liberia idsr epidemiology bulletin - reliefweb · 2017-04-10 · liberia idsr epidemiology bulletin...

Liberia IDSR Epidemiology Bulletin 2017 Epi Week 13 (March 27 – April 2)

IDSR Weekly Epidemiology and Surveillance Bulletin

Table 1. Weekly IDSR Reporting Coverage, Liberia, Epi week 13, 2017

Keynotes and Events of Public Health

Significance

One hundred thirty three public health

events were reported across the

country.

Two outbreaks confirmed during the

week.

o Cholera in Nimba County

o Measles in Lofa & Grand Bassa

Counties

98% completeness in reporting from

health facilities.

97% reporting timeliness from health

facilities.

IDSR Data Quality Audit commenced in

five counties.

Round 2 NIDs completed with OPV

(99% administrative coverage), Vitamin

A (100%), and Mebendazole (104%)

Country Population: 4,373,279 l Volume 09, Issue 13 Mar. 27 – Apr. 2, 2017 l Data Source: CSOs from 15 Counties and Lab

Highlights

Reporting Coverage

County

Number of

Health Facility

Report Expected

Number

of Reports

Received

Number

Received

on Time

Completeness

(%)

Timeliness

(%)

Bomi 23 23 23 100 100

Bong 55 55 55 100 100

Gbarpolu 15 15 15 100 100

Grand Bassa 33 33 32 100 97

Grand Cape Mount 32 32 32 100 100

Grand Gedeh 24 24 24 100 100

Grand Kru 19 17 15 89 79

Lofa 59 59 59 100 100

Margibi 44 44 44 100 100

Maryland 25 25 25 100 100

Montserrado 284 274 274 96 96

Nimba 75 74 74 99 99

Rivercess 19 19 14 100 74

River Gee 19 19 19 100 100

Sinoe 35 35 35 100 100

Liberia 761 748 740 98 97

Legend ≥80 ≤80

The national target for weekly IDSR reporting is 80%.

Figure 1. Public Health Events Reported in Epi-week 13

748 (98%) Health facilities

out of 761

reported IDSR

data

90 (100%) Health

districts out of

90 reported

IDSR data

740 (97%) Health facility

timeliness for

weekly IDSR

reporting



Figure 2. Comparison of Suspected Cases of Measles Reported, Liberia, Epi weeks 1-13, 2016 & 2017

Vaccine Preventable Diseases

Measles Sixty-nine suspected cases were reported from Montserrado (18), Lofa (17), Margibi (12), Bong (7), Bomi (8),

Grand Bassa (5), Sinoe (1), and Grand Cape Mount (1) counties.

Samples were collected from 59 cases out of which 54 were tested. 12 tested positive, 39 negative and 3

equivocal.

The confirmed measles cases were reported from Foya in Lofa county (5), Campwood in Grand Bassa county (3),

Suakoko in Bong county (2), and Commonwealth in Montserrado county (2).

Of the 39 negative measles samples, 12 were tested for rubella of which 6 were positive.

Compared with the same week in 2016, there is an 86% increase in the number of suspected cases reported this

week.

Of the 69 suspected cases reported this week, 31 (45%) were reported to have been previously vaccinated, 10

(14.5%) were not vaccinated and 28 (40.5%) had unknown vaccination status.

Twenty-four (35%) of the suspected cases were <5 years and 45 (65%) were ≥5 years.

Cumulatively, since Epi week one, 464 suspected cases have been reported, and samples were collected, of which

37 were positive, 405 negative, and 22 equivocal. Of the negative cases, 130 samples have been tested for rubella,

out of which 51 were positive.

Public Health Actions

VPD surveillance awareness along Liberia-Guinea border health facilities in Bong, Lofa and Nimba.

Assessment of border health facilities preparedness to manage measles cases.

County Health Teams conducted sensitization of Joint Security/Immigration Officers and communities at PoE on

active case finding.



Acute Flaccid Paralysis (Suspected Polio)

Four cases of AFP were reported in Montserrado (1), Grand Bassa (1), Grand Cape Mount (1), and River Gee (1)

counties.

Samples were collected from all cases and pending laboratory confirmation.

Cumulatively, since Epi week one, 47 AFP cases have been reported, of which 39 have tested negative for

poliovirus and 8 are pending laboratory confirmation.


