MINISTRY OF HEALTH

 Influenza A H3N2 constitutes 84% of all confirmed ILI and SARI cases

 All regions achieve the surveillance reporting targets for both Measles and Yellow Fever VOLUME 4 WEEK 14 th 7 April, 2019

The Ghana 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. 4 Week 14 07 April 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 14 07 April 2019 ii

Summary of Weekly Epidemiological Data, Week 14, 2019

Summary of Weekly Epidemiological Data for Week 14, 2019

Highlights:  Influenza A H3N2 constitutes 84% of all confirmed ILI and SARI cases  All regions achieve the surveillance reporting targets for both Measles and Yellow Fever

SUMMARY OF PRIORITY Acute watery diarrhoea in persons… 751

DISEASES AND EVENTS - Influenza-like illness 356 WEEK 14, 2019 Measles 73 The total all-cause notifiable disease morbidity for the week (as per IDSR Diarrhoea with blood 29 Weekly Summary Reporting Form) Meningitis 24

was 1,280 with one maternal death Yellow fever (suspected) 19 and a death each from Meningitis, AFP (suspected polio) 13 Neonatal Tetanus and Human Rabies.

Disease/Health Event Disease/Health Adverse events following… 12 Acute watery diarrhoea in persons Neonatal tetanus aged 5 years and above was the 2 highest proportion of cases reported, Human rabies 1 contributing 59% of the notifiable diseases case load during Week 14 0 200 400 600 800 [See Figure 1 and Annex 1] Number of Cases

Figure 1: Reported notifiable disease conditions, Ghana, Week 14, 2019

REGIONAL PERFORMANCE BASED ON REPORTING The best performing region was Upper West with a mean Timeliness and Completeness of reporting for all notifiable score of 96.1% whilst the Ashanti region had the lowest conditions for the Week were 97.9% and 99.1% respectively. mean score of 72.9%. All regions achieved the expected All regions scored above 85% for both timeliness and target (21.5%) for percentage of districts reporting at least completeness of reporting. a suspected case of Measles and Yellow Fever [Table 1]. .

Table 1: Ranking of Regional Performance based on selected Surveillance reporting indicators, Ghana, Week 14, 2019 Region Timeli- Complete- Measles YF Average ness (%) ness (%) Cum. Annualized AFP % % Score % Position Week Week AFP Non-Polio Score District District 14 14 Cases AFP Rate (%) reporting reporting (A+B+C+ A B Week 14 C D E D+E)/5 Upper West 99.2 99.4 21 19.6 100 100.0 81.8 96.1 1st Brong-Ahafo 99.6 99.6 21 3.4 100 96.3 55.6 90.2 2nd Eastern 100 100 16 2.8 100 100.0 46.2 89.2 3rd Upper East 100 100 8 2.9 100 76.9 53.8 86.2 4th Greater Accra 90.7 98.1 20 1.7 86 100.0 50.0 85.0 5th Western 99.9 100 12 3.1 100 68.2 54.5 84.5 6th Northern 99.1 99.4 18 3.3 100 57.7 46.2 80.5 7th Volta 99.8 100 12 1.6 82 68.0 44.0 78.8 8th Central 86.4 93.6 14 3.3 100 65.0 30.0 75.0 9th Ashanti 98.8 99.1 16 1.0 50 70.0 46.7 72.9 10th Ghana 97.9 99.1 158 2.8 100 78.7 49.1 85.0

Ghana Weekly Epidemiological Report Vol. 4 Week 14 07 April 2019 1

Summary of Weekly Epidemiological Data, Week 14, 2019

INFLUENZA-LIKE ILLNESS (IDSR Weekly Report) A total of 356 cases with no deaths were reported through IDSR weekly reporting [Table 2]. Laboratory samples were sent from sentinel sites to Noguchi Memorial Institute for Medical Research (NMIMR).

