Lassa fever in Implications for research

Dr. Chikwe Ihekweazu Chief Executive Officer Nigeria Centre for Disease Control

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 1 Nigeria- health and economic situation

Population size ~ 186 million

History of disease outbreaks- Lassa fever, , , Meningitis, Monkeypox

Annual population growth rate of 2.6%

Low total expenditure on health as a percentage of GDP

2 03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 2 Nigeria Centre for Disease Control

Nigeria’s National Agency

Mandate Prevent, detect, and control diseases of public health importance. Coordinate surveillance systems to collect, analyse and interpret data on diseases of public health importance to guide action Support States in responding to small outbreaks, and lead the response to large disease outbreaks

Develop and maintain a network of reference and specialised laboratories Conduct, collate, synthesise and disseminate public health research to inform policy Coordinate the compliance with international health regulations

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 3 Lassa fever epidemiological situation (1st January-22nd April 2018)

1865 Total suspected Lassa fever cases 416 Confirmed cases 9 Probable cases decline in cases 105 Deaths in confirmed cases 37 Health workers infected

• Decreasing trend • 1 new case last week

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 4 Lassa fever confirmed cases: 2016 - 2018

70

60 2016

2017 50 2018 40

30

20

10 Number of confirmed or probable cases probable or confirmed of Number

0

W01 W02 W03 W04 W05 W06 W07 W08 W09 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 W40 W41 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 Week notified to NCDC

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 5 Lassa fever confirmed cases: 2016 - 2018

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 6 2018 Lassa fever response activities

• Emergency Operations Centre (EOC) activated at NCDC to coordinate response • Drugs, PPE, and other medical supplies deployed to States • Rapid Response Teams deployed to States • Intensive risk communication activities- public health advisory, press releases and media appearances • 24 hours case management helpdesk established at NCDC • High level advocacy visit to most affected States • Guidelines, SOPs, IEC materials distributed to States • Ongoing development of national protocol for Lassa fever diagnosis • Ongoing review of national treatment protocol

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 7 Why are we finding more cases???

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 9 What are the epidemiological drivers???

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 10 Surveillance and detection architecture

• Increase from two laboratories to four in country

• Increased awareness among clinicians

• Enhanced surveillance- IDSR strengthened, SORMAS tool introduced

• National sample transportation protocol developed

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 11 Environmental factors

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 12 Are people more aware?

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 13 Five key lessons learnt so far

1. Sequencing: Initial results show no significant change in virus / increased virulence

2. Epidemiology: 80% of cases in 3 states, students, health workers affected

3. Detection: Increasing diagnostic capacity & confirmation rate

4. Preparedness: Increasing awareness & index of suspicion

5. Response: Strong collaboration- States, Federal Government, Partners

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 14 Priorities for research

Laboratory diagnostic methods Treatment protocol Vaccine development

Community practices and behavior Disease vector Route of transmission of the virus change

03/05/2018 NIGERIA CENTRE FOR DISEASE CONTROL 15 THANK YOU!!!!

UK PUBLIC HEALTH RST

1 6 We are stronger together

Nigeria Centre for Disease Control

be a world-class, science based organisation with the competence to protect the Nigerian people from the threats from diseases of public health importance