Round 2 Polio campaign ended

o 99% of 945,464 children less than 5 years received bOPV throughout the 15 counties.

Auto Visual AFP Detection and Reporting (AVADAR) implementation ongoing in four health districts in

Montserrado County.

Table 2: Non-polio AFP rate/100,000 <15yrs, Liberia, Epi weeks 1 - 13, 2017

Neonatal Tetanus Zero suspected cases of Neonatal tetanus were reported.

Cumulatively, since Epi week one, 5 suspected cases have been reported.

Viral Hemorrhagic Diseases

Ebola Virus Disease (EVD) One EVD alert was reported from River Gee County. The alert was a death.

Specimens was collected from the suspected cases and tested negative by RDT and PCR.

Cumulatively, since Epi week one, 270 EVD have been reported alerts all of which have been tested negative.

Lassa fever Zero suspected cases of Lassa fever were reported.

Cumulatively, since Epi week one, 14 suspected cases of Lassa Fever have been reported of which 3 tested

positive, 9 negative and 2 are pending laboratory confirmation.

County

<15

years

pop

# of AFP

Cases

Reported

# of

Cases

with Lab

Result

Non-

Polio

AFP

Rate

# of cases

<14 days

specimen

collected

% of stool

<14days

# of

NPENTs

% of

NPENT

Bomi 45639 3 3 26.3 3 100 0 0

Bong 180932 2 1 2.2 2 100 0 0

Gbarpolu 45243 0 0 0 0 0 0 0

Grand Bassa 120281 2 2 6.7 1 50 2 100

Grand Cape Mount 68945 2 1 5.8 2 100 0 0

Grand Gedeh 67959 4 3 17.7 4 100 1 33

Grand Kru 31421 0 0 0 0 0 0 0

Lofa 150214 7 5 13.3 7 100 0 0

Margibi 113895 8 8 28.1 8 100 2 25

Maryland 73754 1 1 5.4 0 0 0 0

Montserrado 606708 4 3 2.0 3 75 0 0

Nimba 250675 6 6 9.6 6 100 1 17

Rivercess 36237 6 6 66.2 5 83 3 50

River Gee 38798 2 0 0 2 100 0 0

Sinoe 55553 0 0 0 0 0 0 0

Liberia 1886254 47 39 8.3 43 91 9 23

Non-Polio AFP

Rate

<2

Stool Adequacy <80% Non-Polio

Enterovirus

<10%

Silent

≥2 ≥80% ≥10%



Table 3. Causes of Maternal Death, Liberia, Epi weeks 1-

13, 2017 (n=68)

Figure 4. Comparison of the trend of Maternal

Deaths Reported, Liberia, Epi weeks 1-13, 2016 &

2017

Yellow fever Two suspected cases of Yellow fever were reported from Grand Gedeh and Grand Kru Counties.

Cumulatively, since Epi-week one, 69 suspected cases have been reported, 60 samples tested negative and 9

pending laboratory confirmation. One case with date of onset in 2016 was confirmed positive for ELISA IgM but

PCR was negative in 2017.


Specimens were collected for all suspected Yellow fever cases.

National risk assessment is planned.

Meningitis Zero cases of meningitis were reported.

Cumulatively, since Epi week one, 6 suspected cases have been reported.

Events of Public Health Importance

Maternal Mortality

Nine maternal deaths were reported from Montserrado (3), Bong (2), Maryland (2), Grand Bassa (1), and Margibi

(1) counties.

Reported causes of deaths were post-partum hemorrhage (3), prolong labor, cardia failure, obstructed labor,

rapture uterus, anemia, and unknown.

Seven of the deaths were reported to have occurred in health facilities.

Cumulatively, since Epi-week one, 68 maternal deaths have been reported (see Table 3).