Table 2: Reported Influenza-Like Illness cases by Region 6% 10% and District, Ghana, Week 14, 2019 Region Districts Cases Deaths Brong-Ahafo 10 0 Flu B VIC Central Cape Coast 26 0 H3N2 Greater Accra Accra 21 0 H1N1 Adentan 8 0 Ga Central 10 0 Ga East 45 0 84% Ga West 31 0 La-Dade-Kotopon 10 0 10 0 Shai Osudoku 82 0 Tema 93 0 Upper East Bolgatanga 5 0 Volta Ketu South 5 0 Figure 2: Distribution of Confirmed cases of ILI & SARI, Total 356 0 Ghana, Week 1 – 14, 2019

Sentinel Reporting As at the end of Week 14 total of 1,223 samples have been YELLOW FEVER taken from Sentinel sites in all regions that included 1057 Nineteen suspected cases of Yellow Fever were reported across samples from Influenza Like –Illnesses (ILI) and 166 from the country [Table 4]. Samples were sent to the National Public Severe Acute Respiratory Infection (SARI) patients [Table Health and Reference Laboratory with results pending due to 3]. Only 4.1% (51) of the samples collected have been lack of reagents. confirmed positive. Forty-four (44) of the ILI and seven (7) of the SARI cases were confirmed. Influenza A H3N2 has Table 4: Suspected Yellow Fever cases by Region, Ghana, constituted 84% of all confirmed cases since Week 1 [Figure Week 14, 2019 2]. Region District Cases Deaths

Ashanti Amansie Central 3 0 Table 3: Cumulative Reported ILI and SARI cases by Bekwai 1 0 Region, Ghana, Week 1 -14, 2019 Brong-Ahafo Asutifi North 1 0 Number of Samples Banda 2 0 Region Dormaa East 2 0 ILI Confirmed SARI Confirmed Sunyani 1 0 Ashanti 116 7 13 2 Sunyani West 1 0 Tano North 2 0 Brong- 111 0 16 1 Eastern New Juaben 2 0 Ahafo Greater-Accra Ada East 1 0 Central 32 1 12 0 Upper East Nabdam 1 0 Eastern 79 2 16 0 Upper West Sissala West 1 0 Greater Western Bia West 1 0 234 9 25 0 Accra Total 19 0 Northern 154 2 19 3

Upper East 65 4 16 0 CHOLERA Upper West 14 4 0 0 No cholera case was reported during the Week. Volta 100 6 1 0

Western 152 9 48 1 NEONATAL TETANUS Ghana 1057 44 166 7 Two cases of Neonatal Tetanus with were recorded in the New Juaben Municipality with one death in Week 14.

MATERNAL DEATHS HUMAN RABIES

During the Week, one maternal death was recorded in the A case of Human Rabies was recorded in the Wassa- Accra Metropolis. Amenfi West district during the week. The case died.

Ghana Weekly Epidemiological Report Vol. 4 Week 14 07 April 2019 2

Summary of Weekly Epidemiological Data, Week 14, 2019

MEASLES HIGH CASES OF SUSPECTED MEASLES IN THREE DISTRICTS During the Week, a total of 73 suspected cases of During the week, three districts namely; Upper West Akim and Sissala West Measles were reported across the country [Table 5]. each recorded four (4) suspected cases and Ketu North recording six (6) Samples were taken and sent to the National Public suspected cases of measles [Table 5]. There were no clustering of cases in Health and Reference Laboratory [NPHRL] for any of the districts. However, the cases were all followed up and investigations with results pending. investigated by the district teams within 24-48 hours. Samples have been taken and sent to the National Public Health and Reference Laboratory [NPHRL] for investigation.

