VOLUME 4 WEEK 43 27TH OCTOBER, 2019

 Nandom District hits epidemic threshold for Meningitis

kicks off Adaptation of 3rd Edition IDSR Technical Guidelines

Summary of Weekly Epidemiological Data, Week 43, 2019

The Ghana Weekly Epidemiological Report is a publication of the Ghana Health Service and the Ministry of Health, Ghana © Ghana Health Service 2019 ISSN - 2579-0439

Ghana Weekly Epidemiological Report Vol. 4 Week 43 27 October 2019 i

Summary of Weekly Epidemiological Data, Week 43, 2019

Acknowledgement

This publication has been made possible with technical and financial support from the Bloomberg Data for Health Initiative (www.bloomberg.org), the CDC Foundation and the World Health Organisation

Ghana Weekly Epidemiological Report Vol. 4 Week 43 27 October 2019 ii

Summary of Weekly Epidemiological Data, Week 43, 2019

Summary of Weekly Epidemiological Data for Week 43, 2019

Highlights:

 Nandom District hits epidemic threshold for Meningitis

SUMMARY OF PRIORITY Influenza-like illness 429 DISEASES AND EVENTS - WEEK Acute watery diarrhoea in persons … 230 43, 2019 Measles 46 Yellow fever (suspected) 14 The total all-cause notifiable disease Diarrhoea with blood 18 morbidity for the week (as per IDSR AFP (suspected polio) 12 Weekly Summary Reporting Form) Meningitis was 767 with two maternal deaths and 13 Adverse events following… 2 one meningitis related death. Disease/Health Event Influenza -like Illnesses contributed Human rabies 0 56% of the notifiable diseases’ Neonatal tetanus 0 caseload during Week 43 [See Figure 0 100 200 300 400 500 1 and Annex 1] Number of Cases

Figure 1: Reported cases/notifiable disease conditions, Ghana, Week 43, 2019

REGIONAL PERFORMANCE BASED ON

REPORTING with the perfect score of 100% was the best Timeliness and Completeness of reporting for all performing regions in the week under review whilst Central region notifiable conditions for the Week were 98.3% recorded the lowest mean score of 90.4%. All regions achieved the and 99.3% respectively. All regions scored expected targets (66.2%) for percentage of districts reporting at least a above 90% for both indicators.

suspected case of either Measles or Yellow Fever [Table 1].

Table 1: Ranking of Regional Performance based on selected Surveillance .reporting indicators, Ghana, Week 43, 2019

Region Timeli- Complete- Measles YF Average ness (%) ness (%) Cum. Annualized AFP % % Score % Position

Week Week AFP Non-Polio Score District District 43 43 Cases AFP Rate (%) reporting reporting (A+B+C+ A B Week 43 C D E D+E)/5

Upper East 100 100 36 4.4 100 100 100 100 1st Brong-Ahafo 99.5 100 54 2.1 100 100 100 99.9 2nd

Upper West 99.5 99.8 40 7.9 100 . 100 100 99.9 2nd Western 99.2 100 48 3.2 100 100 100 99.8 4th Volta 98.9 100 50 3.5 100 100 100 99.8 4th Ashanti 99.0 99.8 70 2.1 100 100 96.7 99.1 6th

Northern 96.9 97.9 92 4.5 100 100 100 99.0 7th

Greater Accra 96.8 97.8 65 1.9 93 100 100.0 97.5 8th Eastern 99.8 100 34 1.7 86 100 92.3 95.6 9th

Central 90.7 96.1 48 3.3 100 90.0 75.0 90.4 10th Ghana 98.3 99.3 537 2.8 100 99.0 96.4 98.6 Ghana Weekly Epidemiological Report Vol. 4 Week 43 27 October 2019 1

