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
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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.
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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.
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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
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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.
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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.
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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
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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
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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. One (1) death was reported from Greenville district Sinoe county All cases from counties received post-exposure prophylaxis (PEP). Since the start of 2016, 141 exposures to animal bites and one (1) death have been reported.
Figure 8: Human exposure to animal bites by epidemiological week, 2016
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Integrated Disease Surveillance and Response Bulletin
Bloody Diarrhea (Shigellosis) In week nine, 9 suspected cases of bloody diarrhea were reported. Case distribution by county: Bomi 3 cases: Senjeh (2) and Klay (1) districts Rivercess 1 case: Dodain district Lofa 1 case: Salayea district Margibi 2 cases: Mamba Kaba district Sinoe 2 case: Jedepoh and Kpayan districts Since the start of 2016, 130 cases of bloody diarrhea have been reported.
Figure 9: Bloody diarrhea cases reported by epidemiological week, 2016
Public Health Measures Visit to the laboratory to verify if weekly number of specimens received in the laboratory corresponds to the number of suspected cases reported from the counties.. Acute flaccid paralysis Investigated the 4 cases from all Counties and Specimen sent to laboratory. 60 days follow-up isongoing in Bong for AFP reported. Measles Isolation and treatment of affected cases. Line listing of all cases. Conducted active case search and investigation in Zoe-Geh district, Nimba County. Community awareness on-going. Lassa fever Increased surveillance activities at all levels in the affected and neighboring counties. Isolation of suspected cases in health facilities. Treatment of suspected cases with ribavirin. Listing and follow up of all contacts. Active case search for further suspected cases. Community education about safe storage of food items to prevent contamination with rat feces or urine.
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Integrated Disease Surveillance and Response Bulletin
Public Health Measures, continued Animal bites All counties have been informed by the division of Disease Prevention and control (DPC) through their County Surveillance Officers to pick up supplies of anti-rabies vaccines for post-exposure prophylaxis. All priority diseases Continued active case search for all priority diseases Sensitized gCHVs on the case definitions, monitoring and reporting of all priority diseases and conditions in their respective catchment communities. Informed all DSOs to strengthen surveillance activities in their respective districts Heightened surveillance activities are ongoing in the fifteen counties.
Note Completeness of report refers to the total number of health facilities reporting to the county health offices versus the total number of health facilities in the counties. Timeliness of report is based on the proportion of those counties that submitted a report, which submitted it on or before 12 noon every Monday to DPC/MOH.
For comments or questions, please contact
Thomas K. Nagbe, PA DIP, BSC, MPH Director, Disease Prevention and Control National IHR Focal Point Ministry of Health Republic of Liberia
E-mail: [email protected] Phone: 0886 937 386/0777442444
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Integrated Disease Surveillance and Response Bulletin Appendix 1: Summary of suspected cases and conditions by county during the current epidemiological week, and cumulative numbers, 2016.
Summary of suspected cases reported from county during the reporting week
orm
Natal Natal Natal
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Counties of ExpectedNo. DistrictsHealth of Health No. District reported Viral Ebola Disease Fever Lassa Yellow Fever Diarrhea Bloody Cholera AFP W Guinea Measles Neo Tetanus Neo Mortality Maternal Mortality Meningitis Rabies DiseasesOther /Events C D C D C D C D C D C D C C D C D D D C D C D C D Bomi 4 4 60 7 0 0 0 0 3 0 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 Bong 8 8 26 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 Gbarpolu 5 5 32 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Grand Bassa 7 7 67 1 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 2 0 0 0 5 0 0 0 GC Mount 5 5 80 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 Grand Gedeh 6 6 16 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Grand Kru 5 5 10 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Lofa 6 6 33 17 0 0 0 0 1 0 0 0 1 0 0 4 0 0 0 1 0 0 0 0 0 0 0 Margibi 4 4 74 2 0 0 0 0 2 0 0 0 0 0 0 17 0 0 0 0 0 0 0 0 0 0 0 Maryland 6 6 48 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Montserrado 7 7 160 3 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 2 3 0 0 15 0 0 0 Nimba 6 6 27 18 0 2 0 0 0 0 0 0 0 0 0 3 0 0 0 1 1 0 0 0 0 0 0 Rivercess 6 6 113 7 0 0 0 0 1 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 River Gee 6 6 2 3 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Sinoe 10 10 23 8 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 Total Weekly 91 91 771 110 0 2 0 0 9 0 0 0 4 0 0 43 0 0 0 8 5 0 0 20 1 0 0 Cumulative suspected since 01/01/2016 26 13 1 0 130 0 0 0 9 0 0 257 1 1 0 0 0 141 0 0 0 Cumulative confirmed 0 0 7 0 0 0 0 0 0 0 0 0 0 66 0 0 0 0 Cumulative deaths 13 0 0 0 0 0 0 47 47 0 1 0
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Integrated Disease Surveillance and Response Bulletin
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