Table 5: Reported Suspected Measles cases by Region and District, Ghana, Week 14, 2019 Region Districts Cases Deaths Region Districts Cases Deaths Ashanti Asante Akim North 1 0 Northern Bunkpurugu-Yunyoo 1 0 Kumasi 2 0 Central Gonja 1 0 Brong- Asunafo North 1 0 Chereponi 1 0

Ahafo Asutifi South 1 0 Kumbungu 1 0

Banda 1 0 Tatale-Sanguli 1 0

Berekum 1 0 West Gonja 1 0

Upper East 3 0 Kassena Nankana West 3 0 Sunyani 2 0 Nabdam 1 0 Sunyani West 1 0 Upper Daffiama-Bussie-Issa 1 0 Central Abura-Asebu- West 1 0 Nandom 1 0 Kwamankese Eastern Birim Central 2 0 Sissala West 4 0 Birim South 1 0 Wa East 1 0 East Akim 2 0 Volta 3 0 Kwaebibirem 1 0 Ketu North 6 0 Kwahu South 1 0 Krachi West 1 0

Lower Manya Krobo 2 0 Western Aowin 1 0

New Juaben 2 0 Ellembelle 2 0 Nsawam Adoagyiri 3 0 Prestea-Huni Valley 1 0 Upper Manya Krobo 1 0 Sekondi Takoradi 1 0 Upper West Akim 4 0 Tarkwa Nsuaem 1 0

Greater Accra 1 0 Accra Ada East 1 0 Ada West 1 0 Total 73 0 Ga South 1 0 Shai Osudoku 1 0

Tema 2 0

MENINGITIS In Week 14, a total of 24 cases of meningitis were recorded with one death [Table 6]. Nandom district recorded 4 cases and

crossed the alert threshold with an attack rate of 7.5 cases per 100,000 population. Kassena-Nankana in the Upper East region also recorded 4 cases and crossed the alert threshold with an attack rate of 3.3 cases per 100,000 population respectively. Lumbar

Puncture was done for all 24 cases recorded with four (4) confirmed as positive for meningitis [Table 6].

Table 6: Meningitis cases and deaths by Region, Ghana, Week 14, 2019 Cerebrospinal Cerebrospinal CFR District in District in Region Cases Fluid (CSF) Lab Deaths Fluid (CSF) (%) Alert Epidemic Test Positive

Ashanti 0 0 0 0 - 0 0

Brong-Ahafo 2 2 0 0 0 0 0 Central 0 0 0 0 - 0 0 Eastern 1 1 0 0 0 0 0

Greater Accra 0 0 0 0 - 0 0 Northern 0 0 0 0 - 0 0

Upper East† 14 14 4 1 7.1 1 0

Upper West† 6 6 0 0 0 1 0

Volta 0 0 0 0 - 0 0 Western 1 1 0 0 0 0 0

Total (Ghana) 24 24 4 1 4.2 2 0 † Attack Rate per 100,000 population [District; Kassena Nankana; 4 cases (AR= 3.3), Nandom; 4 cases (AR=7.5)]

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Summary of Weekly Epidemiological Data, Week 14, 2019

CONFIRMED CAUSATIVE ORGANISMS FROM Nandom Alert Epidemic 12 MENINGITIS LABORATORY TESTS 10 A case of Streptococcus pneumoniae each was confirmed in the Binduri and Garu Tempane districts [Table 7]. The 8 Bawku West district recorded two confirmed cases of 6 Streptococcus pneumoniae in Week 14. Nandom district Cases 4 crossed the alert threshold [Figure 3]. Lumbar puncture was done for all cases and all were negative for any strain of 2 meningitis. 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Epidemiological Week

Figure 3: Meningitis threshold monitoring chart for Nandom, Week 1 - 14, 2019 Table 7: Meningitis cases confirmed, Ghana, Week 14, 2019 Districts Cases CSF CSF positive Deaths Causative Organism Bawku West 4 4 2 0 2-Streptococcus pneumoniae Binduri 2 2 1 0 Streptococcus pneumoniae Garu-Tempane 4 4 1 1 Streptococcus pneumoniae

ACUTE FLACCID PARALYSIS (SUSPECTED

POLIOMYELITIS) Summary on Acute Flaccid Paralysis (AFP)

