSN - 2579-0439

Ghana Weekly Epidemiological Report Vol. 3 Week 16 22 April 2018. 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. 3 Week 16 22 April 2018. ii

Summary of Weekly Epidemiological Data, Week 16, 2018

Summary of Weekly Epidemiological Data for Week 16, 2018

Weekly Spotlight: • Three districts cross alert threshold for meningitis. • Two cases of clinically confirmed human rabies from two districts in the Eastern and Upper West Regions.

Summary of Priority Diseases and Events The expected number of reports for Week 16 was 5,858. Out The total all-cause notifiable disease morbidity for Week 16 of this figure, 5,684 were complete and 5,645 were timely was 2,278, indicating an increase of 74 cases with respect giving a percentage Completeness and Timeliness of 97.0% to Week 15.There were seven deaths; two due to Human and 96.4% respectively. Three regions, Brong-Ahafo, Rab ies while the others were maternal deaths. Acute watery Upper East and Volta scored 100% for both Completeness diarrhoea in persons aged >5 years contributed 64% of the and Timeliness. Greater Accra Region recorded the lowest no tifiable d iseases case load during Week 16 (See Annex 1, score for both Completeness (78.7%) and Timeliness sum mary of reported cases/deaths) (78.2%) of reporting [Table 1]. Table 4: Meningitis cases and deaths by Region, Ghana, Week 08 , 2018 Cerebrospinal Fluid (CSF) CFR District in District in TimelRegioniness and CompletenessCases of Reporting Deaths Table 1: Timeliness and Completeness of LabReporting Test Positive from Regions based on DHIMS reporting(%), Ghana, AlertWeek 16, 2018Epidemic

Ashanti 1 Expected 1 1 100.0 0 0 Brong-Ahafo† 11 Number of Actual2 Reports 1 9.1Reports on 1 % Report 0on CentralRegion 0 Reports 0Received % Completeness0 0.0 Time 0 Time 0 EasternAshanti 1 574 0 569 99.10 0.0 567 0 98.8 0 GreaterBrong- AhafoAccra 0 685 0 685 100.00 0.0 685 0 100 0 NorthernCentral † 13 504 2 445 88.30 0.0 415 2 82.3 0 UpperEastern East † 9 836 9 836 100.00 0.0 834 1 99.8 0 UpperGreater West Accra† 32 380 5 299 78.74 12.5 297 5 78.2 1 VoltaNorthern 0 646 0 646 100.00 0.0 645 0 99.8 0 WesternUpper East 0 449 0 449 100.00 0.0 449 0 100 0 TotalUpper (Ghana) West 67 357 19 331 92.76 9.0 330 9 92.4 1 Volta 626 626 100.0 626 100 Western 801 798 99.6 797 99.5 Ghana 5,858 5,684 97.0 5,645 96.4

Regional Performance Based on Reporting The expected percentage for districts reporting suspected The overall performance of the regions improved during the Measles or Yellow fever as at Week 16 was 24.6%. All Week compared to the Week 15 and ranged from 73.1% to regions achieved the target for both Measles and Yellow 91.9% [Table 2]. Fever surveillance.

Table 2: Ranking of Regional Performance, Week 16, 2018 Timeli- Complete- AFP Measles YF Average ness (%) ness (%) Cum. Annualize AFP % % Score % Position Week Week AFP d Non- Score District District Region 16 16 Cases Polio AFP (%) reporting reporting (A+B+C+ A B Week 16 Rate C D E D+E)/5 Brong-Ahafo 99.5 99.6 4.00 86.4 74.1 26 100 91.9 1st Northern 99.8 100 3.00 73.1 65.4 21 100 87.7 2nd Eastern 92.4 92.7 3.00 81.8 61.5 15 100 85.7 3rd Greater Accra 100 100 2.00 61.5 56.3 5 100 83.6 4th Western 98.8 99.1 4.00 36.7 72.7 8 100 81.5 5th Central 100 100 1.40 92 35 17 70 79.4 6th Ashanti 100 100 1.10 85.2 53.3 21 55 78.7 7th Volta 99.8 100 1.89 19.2 68 10 95 76.4 8th Upper West 82.3 88.3 7.00 55 45.5 7 100 74.2 9th Upper East 78.2 78.7 2.00 62.5 46.2 8 100 73.1 10th

