Liberia IDSR Epidemiology Bulletin 2016 Epi Week 45 (November 7 – 13) Data Source: CSOs from 15 Counties and Lab Highlights Eleven neonatal deaths reported from five counties Twenty suspected cases of measles reported from six counties, of which nine were reported from a single facility in Lofa County Six cases of acute flaccid paralysis reported from three counties with dates of onset from Epi week 38 to 45 Nineteen clinically confirmed cases of pertussis were reported from Grand Gedeh County Thirteen laboratory results received for measles, of which one was positive from Bong County Reporting Coverage 100% (745/745) of expected health facilities reported from 90 health districts across 15 counties. 98% (733/745) of health facilities submitted timely reports to the district level. 94% (85/90) of health districts submitted timely reports to county level. 100% (15/15) of counties submitted timely reports to the national level. Vaccine Preventable Diseases Measles Twenty (20) suspected cases reported. Lofa (9), Montserrado (4), Bong (3), Margibi (2) Gbarpolu (1) and Grand Bassa (1). Specimens were collected from fourteen (14) out of the twenty (20) cases for laboratory confirmation. Cumulatively, 944 cases have been reported: Lab-confirmed (124), Epi-linked (485), compatible (149), suspected (29) and discarded (157) (Figure 2). CFR 0.8% (n=5). Liberia's annualized non-measles febrile rash illness rate stands at 4.4 per 100,000. Grand Cape Mount, Nimba, Rivercess, River Gee and Sinoe Counties are below the target of 2/100,000 (Table 1). Of the total 944 cases reported (Lab confirmed, Epi-linked and suspected), 15% were reportedly previously vaccinated, 39% were unvaccinated, and 47% had unknown vaccination status. 33% of the confirmed and suspected cases are below 5 years. 1 Liberia IDSR Epidemiology Bulletin 2016 Epi Week 45 (November 7 – 13) Table 1. Distribution of Reported Measles Cases by County and Epi-Classification, Liberia, Week 1 - 45, 2016 Annualized Non Lab Epi- Measles Febrile County Confirmed Linked Compatible Suspected Discarded Total Rash Illness Rate Bomi 2 2 3 0 17 24 19.8 Bong 10 49 3 3 13 78 3.8 Gbarpolu 0 0 5 0 4 9 4.7 Grand Bassa 20 116 5 0 13 154 5.7 Grand Cape Mount 0 0 1 0 0 1 0.0 Grand Gedeh 0 0 15 3 6 24 4.7 Grand Kru 0 0 0 0 3 3 5.1 Lofa 4 29 75 11 11 130 3.9 Margibi 46 164 0 6 42 258 19.6 Maryland 0 0 0 0 5 5 3.6 Montserrado 41 104 35 5 32 217 2.8 Nimba 1 21 5 0 8 35 1.7 Rivercess 0 0 0 0 1 1 1.5 River Gee 0 0 1 0 0 1 0.0 Sinoe 0 0 0 1 2 3 1.9 NP 0 0 1 0 0 1 Liberia 124 485 149 29 157 944 4.4 Target Achieved >=2 Below Target <2 Acute Flaccid Paralysis Six (6) suspected cases reported. Bong (4) and Montserrado (2). Cumulatively, 63 cases of AFP have been recorded: Zero confirmed, 49 discarded and 14 pending lab confirmation. As of week 45, the annualized non-polio AFP rate is at 3.9 per 100,000 population in less than 15 years of age (Table 2). Table 2: Non-polio AFP rate/100,000 <15yrs, Liberia, Epi week 1-45, 2016 < 15 years Non-Polio % of stool County Expected Reported % of NPENT pop AFP Rate <14days Bomi 44700 0.4 4 10.3 100 50% Bong 177210 1.5 10 6.5 80 40% Gbarpolu 44312 0.4 1 2.6 100 0% Grand Bassa 117807 1.0 3 2.9 100 20% Grand Cape Mount 67527 0.6 1 1.7 100 0% Grand Gedeh 66562 0.6 3 5.2 100 0% Grand Kru 30775 0.3 2 7.5 100 0% Lofa 147124 1.2 7 5.5 100 0% Margibi 111552 0.9 5 5.2 100 120% Maryland 72237 0.6 2 3.2 100 0% Montserrado 594229 5.0 11 2.1 100 14% Nimba 245519 2.1 7 3.3 100 17% Rivercess 35492 0.3 1 3.3 100 0% River-Gee 38000 0.3 2 6.1 100 0% Sinoe 54410 0.5 4 8.5 25 50% Liberia 1847457 15.6 63 3.9 95 32% <2 = Non-Polio AFP Rate ≥ 2 = <80% = Stool adequacy ≥80% = <10% = Non-Polio Enterovirus ≥10% = Silent 2 Liberia IDSR Epidemiology Bulletin 2016 Epi Week 45 (November 7 – 13) Neonatal Tetanus Two (2) cases reported including one (1) death. Grand Cape Mount (1) and Grand Kru (1). The death was reported from Grand Kru County. Cumulatively, 21 cases have been reported. CFR is 33% (n=7). Viral Hemorrhagic Diseases Ebola Virus Disease (EVD) A total of sixty (60) suspected cases reported (2 alive and 58 dead) of Figure 3: Number of EVD alerts reported, Liberia, Epi week 1-45, 2016 1600 which samples were collected from 1500 1400 fifty-four (54). 1300 1200 94 samples tested (6 whole blood 1100 1000 and 88 oral swab). 