Issue: Volume 12 No. 27. 27th July 2021

Nigeria Centre for Disease Control Protecting the health of Nigerians Weekly Epidemiological Report Week 27: 5th – 11th July, 2021 Highlight of the Week NCDC hosts her 5th Annual Scientific Conference titled- “Building Back Better_ COVID-19 and Other Disease Outbreaks”

Since 2016, the Centre for Disease Control (NCDC) in collaboration with the African Field Network (AFENET) has held her annual scientific conference on field epidemiology, the NCDC/NFELTP Conference. The 2020 edition could not hold due to the country-wide COVID-19 outbreak. Lessons and best practices learnt from previous conferences have continued to inform our preparedness, response and other actions in line with our mandate. To improve the scope of the conference while ensuring ownership and sustainability, the NCDC / NFELTP conference has now been renamed the “Nigerian Conference of Applied and Field Epidemiology (NiCAFE). This year, given the need to ensure strict compliance with the national COVID-19 protocol, the NCDC hosted a virtual NiCAFE in Abuja from 26th – 28th July 2021 with the pre-conference workshops on 26th July. With the theme “Building Back better - COVID-19 and other Disease Outbreaks”, the NiCAFE provided an opportunity to discuss the epidemiology of infectious diseases in Nigeria and the impact of these on regional and global health security. The objectives of the conference were: 1. Review the epidemiology and severity of COVID-19 and other infectious diseases in Nigeria 2. Evaluate the direct and indirect impacts of infectious diseases on the Nigerian health system, including protecting the health workforce 3. Review available public health, economic, and behavioural data to inform the implementation of robust public health and social measures at national and subnational levels 4. Synthesise the lessons learnt from Africa and Nigeria’s response to infectious disease outbreaks 5. Discuss emerging research and evidence on COVID-19 and other infectious diseases, and how this can affect future response activities 6. Improve core public health skills of conference attendees through workshops and lectures 7. Discuss the direct and indirect impact of COVID-19 and other infectious diseases on socio-economic activities

The subthemes covered included but were not limited to epidemiology & surveillance; laboratory & diagnostics; health system strengthening; case management; governance and leadership; social sciences & community engagement; research and development etc. We are pleased with the vast knowledge and experience shared via parallel scientific oral sessions. Our renowned invited speakers from diverse backgrounds also shared their wealth of experience and impacted remarkably on the conference attendees. In his closing remarks, the Director-General of the NCDC, Dr. Chikwe Ihekweazu commended our partners - the World Health Organisation, World Bank REDISEE project, US Centres for Disease Control and Prevention, Resolve to Save Lives, Tony Blair Institute, Public Health England, E-Health Africa and the United States Children Fund for providing strong support and partnership for a successful conference. He also thanked the invited speakers for sharing their wealth of experience, leaving a remarkable impact on the conference attendees. He also appreciated the impressive participation of all conference attendees. The NCDC will continue to apply all lessons and best practices learnt from the conference to inform and shape our future public health actions.

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Summary of Incidents

Ongoing incidents

2

Ongoing incidents are defined as confirmed cases where a national EOC or equivalent has been activated (EOC is currently activated for COVID-19 and Cholera)

Other incidents are those with confirmed cases for which EOC is not activated

Data Source: SITAware

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Summary Week 27: 5th – 11th July, 2021 Note: Coronavirus Disease is from outbreak onset till week 29 2021: 25th July, 2021) Cerebrospinal Lassa Fever1,2 Yellow Fever3,4 Meningitis (CSM) 3,4 69 5 22 Suspected case(s) Suspected case(s) Suspected case(s)

7 1 0 Confirmed case(s) Confirmed case(s) Confirmed case(s)

4 0 0 Death(s) Death(s) Death(s)

Cholera3,4 Measles3,4 Monkeypox1,4

2559 523 3 Suspected case(s) Suspected case(s) Suspected case(s)

5 0 0 Confirmed case(s) Confirmed case(s) Confirmed case(s)

30 5 0 Death(s) Death(s) Death(s)

Acute Flaccid National Sentinel Coronavirus Disease

Paralysis (AFP) 3,4 influenza surveillance5 as at week 291,

106 0 2,439,850 Suspected case(s) Suspected case(s) Suspected case(s)

0 0 171,097 Confirmed case(s) Confirmed case(s) Confirmed case(s) 2,132 Death(s)

Timeliness Completeness

of reports3 of reports3 93.3% 98% Last 4 weeks Last 4 weeks 95.5% 98.2% Year to date Year to date Notes 1. Information for this disease was retrieved from the Technical Working Group and Situation Reports 2. Case Fatality Rate (CFR) for this disease is reported for confirmed cases only 3. Information for this disease was retrieved from IDSR 002 data 4. CFR for this disease is reported for total cases i.e. suspected + confirmed 5. Information for sentinel influenza was retrieved from the laboratory