Indicators, Week 1 – 14, 2019 Thirteen cases of Acute Flaccid Paralysis (AFP) were reported A total of 158 AFP cases have been recorded with during the Week [Table 8]. All the stool specimens tested at the no compatible. Brong-Ahafo region has recorded Polio Laboratory at NMIMR were negative for wild poliovirus. the highest number of cases (21). All regions

achieved the annualized Non-Polio AFP rate of Table 8: Suspected Poliomyelitis cases and deaths by Region and 2.0 per 100,000 population less than 15 years District, Ghana, Week 14, 2019 except Ashanti (1.0), Greater Accra (1.7) and

Region Districts Cases Deaths Volta (1.6) regions as at the end of Week 14

Ashanti Sekyere Afram Plains 1 0 [Table 9]. All regions achieved timeliness and

Brong-Ahafo Kintampo North 1 0 adequacy of stool received by the laboratory Eastern Akwapim North 1 0 except Greater Accra (70%) which failed to Birim South 1 0 achieve for timeliness and adequacy of stool West Akim 1 0 submission. Northern Karaga 1 0

Upper East Builsa South 1 0 Nabdam 1 0

Upper West Sawla-Tuna-Kalba 1 0

Volta Afadzato 3 0

Western Jomoro 1 0

Total 13 0

Table 9: Summary on Acute Flaccid Paralysis Surveillance, Ghana, Week 1 – 14, 2019

Expected

Non- Annualized Population Reported % Timely % Adequate Region Polio Compatible Discarded Non-Polio Under 15 years AFP Stools Stools AFP for AFP Rate

the year

Ashanti 2,559,248 52 16 0 7 1.0 87.5 81.3 Brong-Ahafo 1,199,191 24 21 0 11 3.4 85.7 85.7 Central 1,216,036 25 14 0 11 3.3 100.0 100.0

Eastern 1,345,144 27 16 0 10 2.8 93.8 81.3

Greater Accra 2,148,065 43 20 0 10 1.7 70.0 70.0

Northern 1,348,239 27 18 0 12 3.3 94.4 94.4 Upper East 498,068 10 8 0 4 2.9 100.0 100.0 Upper West 353,090 7 21 0 19 19.6 100.0 100.0 Volta 1,116,490 23 12 0 5 1.6 91.7 91.7 Western 1,204,310 24 12 0 10 3.1 91.7 91.7 Ghana 12987879.76 260 158 0 99 2.8 90.5 88.6

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Summary of Weekly Epidemiological Data, Week 14, 2019

ANNEX 1: SUMMARY OF REPORTED CASES/ EVENTS: WEEK 14 (WEEK ENDING 07 APRIL 2019)

Disease/Health Event Week 13 Week 14 Cumulative to Week 14 (suspected/confirmed) Cases Deaths CFR Cases Deaths CFR Cases Deaths CFR (susp) (%) (susp) (%) (susp) (%)

AFP (suspected polio) 9 0 0 13 0 0 158 0 0

Acute haemorrhagic 0 0 - 0 0 - 0 0 - fever syndrome Adverse events 11 0 0 12 0 0 69 0 - following immunization Anthrax 0 0 - 0 0 - 0 0 - Acute watery diarrhoea 996 0 0 751 0 0 11,979 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 49 0 0 29 0 0 518 0 0 Dracunculiasis (Guinea 0 0 - 0 0 - 0 0 - worm) Influenza-like illness 568 0 0 356 0 0 6,821 0 0 Maternal deaths - 3 - - 1 - - 28 - Measles 53 0 0 73 0 0 713 0 0 Meningitis 31 1 0 24 1 4.2 565 16 2.8 Neonatal tetanus 0 0 - 2 1 50.0 5 2 40.0 Plague 0 0 - 0 0 - 0 0 - Public health event of 0 0 - 0 0 - 0 0 - international concern (PHEIC) Human rabies 0 0 - 1 1 100.0 2 2 100.0 SARS 0 0 - 0 0 - 0 0 - Smallpox 0 0 - 0 0 - 0 0 - Yellow fever (suspected) 21 0 0 19 0 0 221 0 0 NATIONAL TOTAL 1,738 4 0.1 1,280 4 0.2 21,051 48 0.1 *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

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Summary of Weekly Epidemiological Data, Week 14, 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. James Addo 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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