Maternal Death Proportion Percentage

Post-partum hemorrhage 18 26.5

Anemia 11 16.2

Sepsis 9 13.2

Renal failure 4 5.9

Congestive Heart failure 4 5.9

Ruptured uterus 4 5.9

Multiple organ failure 2 2.9

Pre-eclampsia 2 2.9

Abruptio placenta 2 2.9

Obstructed labor 2 2.9

Eclampsia 2 2.9

Dissimilated intravascular coagulation 1 1.5

Amniotic fluid embolism 1 1.5

Cardiac pulmonary failure 1 1.5

Respiratory Distress 1 1.5

Umbilical Hernia (Omphalocele) 1 1.5

Spinal shock 1 1.5

Prolonged labor 1 1.5

Unknown 1 1.5

Total 68 100



Table 4. Cumulative Maternal Deaths Reported by Counties, Liberia, Epi weeks 1-13, 2017

County

Annual Live birth

4.3% (EPI 2017)

Current

week Cumulative

% of Cumulative

Maternal deaths

Annualized Maternal

Mortality Ratio

Maryland 7048 2 5 7 284

Grand Bassa 11494 1 7 10 244

Sinoe 5308 0 3 4 226

River Gee 3707 0 2 3 216

Bomi 4361 0 2 3 183

Montserrado 57974 3 24 35 166

Bong 17289 2 7 10 162

Nimba 23953 0 9 13 150

Grand Kru 3002 0 1 1 133

Rivercess 3463 0 1 1 116

Lofa 14354 0 4 6 111

Gbarpolu 4323 0 1 1 93

Margibi 10883 1 2 3 74

Grand Cape Mount 6588 0 0 0 0

Grand Gedeh 6494 0 0 0 0

Total 180242 9 68 100 151

Neonatal Mortality

Twelve neonatal deaths

were reported from

Montserrado (3), Bong (3),

Grand Kru (2) Grand

Gedeh (1), Maryland (1),

Nimba (1), and River Gee

(1) counties.

Reported causes of death

were:

o Birth asphyxia (6)

o Neonatal sepsis (3)

o Neonatal Tetanus (2)

o Preterm (1)

Ten of the deaths were

reported to have occurred

in health facilities.

Cumulatively, since Epi

week one, 148 neonatal

deaths have been

reported.

Figure 5. Causes of Neonatal Death, Liberia, Epi weeks 1-13,

2017 (n=148)



Table 5. Cumulative Neonatal Deaths Reported by Counties, Liberia, Epi weeks 1-13, 2017

Human Exposure to Animal Bites (Suspected Rabies) Twenty-four records of animal bites were reported from Montserrado (8), Sinoe (4), River Gee (4), Rivercess (3),

Grand Gedeh (2), Grand Bassa (2), and Lofa (1) counties.

No specimens were collected.

Cumulatively, since Epi week one, 485 events of animal bites have been reported.

Public Health Action

All cases (suspected human rabies) received post-exposure prophylaxis (anti-rabies vaccine).

Bloody Diarrhea (Shigellosis) Four cases of bloody diarrhea were reported from Rivercess (2), Montserrado (1) and Sinoe (1) counties.

Specimens were collected from three of the four suspected cases.

One suspected case of shigella tested positive from Sanniquellie-Mah District in Nimba County.

Cumulatively, since Epi week one, 77 cases of bloody diarrhea have been reported, of which two were confirmed

positive for shigella, 40 were negative and 35 are pending laboratory testing.

Severe Acute Watery Diarrhea (Cholera) Eight suspected cases of cholera were reported from Sinoe (7) and Grand Bassa (1) Counties.

Specimens were collected from all suspected cases, and are pending laboratory confirmation.

Cumulatively, since Epi week one, 37 suspected cases of cholera have been reported, including 3 deaths

attributable to cholera. Of the 15 samples collected, 9 samples have been tested negative, 8 are pending

laboratory confirmation and 5 were rejected.

Public Health Action

Social mobilization and awareness activities on going in the affected communities.

100 jerry cans donated by Red Cross were distributed to the affected communities with 23 homes benefiting

from the initial supply.

Drug sensitivity test is ongoing at the Jackson F. Doe Hospital laboratory with results pending.

The confirmed case was isolated and management of other cases ongoing.

IPC materials (PPEs, Chlorine, antibiotics, ringer lactate, gloves etc.) supplied to Diallah Clinic.

The National team provided remote technical support to County Health Team.