Summary of Weekly Epidemiological Data, Week 43, 2019

INFLUENZA-LIKE ILLNESS (IDSR Weekly MEASLES Report) During the Week, 46 cases of suspected Measles were recorded A total of 429 cases with no deaths were reported across the country [Table 3]. Samples were taken and sent to the National Public Health and Reference Laboratory [NPHRL] for through IDSR weekly reporting [Table 2]. Laboratory samples were sent from sentinel sites to Noguchi testing and awaiting results. Memorial Institute for Medical Research (NMIMR) for testing and awaiting results. Table 3: Suspected Measles cases by Region and District, Ghana, Week 43, 2019 Table 2: Reported Influenza-Like Illness cases by Region District Cases Deaths Region and District, Ghana, Week 43, 2019 Ashanti Afigya-Kwabre 1 0 Kwabre 1 0 Region District Cases Deaths Kumasi 1 0 Central Cape Coast 90 0 Asante Akim North 2 0 Greater Accra Accra 78 0 Sekyere South 1 0 Adentan 10 0 Brong Ahafo Banda 1 0 Ga Central 9 0 Nkoranza North 1 0 Ga West 74 0 Sunyani 4 0 La-Dade-Kotopon 11 0 Central Ajumako-Enyan-Essiam 3 0 Ledzokuku Krowor 44 0 Eastern Kwahu East 2 0 Shai Osudoku 108 0 Kwahu West 1 0 Volta Ketu South 5 0 Fanteakwa 1 0 Total 429 0 Akwapim North 1 0 Akwapim South 1 0 CHOLERA Asuogyaman 2 0 No cholera case was reported during the Week. Ayensuano 1 0 Greater-Accra Ledzokuku-Krowor 2 0 NEONATAL TETANUS Upper West Jirapa 2 0 No case of Neonatal Tetanus was reported during the Sissala East 1 0 Week. Wa 1 0 Sissala West 1 0 Nadowli-Kaleo 1 0 Volta South 2 0 MENINGITIS 1 0 During the week, 13 suspected cases of meningitis Ketu South 2 0 were recorded with one death across the country. Tain 1 0 Nandom district with 7 cases crossed the epidemic South Tongu 2 0 threshold (A.R. =13.1) while Lawra on the other hand North Dayi 1 0 was in alert phase recording 2 cases [Table 4]. Western Tarkwa-Nsuaem 1 0 Lumbar Punctures were done for all cases with none Nzema East 1 0 Upper East Talensi 2 0 confirmed positive for meningitis. Total 46 0

Table 4: Meningitis cases and deaths by Region, Ghana, Week 43, 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 0 0 0 0 - 0 0 Central 1 1 0 0 0 0 0

Eastern 0 0 0 0 - 0 0 Greater Accra 0 0 0 0 - 0 0

Northern 0 0 0 0 - 0 0 Upper East 2 2 0 0 0 0 0

Upper West† 9 9 0 1 11.1 1 1 Volta 1 1 0 0 0 0 0

Western 0 0 0 0 - 0 0 Total (Ghana) 13 13 0 1 7.7 1 1

† Attack Rate per 100,000 population [District; Nandom; 7 cases (AR= 13.1) Lawra; 2 cases (AR=3.0)]

Confirmed Pathogens from Meningitis Laboratory Districts in Meningitis Alert or Epidemic Results, Week 43, 2019 Nandom district with seven cases and none confirmed hit the

Lumbar Puncture was done for all 13 cases recorded in epidemic threshold in Week 43 having been in alert phase in the week with none testing positive [Table 4] including Weeks 38, 40, 41 and 42 [Figure 2]. Lawra crossed the alert cases from Nandom and Lawra districts which were in threshold in the Week under review and previously in Week 36 epidemic and alert phase respectively [Table 5]. [Figure 3].

Table 5: Meningitis cases confirmed, Ghana, Week 43, 2019

Districts Cases CSF CSF positive Deaths Causative Organism Nandom 7 7 0 1 Nil Lawra 2 2 0 0 Nil

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Summary of Weekly Epidemiological Data, Week 43, 2019

Table 6: Suspected Yellow Fever cases by Region, Ghana, Nandom Alert Epidemic 10 Week 43, 2019 Region District Cases Deaths 5

Ashanti Asante Akim North 1 0 Cases Sekyere South 1 0 0 Brong Ahafo Banda 1 0 36 37 38 39 40 41 42 43 Asunafo South 1 0 Epidemiological Week Nkoranza South 1 0 Figure 2: Meningitis threshold monitoring chart for Tano South 1 0 Eastern Kwahu West 1 0 Nandom, Week 36 - 43, 2019 Upper East Binduri 1 0 Pusiga 2 0 Lawra Alert 10 Bolgatanga 1 0 Upper West Sissala West 1 0 5 Volta North Dayi 2 0