Ghana 96.4 97 138 3.00 100 63.9 59.7 83.4

Ghana Weekly Epidemiological Report Vol. 3 Week 16 22 April 2018. 1

Summary of Weekly Epidemiological Data, Week 16, 2018

MENINGITIS There were 23 reported cases with no death for Week 16 respective attack rates of 3.3 and 5.7 per 100,000 cases. [Table 3]. Jaman North district in the Brong-Ahafo region Lawra, Nadowli-Kaleo, Wa and Daffiama-Bussie-Issa crossed the alert threshold for meningitis with an attack rate districts in the Upper West region reported a case each.. of 5.0 per 100,000 cases. Lambussie-Karni and Nandom The single cases reported from Nandom and Nadowli-Kaleo districts in the Upper West region were in alert phase with districts were Gram Positive diplococci [Table 4].

Table 3: Meningitis cases and deaths by Region, Ghana, Week 16, 2018 . Cerebrospinal Fluid (CSF) CFR District in District in Region Cases Deaths Lab Test Positive (%) Alert Epidemic Ashanti. 0 0 0 - 0 0 Brong-Ahafo† 6 6 0 0.0 1 0 Central 0 0 0 - 0 0

Eastern 2 2 0 0.0 0 0

Greater Accra 1 1 0 0.0 0 0

Northern 1 1 0 0.0 0 0 Upper East 2 2 0 0.0 0 0 Upper West† 10 10 0 0.0 2 0 Volta 0 0 0 - 0 0 Western 1 1 0 0.0 0 0 Total (Ghana) 23 23 0 0.0 3 0 † Jaman North: 5 cases [AR=5.0] Lambussie-Karni: 2 cases [AR=3.3] Nandom: 3 cases [AR=5.7]

Table 4: Meningitis cases confirmed cases by Gram stain, Latex, and Culture/PCR*, Week 16, 2018 Districts Cases CSF CSF positive Confirmed Deaths Causative Organism Jaman North 1 1 0 0 0 Nil Daffiama-Bussie-Issa 1 1 0 0 0 Nil Jirapa 1 1 0 0 0 Nil Lambussie-Karni 1 1 0 0 0 Nil Nadowli-Kaleo 3 3 1 1 0 Gram Positive Diplococci Nandom 3 3 1 1 0 Gram Positive Diplococci

ACUTE FLACCID PARALYSIS (SUSPECTED CHOLERA In Week 16, there was no case of cholera reported. POLIOMYELITIS)

Four cases of acute flaccid paralysis (AFP) were reported from

four districts [Table 5]. All the stool specimens tested at the MATERNAL DEATHS

Noguchi Memorial Institute for Medical Research [NMIMR] During the week, there were five maternal deaths reported

were negative for wild polio virus. nationwide [Table 6].

Table 5: Suspected Poliomyelitis cases and deaths by Region Table 6: Maternal deaths by Region and District, Ghana,

and District, Ghana, Week 16, 2018 Week 16, 2018

Region Districts Cases Deaths Region Districts Deaths Brong-Ahafo Dormaa East 1 0 Asante-Mampong 1 Eastern Akwapim South 1 0 Ashanti Kumasi 1 Greater Accra Ga West 1 0 Central Cape Coast 1 Northern Nanumba North 1 0 Eastern Lower Manya Krobo 1 Total 4 0 Western Prestea-Huni Valley 1 Total 5

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Summary of Weekly Epidemiological Data, Week 16, 2018

