Liberia IDSR Epidemiology Bulletin 2017 Epi Week 22 (May 29 – June 4, 2017) Country Population: 4,373,279 l Volume 09, Issue 22 May 29 – June 4, 2017 l Data Source: CSOs from 15 Counties and Lab Highlights Keynotes and Events of Public Health Figure 1. Public Health Events Reported in Epi-week 22 Significance Seventy-two cases of public health events were reported across the country 99% completeness in reporting from health facilities 88% reporting timeliness from health facilities o Three counties health facilities timeliness was below the 80% target Six confirmed measles cases reported from the National Reference Laboratory Three ELISA-Antigen positive Lassa fever cases reported from the National Reference Laboratory Maryland County sent late report to the National level Reporting Coverage Table 1. Weekly IDSR Reporting Coverage, Liberia, Epi week 22, 2017 Number of Number Number Health Facility of Reports Received Completeness Timeliness 756 (98%) County Report Expected Received on Time (%) (%) Health facilities Bomi 23 23 23 100 100 out of 761 Bong 55 55 55 100 100 reported IDSR Gbarpolu 15 15 11 100 73 data Grand Bassa 33 33 33 100 100 Grand Cape Mount 32 32 32 100 100 Grand Gedeh 24 24 24 100 100 Grand Kru 19 19 13 100 68 90 (100%) Lofa 59 59 59 100 100 Health districts out of Margibi 44 44 44 100 100 90 reported Maryland 25 25 25 100 100 IDSR data Montserrado 284 280 205 99 72 Nimba 75 74 74 99 99 Rivercess 19 19 19 100 100 River Gee 19 19 19 100 100 671 (88%) Sinoe 35 35 35 100 100 Health facility timeliness for Liberia 761 756 671 99 88 weekly IDSR reporting Legend ≥80 <80 The national target for weekly IDSR reporting is 80% IDSR Weekly Epidemiology and Surveillance Bulletin Page 1 Liberia IDSR Epidemiology Bulletin 2017 Epi Week 22 (May 29 – June 4, 2017) IDSR Weekly Epidemiology and Surveillance Bulletin Page 2 Liberia IDSR Epidemiology Bulletin 2017 Epi Week 22 (May 29 – June 4, 2017) Vaccine Preventable Diseases Measles Nineteen suspected cases were reported from: Montserrado (6), Nimba (3), Margibi (3), Grand Cape Mount (3), Grand Bassa (2), Grand Gedeh (1), and Lofa (1) Of the 19 suspected cases reported this week, 6 (32%) were reported to have been previously vaccinated and 13 (68%) had unknown vaccination status Five (26%) of the suspected cases were <5 years and fourteen (74%) were ≥5 years of age The six confirmed cases were reported from Commonwealth (2) and Somalia Drive (1) in Montserrado County, Gola Konneh (1) in Grand Cape Mount County, Sanniquellie Mah (1) in Nimba, and Gbarma (1) in Gbarpolu County Cumulatively, since Epi week one, 864 suspected cases have been reported, of which 684 were tested: 84 (12.2%) positive, 568 (65.7%) negative and 32 (4.7%) equivocal. One hundred twenty of the suspected cases were compatible and epi-linked while sixty pending laboratory confirmation. Of the 600 equivocal and negative cases, 291 (48.5%) samples have been tested for rubella, of which, 135 (46.4%) were positive Public Health Actions Active case search ongoing in affected Counties In Tappita district, Nimba County, re-active immunization was cconducted, case management and surveillance is ongoing Samples were collected from 17 suspected cases and sent to the National Reference Laboratory for confirmation Figure 3. Comparison of Suspected Cases of Measles Reported, Liberia, Epi weeks 1 – 22, 2016 & 2017 Acute Flaccid Paralysis (Suspected Polio) Two cases of Acute Flaccid Paralysis were reported from Bong and Lofa counties Cumulatively, since Epi week one, 64 AFP cases have been reported, of which, 59 (92%) have been tested negative for poliovirus and 5 (8%) are pending laboratory confirmation IDSR Weekly Epidemiology and Surveillance Bulletin Page 3 Liberia IDSR Epidemiology Bulletin 2017 Epi Week 22 (May 29 – June 4, 2017) Public Health Actions Samples were collected from the two cases reported and sent to laboratory for confirmation Active surveillance ongoing in all fifteen (15) counties Table 2: Non-polio AFP rate/100,000 <15yrs, Liberia, Epi weeks 1 - 22, 2017 # of cases # of AFP # of Cases <14 days <15 years Cases with Lab Non-Polio specimen % of stool # of % of County pop Reported Result AFP Rate collected <14days NPENTs NPENT Bomi 45639 4 4 20.7 4 100 1 25 Bong 180932 3 2 3.9 3 100 0 0 Gbarpolu 45243 0 0 - - - - - Grand Bassa 120281 2 2 3.9 1 50 2 100 Grand Cape Mount 68945 2 2 6.9 2 100 0 0 Grand Gedeh 67959 4 4 13.4 4 100 1 25 Grand Kru 31421 1 0 7.5 0 - - - Lofa 150214 9 8 14.2 8 89 0 0 Margibi 113895 8 8 16.6 8 100 2 25 Maryland 73754 2 2 6.4 1 50 0 0 Montserrado 606708 11 11 4.3 5 45 0 0 Nimba 250675 7 6 6.6 7 100 