Cases Total 14 0 0 36 37 38 39 40 41 42 43 Epidemiological Week ACUTE FLACCID PARALYSIS (SUSPECTED POLIOMYELITIS) Twelve cases of Acute Flaccid Paralysis (AFP) were reported in Figure 3: Meningitis threshold monitoring chart for Week 43 [Table 7]. The stool specimens were tested at the Polio Nandom, Week 36 - 43, 2019 Laboratory at NMIMR and were negative for wild poliovirus.

HUMAN RABIES Table 7: Suspected Polio cases by Region and District, Ghana, No case of Human Rabies was recorded in Week 43. Week 43, 2019 Region District Cases Death MATERNAL DEATHS Ashanti Asante-Akim Central 1 0 During Week 43, one maternal death each was recorded in . Atwima Mponua 1 0 the Cape Coast Metropolis and New Juaben Municipality. Brong Ahafo Dormaa West 1 0

Sunyani 1 0 Tano North 1 0 YELLOW FEVER Greater-Accra La-Dade-Kotopon 1 0

Fourteen cases of suspected Yellow Fever were reported Northern Central Gonja 1 0 across the country [Table 6]. Samples were sent to the Kumbungu 1 0

National Public Health and Reference Laboratory for testing Upper East Bongo 1 0 and awaiting results Upper West Jirapa 1 0

Lambussie-Karni 1 0 Lawra 1 0

Total 12 0 .

Summary on Acute Flaccid Paralysis (AFP) Indicators, Week 1 – 43, 2019 All regions achieved the annualized Non-Polio AFP rate of 2.0 per 100,000 population less than 15 years except Eastern (1.7)

and Greater Accra (1.9) as at the end of Week 43 [Table 7]. All regions achieved timeliness and adequacy of stool received by the laboratory except Greater Accra (78.5%) which failed to achieve for the expected target.

Table 7 Summary on Acute Flaccid Paralysis Surveillance, Ghana, Week 1 – 43, 2019 . Expected Population Non- Annualized % % . Reported Region Under 15 Polio Compatible cVDPV Discarded Non-Polio Timely Adequate AFP years AFP for AFP Rate Stools Stools the year Ashanti 2,559,248 72 70 1 64 0 2.1 91.2 89.5

Brong-Ahafo 1,199,191 59 54 0 52 0 2.1 85.5 83.4 Central 1,216,036 33 48 0 45 0 3.3 96.6 96.6

Eastern 1,345,144 42 34 0 30 0 1.7 96.0 92.0 Greater Accra 2,148,065 73 65 0 56 0 1.9 78.5 78.5

Northern 1,348,239 39 92 1 72 3 4.5 89.6 89.6 Upper East 498,068 17 36 0 31 0 4.4 96.0 96.0

Upper West 353,090 11 40 0 36 0 7.9 94.1 94.1 Volta 1,116,490 33 50 0 48 0 3.5 86.8 86.8

Western 1,204,310 36 48 0 47 0 3.2 87.5 84.6

Ghana 12,987,880 415 537 2 481 3 2.8 89.4 88.9

*Circulating Vaccine-Derived Polio Virus

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Summary of Weekly Epidemiological Data, Week 43, 2019

ANNEX 1: SUMMARY OF REPORTED CASES/ EVENTS: WEEK 43 (WEEK ENDING 27 OCTOBER 2019)

Disease/Health Event Week 42 Week 43 Cumulative to Week 43 (suspected/confirmed) Cases Deaths CFR Cases Deaths CFR Cases Deaths CFR (susp) (%) (susp) (%) (susp) (%)

