ATION N AL P U B L I C H E Liberia IDSR Epidemiology Bulletin A A L I T R H E B I 2019 Epi Week 5 (January 28- Feb 3, 2019) I N L S T F I O T U E T Country Population: 4,433,398 Volume 11, Issue 5, January 28 - Feb 3, 2019 Data Source: CSOs from 15 Counties and Lab Highlights Figure 1. Public Health Events Reported in Epi week 5 Keynotes and Events of Public Health Significance • A total of 105 events of public health importance including 10 deaths were reported • Completeness and timeliness of health facility reports were both 98% • Ongoing Lassa fever outbreaks in Grand Bassa and Nimba Counties • Ongoing Measles outbreaks in Grand Gedeh and Gbarpolu Counties Reporting Coverage Table 1. Health Facility Weekly IDSR Reporting Coverage, Liberia, Epi week 5, 2019 Number of Number of Number Expected Report Reports Received Completeness Timeliness 867(98%) County from Health Facility Received on Time (%) (%) Health Bomi 26 26 26 100 100 facilities Bong 57 57 57 100 100 reported IDSR Gbarpolu 16 16 16 100 100 data Grand Bassa 34 34 34 100 100 Grand Cape Mount 34 34 34 100 100 Grand Gedeh 24 24 24 100 100 Grand Kru 19 19 19 100 100 92(99%) Lofa 59 59 59 100 100 Health districts reported IDSR Margibi 59 57 57 97 97 data Maryland 26 26 26 100 100 Montserrado 367 354 354 96 96 Nimba 84 84 84 100 100 Rivercess 20 20 20 100 100 River Gee 20 20 20 100 100 867(98%) Sinoe 37 37 37 100 100 Health facilities out of 882 Liberia 882 867 867 98 98 reported timely Legend: ≥80 <80 IDSR data • The national target for weekly IDSR reporting is 80% • All counties submitted weekly IDSR report on time to national level IDSR Weekly Epidemiology and Surveillance Bulletin © 2019 Page 1 ATION N AL P U B L I C H E Liberia IDSR Epidemiology Bulletin A A L I T R H E B I 2019 Epi Week 5 (January 28- Feb 3, 2019) I N L S T F I O T U E T Vaccine Preventable Diseases Measles • Fifty (50) suspected cases were reported from Montserrado (18), Grand Gedeh (6), Grand Kru (6), Sinoe (6), Margibi (4), Grand Bassa (4), Rivercess (2), Nimba (2), Bong (1) and River Gee (1) • Forty (40) specimens were collected; thirty-five tested by the National Public Health Reference Laboratory o Eight lab-confirmed (positive): Montserrado (2), Margibi (2), River Gee (1), Sinoe (1), Rivercess (1), Grand Kru (1) o Twenty-seven discarded (negative) o Two pending testing while three pending arrival • Tchien District in Grand Gedeh County and Bokomu in Gbarpolu County are currently in outbreak • Vaccination status: o Vaccination status among suspected cases: 24 (48%) vaccinated, 9 (18%) not vaccinated and 17 (34%) unknown o Vaccination status among confirmed cases: 3 vaccinated, 2 not vaccinated and 3 unknowns • Age distribution o Age distribution among suspected cases: <1 year: 3 (6%), 1 – 4 years: 14 (28%) and ≥5 years: 33 (66%) o Age distribution among confirmed cases: <1 year: 1 (12.5%), ≥5 years: 7 (87.5%) • Cumulatively, since Epi-week one, 170 suspected cases including zero deaths have been reported. Of these, 109 have been tested by the laboratory and results showed 31 positive, 75 negative and 3 equivocal • Epi-classification are as follows: 92 (54%) confirmed (lab confirmed 31, clinically confirmed 47, epi-linked 14) cases, 3 (1.8%) indeterminate and 75 (44%) discarded. See table 2 Public Health Action • Active case search, health education, and community engagement are ongoing in districts that reported • Mini vaccination campaign ongoing in the surrounding communities of affected community Table 2. Cumulative Measles Cases Reported by County and Epi-classification, Liberia, Epi-week 1 - 5, 2019 Epi-classification Annualized Non- Lab Epi- Clinically Measles Febrile Reporting County confirmed linked confirmed Indeterminate Discarded Total Rash Illness Rate Bomi 0 0 0 0 0 0 0.0 Bong 4 0 1 1 5 11 11.9 Gbarpolu 4 0 0 0 0 4 0.0 Grand Bassa 0 2 10 0 5 17 18.7 Grand Cape Mount 0 0 0 0 1 1 6.5 Grand Gedeh 8 8 1 0 10 27 66.1 Grand Kru 4 4 3 0 3 14 42.9 Lofa 0 0 1 0 0 1 0.0 Margibi 3 0 0 1 4 8 15.8 Maryland 0 0 0 0 0 0 0.0 Montserrado 5 0 1 1 26 33 18.6 Nimba 0 0 1 0 4 5 7.2 River Gee 1 0 0 0 9 10 111.5 Rivercess 1 0 1 0 5 7 57.9 Sinoe 1 0 28 0 3 32 24.2 Liberia 31 14 47 3 75 170 17.6 Target Achieved >=2 Below Target <2 IDSR Weekly Epidemiology and Surveillance Bulletin © 2019 Page 2 ATION N AL P U B L I C H E Liberia IDSR Epidemiology Bulletin A A L I T R H E B I 2019 