YELLOW FEVER SITUATION REPORT Serial Number: 004 July 2021 Monthly Sitrep Epi Week: 26 - 30 as at 31st July 2021 Reporting Month: July, 2021

The information contained in this document is confidential, privileged and only for the intended recipient and may not be used, published or redistributed to the public REPORTING MONTH: JULY 2021

The information contained in this document is confidential, privileged and only for the intended recipient and may not be used, published or redistributed to the public

HIGHLIGHTS

ST ST REPORTING PERIOD: JULY 1 – 31 , 2021

▪ The Nigeria Centre for Disease Control (NCDC) continues to monitor reports of yellow fever cases in Nigeria.

▪ A total of 220 suspected cases were reported from 134 Local Government Areas (LGAs) across 30 states:

Abia (14) Adamawa (4), Anambra (25), Bauchi (16), Bayelsa (4), Benue (3), Borno (15), Cross River (1),

Delta (2), Ebonyi (15), Edo (5), Ekiti (3), Enugu (16), Gombe (1), Imo (15), Jigawa (1),Kaduna (1), Kano (1), Katsina (20), Kebbi (3), Kogi (4), Kwara (5), Nasarawa (7), Niger (1), Ogun (4), Ondo (11), Oyo (10),

Plateau (7), Sokoto (1), Taraba (5).

▪ A total of 3 presumptive positive results were recorded from University of Nigeria Teaching Hospital (UNTH) Enugu (2) and Maitama District Hospital (MDH) Abuja (1). These cases were reported from Anambra -1 (Idemili South), Imo -1 (Mbaitoli) and Kwara -1 (Pategi) ▪ No new confirmed case recorded from laboratories in Nigeria or IP Dakar ▪ No death was recorded within the review period.

30 220 SUSPECTED STATES WITH CASES SUSPECTED CASES

0 0 CONFIRMED STATES WITH CASES CONFIRMED CASES

0 0 DEATHS IN STATES WITH CONFIRMED DEATHS IN CASES CONFIRMED CASES

CUMMULATIVE FOR 1ST JANUARY– 31TH JULY, 2021

▪ st Cumulatively from 1 January – 31 July 2021, a total of 1082 suspected cases have been reported from 37 states including FCT in 367 LGAs ▪ The cases were reported from the following states: Abia (30), Adamawa [21], Akwa Ibom [2], Anambra [92], Bauchi [51], Bayelsa [20], Benue [23], Borno [123], Cross River [13], Delta [28], Ebonyi (20), Edo [36], Ekiti [6], Enugu [66], FCT Abuja [9], Gombe (2), Imo [34], Jigawa [29], Kaduna (2), Kano [16], Katsina [107], Kebbi [28], Kogi [14], Kwara [26], Lagos [5], Nasarawa [21], Niger [35], Ogun [20], Ondo [27], Osun [16], Oyo [38], Plateau [20], Rivers [5], Sokoto [6], Taraba [13], Yobe [64] and Zamfara [14] States ▪ All the suspected cases were reported from 367 LGAs across the 36 states and FCT ▪ Total of 45 presumptive positive and 12 inconclusive samples were recorded from the Nigeria Laboratories ▪ Presumptive positives were recorded from CPHL Lagos (31), NRL Abuja (10), MDH Abuja (2), UNTH Enugu (2) and these cases were reported from Anambra (9), Bauchi (1), Benue (2), Borno (5), Delta (5), Edo (1), Enugu (13), Imo (1), Kano (1), Katsina (1), Kwara (1), Niger (1), Oyo (4). ▪ Inconclusive results were reported CPHL (6), NRL (2), MDH (1) AND YDMH Kaduna (3), These cases were reported from Benue (1), Borno (1), Ebonyi (1), Edo (1), Enugu (2), Katsina (2), Osun (1), Ondo (1), Yobe (1) and Zamfara (1). These cases have been sent to IP Dakar for confirmation. ▪ Twenty-seven (27) confirmed cases have been reported from IP Dakar from: Anambra-2 [Idemili North (1), Onitsha North (1)], Delta-4 [Aniocha South (1), Ika South (2), Patani (1)], Enugu-13 [Nkanu East (11), Nkanu West (1), Udenu (1)], Imo-1 [Ideato North (1)], Niger -1[Munya (1)], Oyo-4 [Ido (2), Ona ara (1), Oyo East (1)] and Ondo -1(Ondo West (1), Osun-1[Irewole (1)] ▪ Thirteen (48%) of the confirmed cases were from Enugu State ▪ Three deaths were recorded from Anambra (1), Imo (1) and Osun (1) among suspected cases ▪ Two deaths among confirmed cases from Anambra (1) and Osun (1); CFR (7.4%) ▪ Male to female ratio was 1.3:1 with males 606 (56.0%) and females 476 (44.0%) ▪ Seventy -nine percent of cases were predominantly aged 30 years and below ▪ One hundred and thirty-seven (12.7%) suspected cases had at least one dose of yellow fever vaccine while 4 (15%) among confirmed cases had at least one dose of yellow fever vaccine ▪ The NCDC is coordinating response activities through the National Multi-agency Yellow Fever Technical Working Group (YF TWG)`

