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Liberia-Early-Warning-Disease Integrated Disease Surveillance and Response Bulletin Republic of Liberia INTEGRATED DISEASE SURVEILLANCE AND RESPONSE BULLETIN Week-9 Feb 29 – March 6, 2016 Data Source: CSOs from 15 Counties Highlights during the reporting week Fifteen out of eighteen samples sent to the laboratory this week were confirmed positive for measles. Of these, six were from Bushord Island district (Montserrado), three cases each were from Mamba Kaba and Kakata districts (Margibi), two from district #4 and one was from Buchanana districts (Grand Bassa). Two tested negative and one was equivocal. Three cases of suspected Lassa fever from Nimba and Bong County were confirmed positive. An outbreak investigation is ongoing and neighboring counties have been informed. A total of five maternal deaths were reported from Montserrado, Nimba and Grand Cape Mount counties. A total of eight neo-natal deaths were reported from Bong, Montserrado, Nimba, Lofa and Grand Bassa counties. Four AFP cases were reported from Bomi, Lofa and RiverGee counties. Reporting Coverage 98% (716/724) of expected health facilities reported from 91 health districts across 15 counties. Table 1: Reporting coverage (completeness) and timeliness of reporting from counties, week 9 No. of expected report from No. of reports Completeness County health facility received (%) On time Bomi 22 22 100.0 Yes Bong 42 42 100.0 Yes Grand Cape Mount 31 31 100.0 Yes Gbarpolu 14 14 100.0 Yes Grand Bassa 30 30 100.0 Yes Grand Gedeh 24 24 100.0 Yes Grand Kru 19 18 94.7 Yes Lofa 59 59 100.0 Yes Margibi 45 39 86.7 Yes Maryland 24 24 100.0 Yes Montserrado 270 270 100.0 Yes Nimba 72 72 100.0 Yes Rivercess 19 19 100.0 Yes River Gee 19 19 100.0 Yes Sinoe 34 33 97,1 Yes Liberia, National 724 716 98 100 1 Integrated Disease Surveillance and Response Bulletin Figure 1: Percentage of health facilities reporting by epidemiological week, 2016 Vaccine Preventable Diseases Measles In week nine, 43 suspected cases of measles were reported. Case distribution by county: Margibi 17 cases: Kakata (10) and Mamba Kaba districts (7) Montserrado 8 cases: Central Monrovia (3), Bushrod Island (2), Commonwealth , St Paul and Somalia Drive districts reported (1) case each. Grand Bassa 8 cases: District #3 and 4 reported (3) cases each, Buchanana and district #1 (1) case each. Lofa 4 cases: Voinjama (3) and Foya districts (1) Nimba 3 cases: Yarwin Mehnsonnoh district Rivercess 2 cases JO-river district Bomi 1 case: Clay district Since the start of 2016, 257 suspected measles cases have been reported. Out of these, 116 were submitted for laboratory testing, with 66 being confirmed positive and 39 testing negative. 2 Integrated Disease Surveillance and Response Bulletin Figure 2: Suspected measles cases reported by epidemiological week, 2016 Figure 3: Epidemiological curve of confirmed measles cases reported, Liberia (October 2015 – March 6, 2016) Five cases were reported in week 41, followed by no cases reported up to week 47 2015. The current outbreak likely started around week 48 with a steady increase of reported cases from week 3 to week 52016. An increase in confirmed cases was observed in week 7 and week 9, this is likely due to outbreak counties still submitting samples . No cases were reported in week 52 and 53, possibly due to the holiday period. Thirty eight suspected cases were reported for the reporting week. 3 Integrated Disease Surveillance and Response Bulletin Figure 4: Distribution of measles samples submitted for laboratory testing by case classification, Liberia (October 2015 to March 6, 2016) Poliomyelitis Four (4) cases of suspected acute flaccid paralysis (AFP) were reported. Specimens were collected and sent, pending laboratory results. Case distribution by county: Bomi 2 cases: (1) each from Suehn Mecca and Senjeh districts. Lofa 1 case: Kolahaum district. RiverGee 1 case: Webbo district. Figure 5: Reported AFP cases by epidemiological week, 2016 4 Integrated Disease Surveillance and Response Bulletin Table 2: Annualized AFP performance indicators as March 6, 2016 Non-polio AFP rate/100,000 <15yrs in 2016 as of Week 9 < 15 Non- % of County years Polio stool pop Expected Reported AFP Rate <14days Bomi 44700 0.1 2 26 100 Bong 177210 0.3 1 3.3 100 Gbarpolu 44312 0.1 0 0.0 0 Grand Bassa 117807 0.2 0 0.0 0 Grand Cape Mount 67527 0.1 0 0.0 0 Grand Gedeh 66562 0.1 0 0.0 0 Grand Kru 30775 0.1 0 0.0 0 Lofa 147124 0.3 3 11.8 100 Margibi 111552 0.2 0 0.0 0 Maryland 72237 0.1 0 0.0 0 Montserrado 594229 1.0 1 1.0 100 Nimba 245519 0.4 0 0.0 0 Rivercess 35492 0.1 0 0.0 0 River-Gee 38000 0.1 1 15.2 100 Sinoe 54410 0.1 1 10.6 25 Liberia 1847457 3.2 9 2.8 87.5 <2 = Non-Polio AFP Rate ≥2 = Neonatal tetanus No case of neonatal tetanus was reported Meningitis No case of meningitis was reported. 