INFLUENZA-LIKE ILLNESS MEASLES The number of reported Influenza-like illnesses at the end of A total of 49 suspected cases of Measles were reported from 32 the week was 643. [Table 7]. At the sentinel sites, samples districts [Table 9]. All samples were sent to the National Public were taken and sent to the NMIMR for laboratory Health Reference Laboratory [NPHRL] for investigation and were investigation. A total of five (38.5%) samples were positive negative for measles and rubella. for influenza type A (H1N1) and eight (61.5) were positive

for influenza B Yamagata. Table 9: Reported Suspected Measles cases by Region and Table 7: Reported Influenza-Like Illness cases by Region District, Ghana, Week 16, 2018

and District, Ghana, Week 16, 2018 Region Districts Cases Deaths Region Districts Cases Deaths Asante-Akim South 1 0

Adansi South 10 0 Ashanti Kwabre 1 0 Bekwai 13 0 Offinso North 1 0 Ashanti Ejisu-Juaben 173 0 Asunafo South 3 0 Kumasi 159 0 Dormaa West 1 0 Brong-Ahafo Sunyani 8 0 Jaman North 1 0 Kintampo North 1 0 Central Cape Coast 39 0 Brong-Ahafo Kwaebibirem 5 0 Nkoranza North 4 0 Sunyani 2 0 New Juaben 104 0 Sunyani West 3 0 Eastern West Akim 10 0 Techiman South 2 0 Accra 34 0 Central Cape Coast 1 0 Ga West 15 0 La-Dade-Kotopon 2 0 Denkyembour 1 0 East Akim 1 0 - 8 0 Kwaebibirem 2 0 Ningo Prampram 1 0 Eastern Kwahu North 1 0 Greater Accra Tema 40 0 West Akim 1 0 Bolgatanga 5 0 Yilo Krobo 1 0 Upper East Kassena-Nankana 1 0 Accra 1 0 Volta Ketu South 3 0 Ga Central 1 0 Western Sekondi Takoradi 4 0 Greater Accra Ga West 1 0 Total 643 0 La-Nkwantanang- 2 0 Madina

Northern Tatale-Sanguli 2 0

HUMAN RABIES Akatsi South 1 0

There were two reported cases of human rabies from Lawra Hohoe 1 0

and Fanteakwa districts [Table 8] with case investigation is Volta Nkwanta North 5 0 North Tongu 1 0 still ongoing. South Tongu 1 0

Ahanta West 1 0 Table 8: Human Rabies cases by Region and District, Bodi 2 0 Ghana, Week 16, 2018 Western Wassa Amenfi East 1 0 Case Deaths Region Districts CFR Tarkwa-Nsuaem 1 0 Total 49 0 1 1 Eastern Fanteakwa 100 Upper West Lawra 1 1 100

Total 2 2 100

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Summary of Weekly Epidemiological Data, Week 16, 2018

YELLOW FEVER

There were 21 suspected Yellow Fever cases, from 17 districts in nine regions [Table 10]. All of the cases tested negative for

yellow fever IgM at the National Public Health and Reference Laboratory, Korle-Bu, Accra

Table 10: Laboratory investigation of suspected Yellow Fever cases, Ghana, Week 16, 2018

Lab Confirmed Samples Region District Suspected Taken Presumptive Positive Negative Deaths Ashanti Adansi South 2 2 0 2 0 Jaman North 1 1 0 1 0 Nkoranza North 1 1 0 1 0 Brong-Ahafo Sene East 1 1 0 1 0 Tain 1 1 0 1 0 Wenchi 1 1 0 1 0 Central Cape Coast 2 2 0 2 0 Eastern Kwahu North 2 2 0 2 0 Greater Accra Accra 1 1 0 1 0 Ga West 1 1 0 1 0 Northern Zabzugu 1 1 0 1 0

Upper East Builsa North 1 1 0 1 0

Akatsi North 1 1 0 1 0

2 2 2 0 0 Nkwanta North 1 1 0 1 0 Volta South Dayi 1 1 0 1 0 Western Wassa-Amenfi Central 1 1 0 1 0 Total 21 21 0 21 0

