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Yellow Fever in Nigeria Nigeria Centre for Disease Control Protecting the health of Nigerians An Overview of the 2017/2018 Yellow fever Outbreak in Nigeria: Lessons, Challenges and Next Steps Dr Adesola Yinka-Ogunleye March 12, 2019 Nigeria Centre for Disease Control 2 NCDC Outline • Nigeria Yellow fever history • Summary of the 2017//2018 outbreak • Edo state outbreak and use molecular diagnostics • Yellow fever Laboratory Network • Challenges • Recommendations • Conclusions 3 NCDC Yellow fever in Nigeria • Yellow fever (YF) caused epidemics in centuries ▪ Earliest documented in epidemic in Nigeria: 1864 ,1894, 1905, 1906, 1925 and 1926 - Lagos ▪ Major outbreaks: 1969 , 1986, 1995 ▪ Current outbreak : 2017 • YF is for immediate reporting and case based surveillance • Routine YF vaccine given at nine month since 2004 • A priority country for the Eliminating Yellow Fever Epidemic strategy (EYE) • PMVC implemented in 3 states in 2013 4 NCDC 2017/2018 outbreak Re-emergence and active outbreak since September 2017 04/04/20195 NCDC NIGERIA CENTER FOR DISEASE CONTROL Outbreak Summary • From September 2017 to Dec 2018, • 4100 Suspected cases in 36 states • 3,800 samples collected • 237 in-country presumptive confirmed cases • 139 IP Dakar confirmed cases in 17 states • 80 Deaths from all cases ( CFR- 2%) • 29 Deaths recorded among confirmed cases( 21%) • Most affected state is Edo State with 69 confirmed cases 6 NCDC 7 NCDC Confirmed Yellow fever cases in Nigeria 2017/2018 Trend of Confirmed Yellow Fever Cases in Nigeria, 2017 - 2019 2017 2018 2019 20 Edo State notified NCDC 18 14 Nov, 2018 16 14 YF Confirmed in Nigeria Newest state with 12 12th Sept, 2017 confirmed YF case (Imo 10 State) 8 6 Number of Yellow fever cases fever ofYellow Number 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Epidemiological week 8 NCDC Edo State – November to December 2018 • A cluster of suspected yellow fever cases was reported in Edo state on 22 November 2018 ▪ 13 samples were tested at non network lab – 9 confirmed by RT PCR positive and metagenomics ▪ Re-confirmed by IP Dakar • Investigations revealed outbreak had started in September 2018 but reported late Actions taken ▪ Rapid Response Team deployed from NCDC ▪ HCW and community sensitization ▪ Entomological studies ▪ Request to ICG for vaccination campaign 9 NCDC Edo outbreak response • Strong collaboration between NCDC• - and vaccination agency (NPHCDA), entomology agency (NAVRC) • Reactive vaccination campaign carried out in 13 (72.2%) LGAs less than a week after ICG approval • Total of 1,734,423 were vaccinated with (120.1%) coverage. 10 NCDC Templates Outbreak response Advocacy, Active surveillance, EOC, Case management , Risk communication , vaccination, Entomology, 11 NCDC Map showing states where PMVC have been Population Target implemented State Census Population Kastina 8,506,596 7,315,673 Phase 3 - 2019 Rivers 8,008,465 6,887,280 Edo 4,550,369 3,913,317 Ekiti 3,545,745 3,049,341 Kano 13,854,062 11,914,494 Phase 4 - 2020 Abia 3,901,620 3,355,394 Anambra 5,825,118 5,009,601 2013 Imo 5,742,354 4,938,424 2018 Phase1 Delta 5,980,944 5,143,612 2018 Phase2 Phase 5 - 2021 Benue 6,015,633 5,173,444 Kaduna 8,649,467 7,438,541 0 70 140 Bauchi 6,984,964 6,007,069 Km 12 NCDC Nigeria’s National Yellow Fever Laboratory Network- 4 labs Legend Existing Yellow Fever Labs (n=4) States assigned to FCT Lab, Maitama, Abuja (7 States including FCT) States assigned to CPHL, Yaba, Lagos Mainland, Lagos State (17 States) States assigned to GSHL, Gombe, Gombe State (6 States) States assigned to YDMH, Kaduna, Kaduna State (7 States) New Laboratories (n=3) ➢ National Reference Laboratory Gaduwa (FCT), ➢ University of Benin Teaching Hospital Benin, Edo State ➢ University of Nigeria Teaching Hospital Enugu, Enugu 04/04/201913 NCDC NIGERIA CENTER FOR DISEASE CONTROL Expanded National Yellow Fever Network • In 2018, seven labs were assessed by WHO Nigeria, AFRO and NCDC ▪ Enugu: (Enugu State University Teaching Hospital and ESUT Teaching Hospital Parklane), ▪ Calabar (Dr Lawrence Henshaw Memorial Hospital), ▪ Calabar (University of Calabar Teaching Hospital) ▪ Maiduguri (University of Maiduguri Teaching Hospital) ▪ Abuja (Gaduwa National Reference laboratory) ▪ Benin City ( University of Benin Teaching Hospital) • Assessment conducted using a common checklist and scoring system ▪ laboratory space, utilities, communication, equipment and supplies, manpower resources, accessibility miscellaneous (after hours, banking, reimbursement facilities) • NCDC recommended three laboratories based on the assessment result ▪ Abuja, Benin City, Enugu 14 NCDC Limitations/Challenges • National testing is by IgM ELISA • 48hrs vs 72 hrs protocols still remain challenging for the staff • Samples shipped to IP Dakar for confirmation • Average turnaround time to get a confirmed positive result is currently ~ퟐퟏ 풅풂풚풔 • Delay in commencement of RVC • Edo outbreak highlighted the impact of shorter confirmation testing times during active transmission • Difficulty accepting RT PCR results at national level from a non network laboratory • Requirement to ship samples to IP Dakar based on regional testing algorithm 04/04/201915 NCDC NIGERIA CENTER FOR DISEASE CONTROL Next Steps • Operationalize the network expansion of serological labs from 4 to 7 in 2019 • Five molecular laboratories registered in the 2019 QCMD YF RT PCR programme • YF done as differential test in some national Lassa fever testing laboratories • Careful integration of molecular testing into the current network structure • RT PCR negatives require IgM testing and adoption of adapted testing algorithm • Strengthen serological testing capacity • 48hrs vs 72 hrs protocols still remain challenging for the staff • Additional supervisory support with the national labs to improve quality management and achieve WHO YF network accreditation • Improve sample transportation from State to national testing laboratories 04/04/201916 NCDC NIGERIA CENTER FOR DISEASE CONTROL Conclusion • The NCDC in collaboration with other agencies and partners is committed to EYE • Strengthening of surveillance systems to detect cases rapidly • Continued support (financial and advocacy) is needed to assist the country to strengthen existing laboratory network and improve real time case confirmation • Funding needed to support procurement of reagents (molecular and serology) • In-country WHO YF network accreditation needed 04/04/201917 NCDC NIGERIA CENTER FOR DISEASE CONTROL ACKNOWLEDGEMENT 04/04/201918 NCDC NIGERIA CENTER FOR DISEASE CONTROL THANK YOU 19 NCDC .
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