1,082 37 STATES WITH SUSPECTED SUSPECTED CASES CASES

27 8 CONFIRMED STATES WITH CASES CONFIRMED CASES

1 1 DEATHS IN STATES WITH DEATHS IN CONFIRMED CASES CONFIRMED CASES

Table 1: Summary of yellow fever cases in Nigeria as at Epi week 30 (July 31st), 2021.

State Laboratory Results Deaths

positive

ein NG)

Cases Cases [CFR]

LGAs with confirmed

# Suspected # Cases # LGAs with cases suspected # cases Samples positive (IgM) Inconclusiv & LGAs with Inconclusivein & (IgM) NG) ConfirmedCases (PCRNG) ConfirmedCases Dakar) (IP TotalConfirmed Cases Deaths # among Confirmed (%) # Deaths among Cases [CFR](%) All Abia 30 10 ------Adamawa 21 12 ------Akwa Ibom 2 2 ------Anambra 92 19 2 9 8 - 2 2 1 1 Bauchi 51 11 - 1 1 - - - - - Bayelsa 20 6 ------Benue 23 7 - 3 1 - - - - - Borno 123 15 - 6 4 - - - - - Cross River 13 10 ------Delta 28 10 3 5 3 - 4 4 - - Ebonyi 20 11 - 1 1 - - - - - Edo 36 10 - 1 1 - - - - - Ekiti 6 4 ------Enugu 66 13 3 15 4 - 13 13 - - FCT Abuja 9 4 ------Gombe 2 1 ------Imo 34 18 1 2 2 - 1 1 - 1 Jigawa 29 12 ------Kaduna 2 2 ------Kano 16 10 - 1 1 - - - - - Katsina 107 27 - 3 2 - - - - - Kebbi 28 13 ------Kogi 14 9 ------Kwara 26 12 - 1 1 - - - - - Lagos 5 3 ------Nasarawa 21 9 ------Niger 35 17 1 1 1 - 1 1 - - Ogun 20 9 ------Ondo 27 11 1 1 1 - 1 1 - - Osun 16 9 1 1 1 - 1 1 1 1 Oyo 38 19 3 4 3 - 4 4 - - Plateau 20 10 ------Rivers 5 5 ------Sokoto 6 4 ------Taraba 13 4 ------Yobe 64 11 - 1 1 - - - - - Zamfara 14 8 - 1 1 - - - - - TOTAL 1,082 367(47%) 15 (2.0%) 56(5.2%) 37 (4.8%) 0 27 27 (3%) 2 (7%) 3 (0.3%)

Figure 1: Map of Nigeria showing yellow fever outbreak attack rates in affected LGAs, Epi week 1 - 30, July 2021

Figure 2: Epicurve of yellow fever cases in Nigeria as at Epi week 30, July 2021

Trend of confirmed yellow fever cases in Nigeria July 2017 - 2021 2017 2018 2019 2020 2021 100