ACTION POINTS • The case definitions of all priority diseases/conditions are • Clinicians should be given in-house orientation on to be adhered to by Clinicians and investigation teams performing lumbar puncture, especially in the southern before classification as a suspected or probable case sector. This can encourage reporting of meningitis cases . • Regions are encouraged to implement the “One Health • Regions are to ensure that influenza sentinel sites pick Approach” in investigating all zoonotic diseases (thus Vet five samples from influenza-like illnesses (ILI) patients Service, other agencies). Advocacy for anti-rabies each week and send to NMIMR for testing. For all vaccination in dogs and cats in all districts is also hospitalized ILI (i.e. Severe Acute Respiratory Illness encouraged. Again, post exposure prophylaxis for e.g., pneumonia), nasal and oropharyngeal swabs are to persons bitten by suspected rabid dogs is also encouraged. be sent to the National Influenza Center. All SARI and ILI patients seen by sentinel and non-sentinel sites should • Surveillance on viral haemorrhagic fevers should be be entered on the weekly summary form in the DHIMS. enhanced in regions, districts, health facilities and at the Sentinel sites are encouraged to complete Points of Entry (ground crossings, airport and ports). epidemiological forms for FluID. Blood samples from suspected cases should be taken, placed in viral transport medium and sent to NMIMR for • This report and subsequent ones should be shared with laboratory investigations. other regional, district and other heads. You are encouraged to disseminate to other agencies as well. A • It is recommended that all regions continue to strengthen feedback addressed to the Editor-In-Chief is also surveillance on meningitis. Periodic meetings of Public welcome. Health Emergency Management Committees should be held even in the absence of health emergencies to be apprised of disease trends. The District Assemblies should be made to own this process.

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Summary of Weekly Epidemiological Data, Week 16, 2018

ANNEX 1: SUMMARY OF REPORTED CASES/ EVENTS: WEEK 16 (WEEK ENDING 22 APRIL, 2018) Disease/Health Event Week 15 Week 16 Cumulative to Week 16 (suspected/confirmed) Cases Deaths CFR Cases Deaths CFR Cases Deaths CFR (susp) (%) (susp) (%) (susp) (%) AFP (suspected polio) 10 0 0.0 4 0 0.0 112 0 0.0 Acute haemorrhagic 0 0 - 0 0 - 25 0 0.0 fever syndrome Adverse events 0 0 - 0 0 - 0 0 - following immunization Anthrax 0 0 - 0 0 - 2 0 - Acute watery diarrhoea 1,408 0 0.0 1,459 0 0.0 16,686 0 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 130 0 0.0 84 0 0.0 1,359 0 0.0 Dracunculiasis (Guinea 0 0 - 0 0 - 1 0 0.0 worm) Influenza-like illness 692 0 0.0 634 0 0.0 9,718 0 0.0 Maternal deaths - 4 - - 5 - - 31 - Measles 63 0 0.0 49 0 0.0 716 0 0.0 Meningitis 25 0 0.0 23 0 0.0 687 50 7.3 Neonatal tetanus 0 0 - 0 0 - 3 0 - Plague 0 0 - 0 0 - 0 0 - Public health event of 0 0 - 0 0 - 0 0 - international concern (PHEIC) Human rabies 3 3 100.0 2 2 100.0 12 12 100.0 SARS 0 0 - 0 0 - 0 0 - Smallpox 0 0 - 0 0 - 0 0 - Yellow fever (suspected) 19 0 - 21 0 0.0 288 0 0.0 NATIONAL TOTAL 2,350 7 0.1 2,276 7 0.1 29,609 93 0.2 *CFR does not include maternal deaths

Ghana Weekly Epidemiological Report Vol. 3 Week 16 22 April 2018. 5

Editorial Board Editorial Team

Dr. Anthony Nsiah-Asare Editor Dr. Badu Sarkodie Mr. Gideon Kwarteng Acheampong Mr. Michael Adjabeng Mr. James Addo Managing Editor Dr. Emmanuel Kofi Dzotsi Mr. Kwame Acheampong Owusu Dr. Kwame Amponsa-Achiano Dr. David Opare Editor-In-Chief Dr. Franklin Asiedu-Bekoe Dr. Kenneth Ofosu-Barko

Mr. Kwame Kodom Achempem 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

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