CEREBROSPINAL MENINGITIS OUTBREAK IN Situation Report as at 28 March 2017

Highlights (28 March 2017):

i. Meningitis outbreaks are currently reported in five States (Zamfara, , Kebbi, Niger and Sokoto) in Northwest and Northcentral zones of Nigeria ii. The most common serotype is Neisseria meningitidis serotype C (Nm C) iii. As at 28th of March 2017, a total of 1966 cases with 282 deaths have been reported with 109 being laboratory confirmed iv. About 500,000 doses of the AC-PS vaccine granted by the International Coordinating Group on Vaccine Provision (ICG) for reactive vaccination in Zamfara has arrived Nigeria v. Reactive Vaccination has been scheduled for 11th – 14th April 2017 in , while other States are preparing their ICG requests

Epi summary

• Total of 1966 suspected cases with 282 deaths (CFR=14.3%) reported from 61 LGAs • Zamfara, Katsina and Sokoto States account for about 93% of the cases reported • A total of 109 positive cases confirmed by Pastorex and Culture; Neisseria meningitides serotype C being the most common serotype • The most affected age group is 5 to 14 years of age • First report of suspected cases began in week 50 of 2016 in Zamfara; cumulative of 15 epid weeks • Risk of international border transmission; LGA in Zamfara State, Gada LGA in and LGA in Katsina State share borders with Niger Republic

Spot map of CSM, Nigeria (week 01 to week 12)

Epidemic curve of CSM n Nigeria as at week 12 (Nigeria)

500 450 400 350 300 250

No of cases 200 150 100 50 0 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 Weeks

Epidemic curve, Zamfara

300 250 200 150

No of cases 100 50 0 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 Weeks

Epidemic curve, Sokoto

200 150

100

No of Cases 50

0 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 Weeks

S/n States Total LGAs Total Deaths CFR (%) Lab. confirmed affected number of cases 1. Zamfara 14 1225 162 13.2 44 2. Katsina 9 175 44 25.1 32 3 Sokoto 13 414 32 7.7 19 4 Kebbi 11 53 8 15.1 10 5 Niger 5 81 33 41 4 6 Nassarawa 1 1 0 0 0 7 FCT 1 4 0 0 0 8 Gombe 1 1 0 0 0 9 Taraba 1 45 0 0 0 10 Yobe 1 1 0 0 0 11 Kano 1 1 0 0 0 12 Osun 1 1 1 100 0 13 C/River 1 2 0 0 0 14 Lagos 1 3 2 66 0 15 Plateau 1 4 0 0 0 Total 61 1966 282 14.3 109

Table 1a: CSM summary by State as at 28th March, 2017

Table 1a: Table showing summary of outbreak data from the states: These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

RESPONSE SINCE DATE OF FIRST NOTIFICATION/REPORT:

Coordination ü CSM outbreak control team constituted to coordinate all responses aimed at controlling the outbreak. Membership include NCDC, NPHCDA, WHO and other partners (MSF, UNICEF, CDC and EHealth Africa) ü Coordination meetings will hold regularly ü All five States have commenced EOC/EPR meetings ü Mapping of resources at State level to identify ongoing activities.

Case Management and Infection Prevention and Control ü Functional Isolation centers/units have been identified in all States but inadequately equipped or manned ü Ceftriaxone and management supplies available and being used as per protocol in all States for treatment ü Number of cases currently on admission or treated since outbreak yet to be determined in states and LGAs ü Micro plan concluded in Zamfara for possible vaccination in week 14

Surveillance ü Active case searches in the affected LGAs and register review ongoing ü Outbreak/rumour investigations ongoing ü Clinician sensitisation and training proposed in selected areas ü As at March 28, 61 LGAs from 15 States reported at least one suspected case of CSM as against 34 LGAs from four states (total of 718 cases) for the 2016/2017 epidemic season. ü CSM guidelines including Laboratory protocol under review.

Laboratory ü Lumber puncture kits provided by WHO but not adequate ü Pastorex and TI media available but limited. Total stock in-country to be determined soon. ü Pastorex used for testing CSF samples in the field (total of 109 cases positive) in all States ü Public health in supporting with culture of positive samples from states (total number to be determined) ü MSF facilitating sample analysis in Oslo for PCR (total number of PCR yet to be determined) ü At least 11 PCR/Culture result is pending

Communication and Social Mobilization ü Community health education ongoing as part of State team responses with support from UNICEF ü Katsina and Zamfara States doing radio jingles with support from UNICEF ü IEC materials being developed by NCDC, NPHCDA and UNICEF

Challenges ü Low CSF collection rates (CSF sample versus reported cases) ü Lack of logistics for sample transportation for prompt laboratory diagnosis ü Weak coordination between SMOH surveillance officers and treatment centres, and late reporting of suspected cases to National level. ü Weak/non-functional EPR committees at State and LGA levels ü Non availability of supplies (Ceftriaxone, Lumber Puncture Kits, TI media etc.) at the national level

Next steps ü Update CSM surveillance and management data base especially for States with scanty epidemiological data ü Dissemination of targeted IEC materials to frontline health care workers in all States ü Redistribution of Ceftriaxone from non-active to actively reporting states to enhance case management ü Reactivate EPR committees at State and LGA levels in all States ü Support Katsina and Sokoto on preparation of ICG request ü Conduct detailed investigation on cases of Men A in Zamfara and Katsina States ü Preparation for 2017/2018 CSM season to commence by October 2017 ü Arrange for cross border surveillance locally in Nigeria and internationally with Republic of Niger and Benin