1 17 Rivercess 36237 6 6 39.1 5 83 3 50 River-Gee 38798 3 2 18.3 1 33 1 50 Sinoe 55553 2 2 8.5 1 50 0 0 Liberia 1886254 64 59 8.0 50 78 11 19 <2 <80% Non-Polio <10% Non-Polio AFP Rate Stool Adequacy Silent ≥2 ≥80% Enterovirus ≥10% Neonatal Tetanus Zero cases of Neonatal tetanus were reported Cumulatively, since Epi week one, 6 clinically diagnosed cases have been reported Viral Hemorrhagic Diseases Ebola Virus Disease (EVD) One EVD alert was reported from Bomi County Cumulatively, since Epi week one, 297 EVD alerts have been reported, all of which have been tested negative Lassa fever Two suspected cases including one death attributed to Lassa Fever were reported from Grand Bassa (alive) and Margibi (dead) Counties Twelve cases results were received from the National Reference Laboratory, of which, three (3) were ELISA- Antigen positive, two (2) ELISA-Antibody IgM positive, six (6) ELISA-Antibody IgG positive, and one (1) negative Cumulatively, since Epi week one, 25 suspected cases have been reported including five deaths. Of the total cases, seven (7) have been confirmed positive by RT-PCR and ELISA-Antigen, 10 negative and 8 are pending Epi classification. The case fatality rate in confirmed cases is 29%. Public Health Actions Samples have been collected and sent to the laboratory for confirmation The live case has been isolated and clinical management is ongoing Yellow fever Four suspected cases were reported from Grand Kru (2), Grand Gedeh (1) and Lofa (1) Counties Cumulatively, since Epi-week one, 111 suspected cases have been reported, 68 samples tested negative and 42 are pending laboratory confirmation. One case with date of onset in 2016 was confirmed positive for ELISA IgM, but PCR testing done in 2017 was negative IDSR Weekly Epidemiology and Surveillance Bulletin Page 4 Liberia IDSR Epidemiology Bulletin 2017 Epi Week 22 (May 29 – June 4, 2017) Public Health Actions Specimens were collected from all suspected cases and pending Laboratory confirmation Active case search ongoing in affected counties Meningitis One suspected case of meningitis was reported from River Gee County. Cumulatively, since Epi week one, 14 suspected cases have been reported. An additional 31 cases (including 13 deaths) have been reported as part of an outbreak in three counties (Grand Bassa, Montserrado and Sinoe), with Neisseria meniningitidis serogroup C confirmed in 13 cases (including 11 deaths and 3 alive) Three (3) negative results from Grand Kru, Grand Bassa including the one case reported from River Gee. Public Health Actions Active surveillance ongoing Specimen was collected and tested negative Events of Public Health Importance Maternal Mortality Five maternal deaths were reported from Margibi (2), Bomi (1), Grand Bassa(1), and Grand Cape Mount (1) Counties Reported causes of deaths were postpartum hemorrhage (2), postpartum sepsis (1), ruptured uterus (1) and eclampsia (1) Three of the deaths were reported to have occurred in health facility and two in the community. Cumulatively, since Epi-week one, 109 maternal deaths have been reported (see Table 3 for causes of death) Figure 4. Comparison of the trend of Maternal Table 3. Causes of Maternal Death, Liberia, Epi Deaths Reported, Liberia, Epi weeks 1-22, 2016 & weeks 1-22, 2017 (n=109) 2017 Maternal Death Number Percentage Post-partum hemorrhage 38 34.8 Sepsis 15 13.7 Anemia 14 12.8 Eclampsia 7 6.4 Ruptured uterus 6 5.5 Renal failure 4 3.6 Congestive heart failure 4 3.6 Abruptio placenta 3 2.8 Unknown 3 2.8 Pre-eclampsia 3 2.8 Multiple organ failure 2 1.8 Obstructed labor 2 1.8 Cardiac pulmonary failure 2 1.8 Disseminated intravascular coagulation 1 1.0 Amniotic fluid embolism 1 1.0 Respiratory distress 1 1.0 Umbilical hernia (Omphalocele) 1 1.0 Spinal shock 1 1.0 Prolonged labor 1 1.0 Total 109 100 IDSR Weekly Epidemiology and Surveillance Bulletin Page 5 Liberia IDSR Epidemiology Bulletin 2017 Epi Week 22 (May 29 – June 4, 2017) Table 4. Cumulative Maternal Deaths Reported by Counties, Liberia, Epi weeks 1-22, 2017 Cumulative Annualized Annual Live Current Maternal % of Cumulative Maternal Mortality County birth1 week deaths Maternal deaths Rate/ 100,000 Bomi 4361 1 7 6 522 Grand Bassa 11494 1 13 12 368 Grand Kru 3002 0 3 3 325 River Gee 3707 0 3 3 263 Sinoe 5308 0 4 5 245 Maryland 7048 0 5 6 231 Bong 17289 0 10 10 188 Lofa 14354 0 8 8 181 Margibi 10883 2 8 7 239 Nimba 23953 0 13 13 176 Montserrado 57974 0 31 30 174 Rivercess 3463 0 1 1 94 Gbarpolu 4323 0 1 1 75 Grand Gedeh 6494 0 1 1 50 Grand Cape Mount 6588 1 1 1 49 Liberia 180242 5 109 100 197 Neonatal Mortality Fourteen neonatal Figure 5.