The current Lassa fever outbreak entered its 5th week with four more states being affected, bringing the total number of affected states to 17. So far, 449 suspected cases have been reported with 132 of them being laboratory confirmed as positive to the Lassa fever virus. 40 deaths were recorded in confirmed cases giving a case fatality rate (CFR) of 29.6%.
With the rapid increase in the number of affected cases and states in this outbreak, high CFR recorded and health care workers’ infections, an emergency National Council on Health (NCH) meeting was held on the 5th of February 2018 under the chairmanship of the Honourable Minister of Health, Prof. Isaac F. Adewole. A total of 364 participants were in attendance including Honourable Commissioners of Health, Permanent Secretaries of States’ Ministries of Health, Directors of Public Health, State Epidemiologists from the 36 states and the FCT.
The meeting was convened to deliberate on the State of Public Health in Nigeria, with the ongoing Lassa fever outbreak as a major focus. A keynote address titled “State of Public Health in Nigeria” was delivered by the Honourable Minister of Health. It centred on the State of the Nigerian Health system, different disease outbreaks, key strategies for preparedness and response, the need for multi-sectoral collaborations, highlighting the roles and responsibilities of all stakeholders. The meeting also provided an opportunity for individual States to provide updates on the current Lassa fever outbreak and the status of their preparedness and response. The Nigeria Centre for Disease Control (NCDC) gave a national update on the Lassa fever outbreak and response activities undertaken by the agency.
Following the State and national updates provided, key issues were identified by the council. These issues ranged from poor/inactive emergency preparedness and response, poor support for State Epidemiologists and State DSNOs by State Governments, deteriorating clinical state of patients who have to move for long distances to be diagnosed or managed, poor public enlightenment and health worker education, lack of (or poor, where available) functional isolation centres /public health laboratories at sub-national levels, poor collaboration/ partnership among stakeholders at all levels especially at sub-national levels, and the need for states to pay attention to the essential needs in Lassa fever control and eradication(Man, Money and Materials). Following this, 12 key resolutions were reached at the end of the meeting:
1. All States should ensure the establishment of functional infection prevention committees (IPCs), Emergency Operational Centres (EOCs) and isolation centres.
2. All States should adopt a multi-sectoral approach to disease outbreaks including Lassa fever.
3. All State Commissioners of Health are to update their State Executives and FMOH about the state of public health including outbreaks on a weekly basis.
4. Each State should prioritise the public health challenges in their respective states and build an appropriate partnership response to it.
5. All tertiary institutions should ensure they have capacity to manage Lassa fever cases.
6. All States to ensure the strengthening of community response through enlightenment campaigns and community involvement.
7. All States to implement the 60th Council resolution on food safety to strengthen ongoing preventive measures.
8. All States especially Borno, Kano and Kebbi states should collaborate with the NCDC to prepare for Measles, Cholera, Yellow fever and Cerebrospinal Meningitis outbreaks for 2018.
9. All States should emulate the Ebonyi State example of partnership with Federal Government by establishing laboratories with existing Federal Hospitals in their State.
10. The States that have made either part payment or no payment should pay-up their counter-part funding for Measles immunisation.
11. The Director Legal and the Director Public Health of FMOH should review the laws on quarantine measures
12. Research should be conducted on disease outbreaks especially in relation to modes of transmission e.g. Monkey pox in immunocompromised persons and all year transmission/outbreak of Lassa fever
It is expected that efforts will commence on implementing the above resolutions in place at the State level to ensure better preparedness and response to disease outbreaks in Nigeria. The NCDC on its part will continue to collaborate with states, and provide technical assistance, particularly in preparedness and response to any outbreak.
SUMMARY OF REPORTS
In the reporting week ending on January 28, 2018:
o There were 279 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio.
o Eight suspected cases of Cholera were reported from three LGAs in three States (Bauchi – 5, Kaduna – 1 &Zamfara – 2). Of these, none was laboratory confirmed and no death was recorded.
o 116 suspected cases of Lassa fever were reported from 44 LGAs in 19 States (Bauchi – 1, Borno – 1, Cross River – 2, Ebonyi – 12, Edo – 51, Ekiti – 2, FCT- 3, Gombe – 4, Imo – 1, Kaduna – 2, Kogi -4, Kwara – 3, Nasarawa – 1, Niger – 1, Ondo – 11, Osun – 2, Plateau – 7, Rivers – 4 & Taraba - 4). 30 were laboratory confirmed and eight deaths were recorded.
o There were 37-suspected cases of Cerebrospinal Meningitis (CSM) reported from 21 LGAs in eight States (Borno – 2, Cross River – 2, Gombe – 1, Katsina - 5, Sokoto – 7, Taraba – 1, Yobe – 1 & Zamfara - 18). Of these, None was laboratory confirmed and one death was recorded. Ongoing surveillance for CSM has been intensified in all the 26 States in the Nigeria meningitis belt and case based surveillance commenced from 4th December, 2017.
o There were 357- suspected cases of Measles reported from 35 States. None was laboratory confirmed and two deaths were recorded.
In the reporting week, all States sent in their report. This is a remarkable improvement! Timeliness of reporting increased from 91% in previous week (week 3, 2018) to 92% in the current week (Week 4, 2018) while completeness remained 100% at same period. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.
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