County

Annual Live birth

4.3% (EPI 2017)

Current

week

Cumulative

Neonatal Deaths

% of Cumulative

Neonatal Deaths

Annualized Neonatal

Mortality Rate

Sinoe 5308 0 13 9 9.8

River Gee 3707 1 8 5 8.6

Grand Kru 3002 2 6 4 8.0

Maryland 7048 1 12 8 6.8

Rivercess 3463 0 4 3 4.6

Bong 17289 3 19 13 4.4

Montserrado 57974 3 60 41 4.1

Grand Gedeh 6494 1 4 3 2.5

Nimba 23953 1 9 6 1.5

Margibi 10883 0 4 3 1.5

Grand Bassa 11494 0 4 3 1.4

Gbarpolu 4323 0 1 1 0.9

Lofa 14354 0 3 2 0.8

Grand Cape Mount 6588 0 1 1 0.6

Bomi 4361 0 0 0 0.0

Total 180242 12 148 100 3.3



Outbreaks

Nimba County: Cholera

On 25th March 2017, a suspected case of cholera was reported from Tapitta district, Nimba County.

The patient was a 16 years old female who died en-route to the health facility.

No samples was collected from the case.

As of 6th April 2017, a total of 6 suspected cases, including 2 deaths were reported from 3

communities: Dialla (1 case), Nahlah 1 (4 cases), Nalah 2 (1 case).

Specimens were collected from 2 cases, one tested positive for vibrio cholera and the other tested

negative at the Jackson F. Doe referral hospital in Tappita District.

Of the six cases, 83% were females while 17% were males.

Age range of the female cases were 10-17 years and male 24 years old.

All 6 suspected cases have been linked to a common drinking water source (Nahlah creek).

83% of the community inhabitants’ main source of drinking water is Nahlah creek while 17% get

water from open well.

None of the communities have flush latrines.

The last case was discharged on 31 March, 2017.

Grand Bassa: Measles

On Monday March 27, 2017 the DSO for Suakoko District received a report from Phebe Hospital of a

suspected case of measles from Camp Wood community Grand Bassa County.

The Suakoko DSO traveled to the community on March 29, 2017 and initiated an investigation on April 1,

2017. During the investigation, additional six suspected cases were identified, of which samples were collected

from four.

The index case was a 16 years old child with onset of symptom on March 21, 2017.

One confirmed case (female) and 7 suspected cases (5 males and 2 females) were reported so far from Garno

town in Camp Wood community.

All cases were from the same community and all of them are alive.

The team also checked the vaccination status of children in 15 households in the same community

The team found 22 children <5 years, of which only 5 had been vaccinated against measles.

Lofa: Measles

Detailed investigation report will be provided in Epi week 14 bulletin

Public health interventions

Case management of measles was conducted with administration of Vitamin A and antibiotics (for

two cases with complication).

All children received measles vaccine in Fenutoli clinic, Suakoko District, Bong County.

Information was provided to the community by the Grand Bassa District #2 DSO on the importance

of vaccines and case reporting.



Nineteen suspected measles cases reported from six

counties.

Ten neonatal deaths reported from six counties.

Six maternal deaths reported from four counties.

Public Health Measures

National level

i. Data Quality Audits are being conducted in five Counties namely Bong, Gbarpolu, Bomi, River Gee,

and Grand Bassa.

ii. Notified CSOs to increase awareness and surveillance in border counties due to ongoing Rubella

outbreak in Sierra Leone and Measles and Yellow fever outbreak in Guinea.

iii. Notified CSOs to enforced border screening and yellow fever certificate (book) inspection at PoEs in

Lofa, Nimba and Lofa counties.

iv. Pilot implementation of an Auto Visual AFP detection and reporting (AVADAR) surveillance in 4

districts in Montserrado County

v. Follow up with counties to verify submitted reports/data.

vi. Follow up with counties to conduct maternal deaths investigation, revision of forms and

implementation of recommendations made.

vii. Planning is ongoing for eIDSR pilot in two counties (Grand Cape Mount and Margibi)

viii. IDSR training rollout in all the 15 counties is scheduled for 3rd week of April to 1st week of May 2017.

ix. Counties are encouraged to conduct health education for all public health diseases based on risk.

x. As the rainy season starts, counties are encouraged to update their cholera preparedness plans and

review existing stocks of supplies for prepositioning.

Notes

Completeness refers to the proportion of expected weekly IDSR reports received (target: ≥80%).

Timeliness refers to the proportion of expected weekly IDSR reports received by the next level on time

(target: ≥80%). Time requirement for weekly IDSR reports:

o Health facility - required on or before 5:00pm every Saturday to the district level

o Health district - required on or before 5:00pm every Sunday to the county level

o County - required on or before 5:00pm every Monday to the national level

Non-polio AFP rate is the proportion of non-polio AFP cases per 100,000 among the estimated

population under 15 years of age in 2017 (annual target: ≥2/100,000).