AFP (suspected polio) 26 0 0 12 0 0 536 0 0 Acute haemorrhagic 0 0 0 0 0 0 0 0 - fever syndrome Adverse events 4 0 0 2 0 0 278 0 0 following immunization Anthrax 0 0 0 0 0 0 0 0 - Acute watery diarrhoea 400 0 0 230 0 0 39,891 0 0 in persons aged ≥5 years Cholera 0 0 0 0 0 0 0 0 - Dengue fever 0 0 0 0 0 0 0 0 - Diarrhoea with blood 34 0 0 18 0 0 1,752 0 0 Dracunculiasis (Guinea 0 0 0 0 0 0 0 0 - worm) Influenza-like illness 494 0 0 429 0 0 19,191 0 0 Maternal deaths - 1 - - 2 - - 83 - Measles 31 0 0 46 0 0 2,040 0 0 Meningitis 6 0 0 13 1 7.6 837 23 2.75 Neonatal tetanus 0 0 0 0 0 0 11 2 18.2 Plague 0 0 0 0 0 0 0 0 - Public health event of 0 0 0 0 0 0 0 0 - international concern (PHEIC) Human rabies 0 0 0 0 0 0 7 7 100

SARS 0 0 0 0 0 0 0 0 - Smallpox 0 0 0 0 0 0 0 0 - Yellow fever (suspected) 17 0 0 14 0 0 2,959 0 0 NATIONAL TOTAL 1,012 0 0 764 3 0.1 67,488 115 0.2 *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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Adaptation of 3rd Edition of IDSR Technical Guidelines

Adaptation of 3rd Edition IDSR Technical Guidelines

INTRODUCTION Ghana was among the first countries that embraced and began implementation of the Integrated Disease ADAPTATION PROCESS Surveillance and Response (IDSR) since its introduction by Five groups were formed from the list of participants with the World Health Organization Regional Office for Africa each team being tasked to review and adapt specific (WHO-AFRO). Ghana adapted the first and second editions portions of the Technical Guidelines. Hard copies and soft of the IDSR Guidelines with full implementation. The copiers of the 3rd Edition IDSR Technical Guidelines as changing health trends necessitated the production of the well as the training modules were provided to the groups. current 3rd Edition IDSR Guidelines by WHO AFRO. The participants were to thoroughly read the documents and Ghana contributed to the revision process and was given the identify areas for modification to fit the Ghana’s health opportunity to fully adapt the generic 3rd Edition IDSR system. A mixed method was used to pursue the objectives Guidelines to the country situation. A five-day workshop of the workshop which included reading, PowerPoint was organized in Accra from 21st -25th October, 2019 by the presentations, group work and plenary sessions. Plenary Disease Surveillance Department of Ghana Health Service sessions were held for presentations by the various groups for the adaptation process. The objective was to adapt the for comments and inputs by other groups Technical Guidelines and develop the training modules of the 3rd Edition IDSR suited to the country situation. OUTCOMES AND CONCLUSION The adaptation team recommended some revisions to be made to the IDSR 3rd Edition and these included the following; 1. Pertusis, Diphtheria, Food-Borne Illness, Adverse Drug Reaction (ADR), Acute Aflatoxicosis (New cases) and Mumps should be added to the list of priority diseases 2. Sub-district core functions and activities should be included in the annex. 3. Real data showing the weekly trend of Bacterial meningitis must be presented 4. Food safety and Resource management units are to have trained officers to rapidly respond to emergency 5. Residents from the Field Epidemiology and Participants of the Workshop for the Adaptation of the 3RD laboratory Training Programs (FELTP) are Edition IDSR Technical Guidelines recommended to assist in the evaluation of the

surveillance system. WORKSHOP PARTICIPANTS 6. The cover page should be adapted to include a map The adaptation of the IDSR 3rd Edition Technical of Ghana, epicurve and spot map of historic cases. Guidelines involved multiple personnel. A total of 40 7. Ghana Health Service in place of the Ministry of participants were present for the Workshop and these Health is to take a lead role in outbreak included personnel from Veterinary Service Division of preparedness Ministry of Food and Agriculture, Health Promotion A sub teams made up of two members from each group Division, Komfo Anokye Teaching Hospital, School of were constituted with the tasked to finalize their respective Public Health-University of Ghana, National Public Health sections within a week for submission. Reference Laboratory, Expanded Programme on

Immunisation, WHO and United States Centers for Disease

Prevention and Control (CDC). There were also

Surveillance officers from the national, regional and district levels.

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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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