Concerns as Lassa fever, meningitis, yellow fever epidemics persist

*NCDC records six new deaths, 25 confirmed cases of LF in eight states
*Centre reports 16 fatalities in 21 verified incidences of CSM in Zamfara, others
*Publishes three presumptive fresh infections of YF, no casualties in Edo, Ondo

Unlike in the past when Lassa fever (LF) and Yellow fever (YF) epidemics used to be seasonal, the country has in the past one year continued to record new cases and deaths as well of those of cerebro spinal meningitis (CSM). Latest figures from the Nigeria Centre for Disease Control (NCDC) showed twenty-five new confirmed cases were reported from Edo (six), Ondo (two), Ebonyi (one), Plateau (two), Taraba (four), Bauchi (eight), Kogi (one) and Kebbi (one) States with six new deaths in Ondo (three), Bauchi (two) and Kogi (one).

According to the NCDC, from January 1 to February 17, 2019, a total of 1,139 suspected cases have been reported from 19 States and Federal Capital Territory (FCT) Abuja and of these, 355 were confirmed positive, three probable and 781 negative (not a case). However, 1,168 suspected cases have been reported from 30 States and FCT.

The centre said since the onset of the 2019 outbreak, there have been 75 deaths in confirmed cases and Case fatality ratio (CFR) in confirmed cases is 21.1 per cent.The NCDC noted that twenty States (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Plateau, Taraba, FCT, Adamawa, Gombe, Kaduna, Kwara, Benue, Rivers, Kogi, Enugu, Imo, Delta, Oyo and Kebbi) have recorded at least one confirmed case across 57 Local Government Areas (LGAs).

According to the NCDC, in the reporting week 07 (February 11-17, 2019), one new health care worker was affected in Edo State and a total of thirteen health care workers have been affected since the onset of the outbreak in seven States – Edo (five), Ondo (three), Ebonyi (one), Enugu (one), Rivers (one), Bauchi (one) and Benue (one) with one death in Enugu.

The centre said eighty-eight patients are currently being managed at various treatment centres across the country: 31 at Irrua Specialist Teaching Hospital (ISTH) treatment Centre, Edo State; 28 at Federal Medical Centre Owo, Ondo; three Federal Teaching Hospital Abakiliki, Ebonyi State; 11 at Bauchi; seven each at Plateau and Taraba facilities; and one at Kebbi treatment centre.
According to the NCDC, a total of 3,872 contacts have been identified from 18 States and of these 2,600 (67.1 per cent) are currently being followed up, 1,227 (31.7 per cent) have completed 21 days follow up, while four (0.1 per cent) were lost to follow up; and 63 (1.6 per cent) symptomatic contacts have been identified, of which 41 (1.1 per cent) have tested positive. -Table 1

It noted that a multi sectoral one-health national rapid response teams comprising of the NCDC, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Federal Ministry of Agricultural and Federal Ministry of Environment have been deployed to Ondo, Edo and Ebonyi. A mid outbreak review meeting with stakeholders held on February 15, 2019, and national Lassa fever multi-partner, multi-sectoral Emergency Operations Centre (EOC) continues to coordinate the response activities at all levels.

Also, the NCDC reported that beginning from October 1, 2018 to
February 19, 2019, a total of 213 suspected cases of meningitis have been reported from fourteen states and twenty-one samples were positive for bacterial meningitis that is Neisseria meningitides serogroup C (NmC), which accounted for 38.0 per cent (eight) of the positive cases.

According to the NCDC, so far, sixteen deaths with CFR of 7.5 per cent have been recorded among all suspected cases and in the last four weeks, no LGA is in the alert threshold.A breakdown of the figures on CSM by the NCDC showed 213 total cases were reported with 16 deaths in 21 confirmed cases and 79 samples were tested out of 109 total samples collected.

The NCDC said the multi-agency CSM EOC has been activated and the National Technical Working Group for Cerebrospinal Meningitis has been monitoring cases and ensuring preparedness and coordination of response across the states.Also, the NCDC has reported 103 suspected cases of yellow fever. According to the centre, three new presumptive positive cases were recorded: NCDC Central Public Health Laboratory (CPHL) reported the three new presumptive cases with two from Ovia South West and Esan North East LGAs of Edo State and one in Ose LGA of Ondo State.

The NCDC said two confirmed and one inconclusive cases of yellow fever were reported on February 15 from Institut Pasteur Dakar: Kwara – one from Ifelodun LGA of Kwara state; one from Gwagwalada Area Council of FCT; and inconclusive cases from Esan West LGA of Edo state.

However, the centre said Edo State Yellow fever outbreak has been declared over and reactive vaccination campaign was carried out in 13 (72.2 per cent) LGAs with a total number of 1,734,423 were vaccinated with (120.1 per cent) coverage. The NCDC said the national Yellow Fever Level 2 EOC has been de-activated and response activities coordinated by the Yellow Fever Technical Working Group (YF TWG).

According to the NCDC, from January 1– February 17, 2019, 254 suspected cases of yellow fever have been reported in 134 (17.3 per cent) LGAs and all suspected cases had blood samples collected. The centre added: “11 presumptive positive and one inconclusive cases from four states in nine LGAs: Edo (six), Ondo (three), Kebbi (one) and Imo (one), inconclusive case from Imo (one). No IP Dakar confirmed case from 2019 data and no death has been recorded.”

The NCDC said a yellow fever outbreak has been active in Nigeria since September, 2017 and from 2017 to 2018, 139 cases have been confirmed in 17 States: Kwara (eight), Kogi (12), Kano (one), Zamfara (19), Kebbi (seven), Nasarawa (three), Niger (one), Katsina (two), Edo (69), Ekiti (two), Rivers (one), Anambra (one), FCT (11), Benue (one), Delta (one), Ondo (two) and Abia (one) States and in 46 LGAs.

It added: “From September 2017 to December 2018, 274 samples (presumptive positive – 237 and inconclusive – 37) in 238 LGAs have been sent to IP Dakar for re-confirmation. All Nigerian states (36 plus FCT) have reported 4,100 suspected cases in 604 (78.0 per cent) LGAs.”

According to the NCDC, of all suspected, probable and confirmed cases, 80 deaths were recorded with 29 deaths among confirmed cases only and the case fatality ratio (CFR) for all cases (suspected, probable and confirmed) is 2.0 per cent, and 21.0 per cent for confirmed cases.
The centre noted that yellow fever preventive mass vaccination campaigns (PMVC) have been successfully completed in 12 states:
*2013 PMVC phase 1 Nasarawa, Cross River, Akwa Ibom.
*2018 Phase 2a: Kogi, Kwara and Zamfara and in 58 political wards in 25 LGAs in Borno State.
*2018 phase 2b PMVC: Sokoto, Kebbi, Niger, FCT, Plateau and Borno (three LGAs (Askira/Uba, Chibok, Konduga) States.