93 samples were 900 800 tested negative and 1 700 600 indeterminate. Overall samples were 500 400 submitted from 12 counties. 300 200 Cumulatively, 29,093 alerts have reported cases suspected of Number 100 0 been reported out of which three (3) Week1 Week2 Week3 Week4 Week5 Week6 Week7 Week8 Week9 Week10 Week11 Week12 Week13 Week14 Week15 Week16 Week17 Week18 Week19 Week20 Week21 Week22 Week23 Week24 Week25 Week26 Week27 Week28 Week29 Week30 Week31 Week32 Week33 Week34 Week35 Week36 Week37 Week38 Week39 Week40 Week41 Week42 Week43 Week44 were confirmed. CFR in confirmed Week45 cases is 33.3% (n=1). Reporting week Alive Dead Table 3. Count of patient samples tested for EVD by county and samples type, Liberia, Epi-week 42 - 45, 2016 Week 42 Week 43 Week 44 Week 45 Whole Oral Whole Oral Whole Oral Whole Oral Geographical Distribution Blood Swab Blood Swab Blood Swab Blood Swab All Counties 10 126 10 166 12 79 6 88 By County Bomi 0 4 6 16 1 3 0 14 Bong 1 3 0 4 1 0 2 1 Gbarpolu 0 3 0 1 0 0 0 0 Grand Bassa 0 5 0 3 0 3 0 0 Grand Cape Mount 0 0 0 0 0 0 0 1 Grand Gedeh 0 5 0 1 0 0 0 9 Grand Kru 1 1 0 0 3 0 0 0 Lofa 1 14 0 10 0 6 0 6 Margibi 0 4 0 5 4 2 3 4 Maryland 0 2 1 2 0 0 0 7 Montserrado 1 77 2 86 0 43 0 31 Nimba 5 5 0 28 3 17 0 5 Rivercess 0 2 0 0 0 1 0 6 River Gee 0 0 0 2 0 2 0 2 Sinoe 1 1 0 8 0 2 1 2 Unknown 0 0 0 0 0 0 0 0 3 Liberia IDSR Epidemiology Bulletin 2016 Epi Week 45 (November 7 – 13) Lassa Fever Zero cases reported. Cumulatively, 68 cases have been reported, of which 12 confirmed, 29 not a case, 27 suspected (13 awaiting lab confirmation: 5 from Epi week 38, 3 for Epi week 39, 2 from Epi week 43 and 1 each from Epi week 40, 42 and 44). CFR for suspected and confirmed cases is 61% and for confirmed cases is 33%. Bong County accounts for 58% of the total confirmed cases. Yellow Fever Zero cases reported. Cumulatively, 40 cases have been reported, of which twenty-nine (29) tested negative and ten (10) are pending laboratory confirmation. Meningitis Zero cases reported. Cumulatively, 26 suspected cases have been reported. Events of Public Health Importance Maternal Mortality Four (4) maternal deaths reported. Sinoe (1), Grand Bassa (1) Montserrado (1) and Grand Kru (1). Primary causes of deaths were all due to post-partum hemorrhage. All of the deaths were reported to have occurred in health facilities. Cumulatively, 262 maternal deaths have been reported, of which 81% (211) were reported from health facilities and 19% (51) from communities. Annualized maternal mortality ratio is at 171 per 100,000 live births (Table 3). The expected MMR based on 2013 Demographic Health Survey (DHS) is 1072 deaths per 100,000 live births. 4 Liberia IDSR Epidemiology Bulletin 2016 Epi Week 45 (November 7 – 13) Table 4: Cumulative Maternal Deaths Reported by Counties, Liberia, Epi week 1- 45,2016 No. of Maternal Deaths % of Deaths Annualized Maternal Counties Reported Reported Mortality Ratio Bomi 14 5 379 Sinoe 13 5 289 Grand Kru 7 3 275 Grand Cape Mount 14 5 251 Bong 34 13 232 Margibi 19 7 206 River Gee 6 2 204 Maryland 12 5 201 Gbarpolu 7 3 191 Rivercess 5 2 159 Grand Bassa 15 6 154 Grand Gedeh 8 3 145 Nimba 27 10 133 Montserrado 65 25 132 Lofa 16 6 132 Liberia 262 100 171 Neonatal Mortality Eleven (11) neonatal deaths were reported from Montserrado (7), Lofa (1), Grand Kru (1), Bong (1) and Gbarpolu (1). Primary causes of deaths were birth asphyxia (7), neonatal sepsis (2) and prolonged labor (1) The reported death from Grand Kru was attributed to Neonatal Tetanus. All reported deaths occurred in health facilities. Cumulatively, 461 neonatal deaths have been reported. Annualized neonatal mortality rate is 6 per 1,000 live births. The expected NNMR based on 2013 DHS is 26 deaths per 1,000 live births. 5 Liberia IDSR Epidemiology Bulletin 2016 Epi Week 45 (November 7 – 13) Table 5: Cumulative Neonatal Deaths reported by counties, Liberia, Epi week 1 - 45, 2016 Cumulative number of % of Deaths Annualized Neonatal Mortality Counties Neonatal Deaths Reported Reported Rate Per 1,000 Live Births Grand Kru 20 4 16 River Gee 16 3 11 Grand Gedeh 29 6 11 Bong 72 16 10 Rivercess 13 3 8 Gbarpolu 14 3 8 Maryland 22 5 8 Montserrado 161 35 7 Sinoe 13 3 6 Lofa 32 7 5 Bomi 9 2 5 Grand Cape Mount 12 3 4 Grand Bassa 20 4 4 Margibi 10 2 2 Nimba 18 4 2 Liberia 461 100 6 Human Exposure to Animal Bites (Suspected Rabies) Twenty-one (21) suspected cases reported.