Epi Week 5 (January 28- Feb 3, 2019) I N L S T F I O T U E T Figure 2. Confirmed Measles Cases Reported by Health District, Liberia, Epi-week 5, 2019 Acute Flaccid Paralysis (Suspected Polio) • One (1) case was reported from Grand Bassa County • Specimen was collected and pending shipment • Cumulatively, since Epi week one, 6 cases have been reported and pending laboratory confirmation Table 3. Non-polio AFP rate per 100,000 population less than 15 years, Liberia, Epi-week 1 - 5, 2019 # of AFP # of Cases # of cases <14 < 15 Cases with Lab Non-Polio days specimen % of stool # of % of County years pop Reported Result AFP Rate collected <14days NPENTs NPENT Bomi 47576 0 0 0.0 0 0% 0 0% Bong 196480 0 0 0.0 0 0% 0 0% Gbarpolu 47163 0 0 0.0 0 0% 0 0% Grand Bassa 125386 1 0 10.4 1 100% 0 0% Grand Cape Mount 71872 1 0 18.1 1 100% 0 0% Grand Gedeh 70844 0 0 0.0 0 0% 0 0% Grand Kru 32755 0 0 0.0 0 0% 0 0% Lofa 156050 0 0 0.0 0 0% 0 0% Margibi 118729 1 0 10.9 1 100% 0 0% Maryland 76884 0 0 0.0 0 0% 0 0% Montserrado 653849 1 0 2.0 1 100% 0 0% Nimba 261314 0 0 0.0 0 0% 0 0% Rivercess 40444 0 0 0.0 0 0% 0 0% River Gee 37775 0 0 0.0 0 0% 0 0% Sinoe 57910 0 0 0.0 0 0% 0 0% Liberia 1995031 4 0 2.6 4 100% 0 0% <2 <80% Non-Polio <10% Non-Polio AFP Rate Stool adequacy Silent ≥ 2 ≥80% Enterovirus ≥10% IDSR Weekly Epidemiology and Surveillance Bulletin © 2019 Page 3 ATION N AL P U B L I C H E Liberia IDSR Epidemiology Bulletin A A L I T R H E B I 2019 Epi Week 5 (January 28- Feb 3, 2019) I N L S T F I O T U E T Neonatal Tetanus • Zero case was reported • Cumulatively, since Epi-week one, 1 clinically diagnosed case has been reported Viral Hemorrhagic Diseases Ebola Virus Disease (EVD) • Three alerts were reported from Montserrado County • Specimens were collected and tested negative • Cumulatively, since Epi-week one, 6 EVD alerts have been reported and tested negative Lassa fever • Six (6) suspected cases were reported from Nimba County o All specimens were collected and pending testing • Cumulatively, since Epi week one, 15 suspected cases have been reported o Of these, eight have been tested by the laboratory. Epi-classification are as follows: 2 lab-confirmed, 6 not a case and 7 pending testing Yellow fever • One (1) suspected case was reported from River Gee County o Specimen was collected and pending testing • Cumulatively, since Epi-week one, 9 suspected cases have been reported; eight tested negative and one pending testing Monkey pox • One (1) case was reported from Bong County • Specimen was collected and pending shipment • Cumulatively, since Epi-week one, 3 suspected cases have been reported pending shipment Meningitis • One (1) case was reported from Nimba County • Specimen was collected and tested negative • Cumulatively, since Epi-week one, 6 suspected cases have been reported and all tested negative Events of Public Health Importance Maternal Mortality • Three (3) deaths were reported from Grand Bassa, Margibi and Montserrado Counties • Reported causes of deaths were: o Eclampsia (2), Postpartum Hemorrhage (1) • All deaths were reported to have occurred in health facilities • Cumulatively, since Epi-week one, 24 maternal deaths have been reported (See Table 4) IDSR Weekly Epidemiology and Surveillance Bulletin © 2019 Page 4 ATION N AL P U B L I C H E Liberia IDSR Epidemiology Bulletin A A L I T R H E B I 2019 Epi Week 5 (January 28- Feb 3, 2019) I N L S T F I O T U E T Table 4. Annualized and Cumulative Maternal Deaths Reported by Counties, Liberia, Epi-week 1 - 5, 2019 Estimated Annual % of Cumulative Annualized Maternal County Live birth (4.3%) Current week Cumulative Maternal deaths Mortality Ratio/100,000 Grand Gedeh 6494 0 2 8 320 Maryland 7048 0 2 8 295 Margibi 10883 1 3 13 287 Grand Bassa 11494 1 3 13 271 Gbarpolu 4323 0 0 0 271 Bong 17289 0 3 13 180 Nimba 23953 0 3 13 130 Montserrado 57974 1 7 29 126 Lofa 14354 0 1 4 72 River Gee 3707 0 0 0 0 Bomi 4361 0 0 0 0 Grand Kru 3002 0 0 0 0 Rivercess 3463 0 0 0 0 Sinoe 5308 0 0 0 0 Grand Cape Mount 6588 0 0 0 0 Liberia (National) 190636 3 24 100 138 Neonatal Mortality • Sis (6) deaths were reported from Montserrado (3) and Bong (3) Counties • Reported causes of deaths were o Sepsis (5) o Preterm (1) • All deaths were reported to have occurred in health facilities • Cumulatively, since Epi-week one, 51 neonatal deaths have been reported (See Table 5) Table 5.