90

80

70

60

50

40

30

Number of Yellow cases Yellow feverof Number 20

10

0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 Epid week

Figure 3: Trend of confirmed yellow fever cases in Nigeria 2017 – 2021

Number of tests by Yellow fever Laboratory Network in Nigeria as at 31st July 2021 400

350

300

250

200

150

100

50 Number of YF samples tested tested samples YF of Number 0 CPHL Lagos NRL Gaduwa YDMH MDH Abuja UNTH UBTH Measles Lab Kaduna Laboratory testing Centers

Figure 4: Distribution of yellow fever samples by Laboratory network testing centres in Nigeria as at Epi week 30, July 2021

Missing Female > 60Years Male 56 - 60 Years 51 - 55 Years 46 - 50 Years 41 - 45 Years 36 - 40 Years 31 - 35 Years 26 - 30 Years 21 - 25 Years

16 Distribution Age - 20 Years 11 - 15 Years 6 - 10 Years ≤ 5Years 150 100 50 0 50 100 Sex Distribution

Figure 5: Age and sex distribution of yellow fever cases in Nigeria as at Epi week 30 July, 2021

Enugu State

Figure 6a: Epicurve of yellow fever cases in Enugu State as at Epi week 25 June, 2021

Figure 6b: Map of yellow fever cases in Enugu State as at Epi week 30 July, 2021

SUMMARY OF TWG ACTIVITIES Coordination ▪ Yellow fever response activities are coordinated by NCDC through a multi-agency Yellow Fever Technical Working Group (YF TWG) ▪ Distributed yellow fever preparedness and response guidelines to all states ▪ Ongoing development of yellow fever training manual for the training of health workers on yellow fever identification, management, documentation, and reporting ▪ Ongoing development of yellow fever field investigation guide

Epidemiology/Surveillance/Data Management ▪ Daily monitoring and analysis of surveillance data across the country to guide response activities ▪ Engagement with State Epidemiologists for weekly updates ▪ Monitoring the effective use of SORMAS in all affected states to improve real-time reporting

Laboratory ▪ Commenced yellow fever testing for the South East and South South at University of Nigeria Teaching Hospital Enugu and University of Benin Teaching Hospital Benin City respectively ▪ Coordination of sample collection and transportation from affected states to the national testing laboratories ▪ Regular testing of yellow fever samples in all the testing laboratories ▪ Ensured availability of reagents and consumables in all testing laboratories ▪ Ongoing validation of Mologic rapid test kit for yellow fever

Case Management

▪ Ongoing sensitisation for health care workers on yellow fever case definition & management in affected states

Vaccination - Led by NPHCDA ▪ Ongoing planning meetings for yellow fever preventive mass vaccination campaign for 2021 in Abia, Ebonyi, Gombe, Imo, Kano, Ogun, Taraba and selected areas in Borno States

Risk Communication ▪ Completed the printing of additional yellow fever Information Education and Communication (IEC) materials ▪ Ongoing daily media monitoring across social and traditional media platforms

NEXT STEPS Coordination ▪ Continue implementation of the Incident Action Plan (IAP) and mobilise required resources for yellow fever preparedness ▪ Develop a protocol to guide response in states/LGAs with YF confirmed cases where vaccination campaigns have been conducted ▪ Planning for the training of Healthcare workers at selected tertiary hospitals in the six geopolitical zones ▪ To deploy a team to Enugu State for investigation of confirmed cases and support state with response

Epidemiology/Surveillance/Data Management ▪ Conduct sensitisation workshop on YF active case search for health care workers and surveillance officers in affected states ▪ Continue monitoring and analysis of YF surveillance data across all states and FCT to guide response

Case Management ▪ Strengthen the capacity at treatment centres to support response in affected states

Laboratory ▪ Off-site support to the new yellow fever laboratories at UNTH Enugu and UBTH Benin

Risk Communication ▪ Follow up with the distribution plan to disseminate YF preparedness and response guidelines and IEC materials to all states

Partners