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Lassa Fever Week 27 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 2 69 7 4 LGA: 4

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

5253 2379 1043 325 218 66 20.9% 20.3%

*Outbreak data added to routine data Figure 1: Number of suspected and confirmed Figure 2: Location of confirmed cases of cases of Lassa Fever, Nigeria, Weeks 1 – 52, Lassa Fever by State, Nigeria, week 27, 2021 2021

Key points ● There were 69 suspected cases, seven were laboratory confirmed and four deaths were recorded from four LGAs in two states

Actions To date: ● Conducted 2021 Lassa fever (LF) high burden states preparedness/response engagement meeting ● Dissemination of reviewed case management and safe burial practices guidelines ● Ensured all five LF molecular laboratories in the NCDC network are working at full capacity for timely testing of samples with reduced turnaround time

Planned: ● Finalise LF five-year strategic plan

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Cerebrospinal Meningitis (CSM) Week 27 Suspected Confirmed Number of States and Deaths cases cases LGAs affected

State: 3 5 1 0 LGA: 5

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

466 158 11 11 9 3 1.9% 1.9%

Figure 3: Number of suspected and confirmed Figure 4: Location of suspected cases of CSM by cases of CSM, Nigeria, weeks 1 – 52, 2021 State, Nigeria, week 27, 2021

Key points ● There were five suspected cases of cerebrospinal meningitis (CSM) reported from five LGAs in three states (Ebonyi – 1, Katsina – 3 & Oyo – 1). One case was laboratory confirmed and no death was recorded.

Actions To date: ● National CSM TWG meets weekly to review reports from states and plan appropriately ● Enhanced surveillance in all states

Planned: ● Continue harmonisation of the national line list and SORMAS data ● Continue to ensure that states reporting cases send their line lists and collect CSM samples

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Week 27 Suspected Confirmed Number of States and Deaths cases cases LGAs affected

State: 11 22 0 0 LGA: 16

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

1202 993 12 13 0 2 0% 0.2%

Figure 5: Number of suspected and Figure 6: Location of suspected cases of confirmed cases of Yellow Fever, Nigeria, Yellow Fever by States, Nigeria, week 27, weeks 1 – 52, 2021 2021

Key points ● There were 22 suspected cases of Yellow Fever (YF) reported from 16 LGAs in 11 states. None were laboratory confirmed and one death was recorded

Actions To date: ● National YF multi-partner Technical Working Group (TWG) continues to coordinate activities across states. ● Ongoing plans to strengthen orientation of at-risk states on YF surveillance ● Ensured availability of reagents and consumables in all testing laboratories

Planned: ● Continue monitoring and analysis of YF (Yellow fever) data across all states and FCT to guide response ● Continue coordination of prompt transportation samples to the laboratories

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Cholera Week 27 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 9 2559 5 30 LGA: 59

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

976 12095 40 251 55 263 5.6% 2.2%

Figure 7: Number of suspected and confirmed Figure 8: Location of suspected cases of cases of Cholera, Nigeria, weeks 1 – 52, 2021 Cholera by State, Nigeria, week 27, 2021

Key points ● There were 2559 suspected cases of cholera reported from 59 LGAs in nine states (Adamawa – 1, Bauchi – 1699, Bayelsa – 4, Ebonyi – 5, Kano – 563, Kebbi – 158, Kogi – 12, Plateau – 114 & Taraba – 3). Five cases were laboratory confirmed and 30 deaths were recorded

Actions To date ● National Cholera Multi-Sectoral Technical Working Group (TWG) is monitoring all states and supporting affected states ● National Rapid Response Teams (RRTs) with response commodities were deployed to support the response in four states – Benue, Kano, Kaduna and Zamfara States ● Cholera jingles being aired in English and local languages across the country

Planned: ● Continue follow up and monitoring of non-reporting states ● Build capacity for sample collection, transportation, and laboratory diagnosis across states

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Measles Week 27 Suspected Confirmed Number of States and Deaths cases cases LGAs affected

State: 18 523 0 5 LGA: 63

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

19778 14220 1957 283 111 183 0.6% 2%

Figure 9: Number of suspected and confirmed cases Figure 10: Location of suspected cases of of Measles, Nigeria, weeks 1 – 52, 2021 Measles by State, Nigeria, week 27, 2021

Key points ● There were 523 suspected cases of Measles reported from 63 LGAs in 18 states. None were laboratory confirmed and five deaths were recorded

Actions To date ● National Measles TWG is closely monitoring measles surveillance data and providing feedback to relevant agencies and development partners ● Ongoing weekly surveillance and laboratory data harmonisation

Planned: ● Intensify follow up with states to update and transmit line list ● Continue monthly measles surveillance data review

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Monkeypox Week 27 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 2 3 0 0 LGA: 3

Year to date (week 1 – 52 Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

18 58 3 14 0 0 0% 0%

Figure 11: Number of suspected and confirmed Figure12: Location of suspected cases cases of Monkeypox, Nigeria, weeks 1 – 52, of Monkeypox by State, Nigeria, week 2021 27, 2021

Key points ● There were three suspected cases of Monkeypox in three LGAs in two states (Bayelsa – 1 & Delta – 2). None were laboratory confirmed and no death was recorded.