5 Integrated Disease Surveillance and Response Bulletin Viral hemorrhagic diseases: Ebola viral disease, Yellow fever, Lassa fever Ebola Virus Disease (EVD) Table 3: Count of patient samples tested for EVD by county and sample type; weeks 6 to 9 from the Laborato Week 7 Week 8 Week 9 Geographical Whole Whole Whole Distribution blood Swab NP blood Swab NP blood Swab NP 645 All Counties 195 1 663 150 0 632 207 2 By County Bomi 36 1 0 52 1 0 58 5 0 Bong 39 12 0 35 11 0 20 16 0 Gbarpolu 13 4 0 21 1 0 7 2 0 Grand Bassa 97 11 0 45 4 0 57 13 0 G. C. Mount 37 1 0 61 3 0 31 6 0 Grand Gedeh 0 6 0 1 5 0 25 9 0 Grand Kru 45 1 0 28 5 0 47 0 0 Lofa 29 5 0 19 12 0 16 16 0 Margibi 81 1 1 113 1 0 70 5 0 Maryland 40 6 0 44 5 0 64 4 0 Montserrado 142 109 0 163 79 0 167 102 0 Nimba 1 22 0 10 13 0 4 16 0 Rivercess 4 3 0 7 1 0 10 1 0 River Gee 38 4 0 8 0 0 0 3 0 Sinoe 31 8 0 26 3 0 40 5 0 Unknown 12 1 0 30 6 0 16 4 2 Total 840 813 841 For the 841 samples tested in week 9, six hundred thirty two (632) were whole blood and two hundred seven (207) were oral swabs. All tested negative. Overall samples were submitted from all 15 counties. Whole blood samples were sent from all counties except for River Gee. Oral swabs were also sent from all counties except Grand Kru. Lassa fever/ Yellow fever Lassa fever Two (2) deaths were reported from Sanniquelleh Mah district Nimba county which one (1) was confirmed positive. During 2016, a total of 26 suspected cases have being reported. Out of these, thirteen (13) deaths have been reported with seven (7) being confirmed positive Yellow fever No case of yellow fever was reported. During 2016, one (1) suspected case of Yellow fever has been reported. 6 Integrated Disease Surveillance and Response Bulletin Events of Public Health Importance Maternal Mortality Five (5) maternal deaths were reported. Case distribution by county: Montserrado 3 deaths: Bushord Island (2) and Central Monrovia districts (1). Nimba 1 death: Sanniquelleh Mah district. Grand Cape Mount 1 Forkpa district Causes of deaths were septic shock, eclampsia, post-partum hemorrhage, pulmonary embolism and respiratory failure. The reporting counties have been requested to send maternal audit reports. Since the start of 2016, 47 maternal deaths have been reported. Figure 6: Maternal deaths reported by epidemiological week, 2016 Table 4: Cumulative maternal deaths reported by counties, 2016 County Reported deaths Percent Montserrado 10 21.3 Bong 8 17.0 Grand Bassa 5 10.6 Bomi 4 8.5 Maryland 4 8.5 Grand Kru 4 8.5 Nimba 3 6.4 Rivercess 3 6.4 Margibi 3 6.4 River Gee 1 2.1 Grand Gedeh 1 2.1 Grand CapeMount 1 2.1 Lofa 0 0.0 Gbarpolu 0 0.0 Sinoe 0 0.0 Total 47 100 7 Integrated Disease Surveillance and Response Bulletin Neonatal Mortality Eight (8) neonatal deaths were reported. Case distribution by county: Bong 2 cases: All from Jorquelleh district Grand Bassa 2 cases: Buchanan district Montserrado 2 cases: Somalia drive and Bushord Island districts Lofa 1: Zorzor district Nimba 1 case: Zoe-Geh district Causes of deaths were: asphyxia (4), sepsis (3) and pre-term delivery (1) Since the start of 2016, 47 neonatal deaths have been reported. Figure 7: Neonatal deaths reported by epidemiological week, 2016 Table 5: Cumulative neonatal deaths reported by counties, 2016 County Reported deaths Percent Montserrado 14 29.8 Bong 10 21.3 Lofa 5 10.6 Maryland 3 6.4 River Gee 3 6.4 Grand Bassa 3 6.4 Nimba 2 4.3 Bomi 2 4.3 Grand Kru 2 4.3 Grand Cape mount 2 4.3 Margibi 1 2.1 Grand Gedeh 0 0.0 Gbarpolu 0 0.0 Rivercess 0 0.0 Sinoe 0 0.0 Total 47 100 8 Integrated Disease Surveillance and Response Bulletin Human Rabies In week nine, 20 suspected cases of human rabies (exposure to dog bites) and one (1) death were reported. Case distribution by county: Montserrado 15 cases: Commonwealth district (14) and Somalia drive districts (1) Grand Bassa 5 cases: Buchanana (3) and district #4 (2) cases.
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