Non-measles febrile rash illness rate refers to the proportion of discarded measles cases per 100,000

population.

Annualized maternal mortality ratio refers to the maternal mortality ratio of a given period less than

one year and it is the number of maternal deaths per 100,000 live births.

Epi-linked refers to any suspected case that has not had a specimen taken for serologic confirmation

but is linked to a laboratory confirmed case.

Confirmed case refers to a case whose specimen has tested positive or reactive upon laboratory

testing, or has been classified as confirmed by either epidemiologic linkage with a confirmed case, or

clinical compatibility with the disease or condition.

Case Fatality Rate (CFR) is the proportion of deaths among confirmed cases.



For comments or questions, please contact

Thomas K. Nagbe, PA Dip., BSc, MPH

Director, Infectious Disease and Epidemiology Division

National IHR Focal Person

National Public Health Institute of Liberia

Republic of Liberia

Email: [email protected]

Phone: 0886 937386/0777442444

Website: www.moh.gov.lr

Epidemiological bulletin published with support of WHO and CDC

http://www.moh.gov.lr/

Liberia IDSR Epidemiology Bulletin 2017 Epi Week 13 (March 27 –April 2)


Appendix 1: Summary of immediately reportable diseases, conditions, and events by County during Epi week 13 and cumulative reports,

Liberia, 2017

No

. o

f H

ealt

h

Dis

tric

ts

No

. o

f H

ealt

h D

istr

ict

rep

ort

ed

Acu

te F

laccid

Para

lysi

s

(P

oli

o)

Blo

od

y D

iarr

ho

ea

(Sh

igell

osi

s)

Severe

Acu

te

Wate

ry D

iarr

ho

ea

(Ch

ole

ra)

Hu

man

Exp

osu

re t

o

An

imal

bit

es

(Su

specte

d R

ab

ies)

Lass

a

Fever

Measl

es

Men

ing

itis

Mate

rnal

Mo

rtali

ty

Neo

nata

l M

ort

ali

ty

Neo

nata

l

Teta

nu

s

VH

F

(in

clu

din

g E

VD

)

Yell

ow

Fever

Oth

er

Dis

ease

s/Even

ts

A D A D A D A D A D A D A D D D A D A D A D A D

Bomi 4 4 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0

Bong 8 8 0 0 0 0 0 0 0 0 0 0 7 0 0 0 2 3 0 0 0 0 0 0 0 0

Gbarpolu 5 4 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0

Grand Bassa 8 8 1 0 0 0 1 0 2 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0

Grand Cape Mount 5 5 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0

Grand Gedeh 6 6 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0

Grand Kru 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 1 0 0 0

Lofa 6 6 0 0 0 0 0 0 1 0 0 0 17 0 0 0 0 0 0 0 0 0 0 0 0 0

Margibi 4 4 0 0 0 0 0 0 0 0 0 0 12 0 0 0 1 0 0 0 0 0 0 0 0 0

Maryland 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 0 0 0 0 0 0 0 0

Montserrado 7 7 1 0 1 0 0 0 8 0 0 0 18 0 0 0 3 3 0 0 0 0 0 0 0 0

Nimba 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0

Rivercess 6 6 0 0 2 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

River Gee 4 4 1 0 0 0 0 0 4 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0

Sinoe 10 10 0 0 1 0 7 0 4 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0

Total Weekly 90 90 4 0 4 0 8 0 24 0 0 0 69 0 0 0 9 12 0 0 1 0 2 0 0 0

Cumulative Reported 50 0 77 0 36 4 485 1 10 3 392 1 5 2 68 148 5 0

21

268 66 1 1707 10

Cumulative Confirmed 0 0 2 0 2 0 0 0 0 3 10 0 0 0

0 0 0 0 0 0 00 0

0

Note: A = Alive,

D = Dead

Editorial Team - MoH: Roseline N. George – Deputy Director/DPC; Advertus N. Mianah – Surveillance Coordinator/DPC; Himiede W. Wilson – Epidemiologist/DPC; Lasee W. Cole –

Disease Investigators/DPC; Trokon O. Yeabah – Data Manager/DPC;

Partners: Dr. E. Kainne Dokubo & Carl Kinkade – CDC; Esther N. Muwanguzi, George Sie Williams & Mohammed Kromah – WHO

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