Actions To date ● Enhanced Surveillance ongoing in Rivers, Delta and Bayelsa States ● National Monkeypox Technical Working Group (TWG) is monitoring activities in all states

Planned: ● Enhance surveillance for monkeypox in high burden states ● Continue harmonisation of the national line list and SORMAS data

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Acute Flaccid Paralysis (AFP) Week 27 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 23 + FCT 106 0 0 LGA: 91

Year to date (week 1 – 52) Suspected Confirmed Deaths CFR cases cases 2020 2021 2020 2021 2020 2021 2020 2021

2342 1633 0 0 0 0 0% 0%

Figure 13: Number of suspected and confirmed Figure 14: Location of suspected cases of AFP cases of AFP, Nigeria, weeks 1 – 52, 2021 by State, Nigeria, week 27, 2021

Key points ● There were 106 suspected cases of AFP reported from 91 LGAs in 23 states and FCT. None were laboratory confirmed and no death was recorded.

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report National Influenza Sentinel Surveillance

Year to date (week 1 – 27) Suspected Suspected Suspected ILI cases SARI Number 830 730 (88%) 100 (12%) (Percentage)

Week 27 Confirmed Confirmed ILI Confirmed SARI cases Influenz Influenz Influenz Influenz Influenz Influenz a A a B a A a B a A a B Number 0 0 0 0 0 0 Positivity (%) 0% 0% 0% 0% 0% 0%

Figure 15: Number of influenza positive specimens by type and percentage positive by epidemiological week, 2021.

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Coronavirus Disease (COVID-19) From outbreak onset (Feb 27 2020) to epi-week 29 2021 Suspected Confirmed Number of States Deaths cases cases and LGAs affected

State: 2,439,850 171,097 2,132 LGA:

Figure 16: Epidemic curve of confirmed cases of Figure 17: Location of confirmed cases of COVID-19, Nigeria, week 1, 2020 – 21, 2021 COVID-19 by State, Nigeria, as at week 29, 2021

Actions To date: ● National COVID-19 multi-partner Emergency Operations Centre (EOC) continues to coordinate response activities across states ● Ongoing review of IPC guidelines on suspected and confirmed cases of COVID-19 ● Ongoing online IPC classes for IPC intermediate diploma course for IPC professionals ● Ongoing sequencing of positive samples among travellers to Nigeria, at the National Reference Laboratory (NRL), Gaduwa

Planned: ● Deploy antigen-based rapid diagnostic test (Ag-RDT) kits and sample collection materials to the selected states ● Intensify genomic surveillance activities ● Conduct WASH (Water, Sanitation and Hygiene) assessment across all health facilities ● Finalise Local Government Area (LGA) / State transmission categorisation

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Timeliness and Completeness of Reports Week 27 Figure 18: A – Timeliness by State (%); B – Completeness by State (%), week 27, 2021

Number of reports received on time, late or not received, the percentage timeliness and completeness, in the last 4 weeks and year to date Last 4 Weeks Year to date Nigeria Total Reports Week 24 – 27 Week 1 – 52 Reports sent on time 138 954 Reports sent late 7 27 Reports not received 3 18 Timeliness 93.3% 95.5% Completeness 98% 98.2% States with reports not received in 2021 (week 1 – 52) State Week(s) report not received 7, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, Benue 22, 23, 24, 25 & 26

Weekly Issue: Volume 12 No. 27. 27th July 2021 Epidemiological Report Timeliness and Completeness of Reports by State Year to date (week 1 – 52) Timeliness Completeness State (%) (%) Abia 93 100 Adamawa 96 100 Akwa Ibom 100 100 Anambra 100 100 Bauchi 96 100 Bayelsa 100 100 Benue 11 33 Borno 81 100 Cross River 100 100 Delta 100 100 Ebonyi 100 100 Edo 96 100 Ekiti 100 100 Enugu 81 100 FCT 100 100 Gombe 96 100 Imo 100 100 Jigawa 96 100 Kaduna 100 100 Kano 100 100 Katsina 96 100 Kebbi 100 100 Kogi 100 100 Kwara 100 100 Lagos 100 100 Nasarawa 100 100 Niger 100 100 Ogun 100 100 Ondo 96 100 Osun 100 100 Oyo 100 100 Plateau 96 100 Rivers 100 100 Sokoto 100 100 Taraba 100 100 Yobe 96 100 Zamfara 100 100