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Nigeria enters peak season for most infectious diseases

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The dry season is here. It is associated with frequent outbreaks of infectious diseases and preventable deaths.

Several researches have shown that Lassa fever peak endemicity incidence and prevalence overlap the dry season (within November to March) and reduced during the wet season (of May to October) annually in Sierra Leone, Senegal to Nigeria.

In 2017, like never before, Nigeria was faced with several outbreaks –of measles, Cerebrospinal Meningitis (CSM), Lassa fever, yellow fever, cholera and monkeypox. An outbreak of CSM, which had begun in December 2016 in Zamfara State, was not reported to the national level until two months into the outbreak. By this time, the number of reported cases began to escalate rapidly, and the situation was not looking good: hundreds of new cases of meningitis were being reported weekly through the Nigeria Centre for Disease Control (NCDC) surveillance systems.

Interestingly, the CSM outbreak was of a different strain, which the country did not have a readily available stock of vaccines. The NCDC led a multi-partner team to control this outbreak, which was ultimately achieved, though not without the loss of over 1,000 lives.

The climax of the 2017 cholera outbreak was in Borno State, where the insurgency had disrupted potable water supply, resulting in challenging hygiene and living conditions.

In September 2017, an unusual outbreak emerged; Nigeria faced an outbreak of monkeypox. This disease had not been detected in Nigeria since the seventies. Further investigations showed that it may actually have been circulating in Nigeria for some time, but could have been under-reported or misdiagnosed in recent years.

The last large outbreak of Yellow fever in Nigeria was reported to have occurred over thirty years ago. In 2017, investigations into news reports of ‘strange illnesses and deaths’ in Kwara and Kogi State revealed the re-emergence of Yellow fever. Given the very low immunisation coverage rates in many parts of the country, this was not surprising.

What is the country doing to prevent the outbreak of these endemic but deadly diseases? Executive Director of National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib, told The Guardian that the agency has been proactive in tackling the situation to prevent what happened in 2017.

Shuaib said: “In the last few years, we have had outbreaks of meningitis and we have massively deployed preventive vaccines against meningitis. This is why you will observe that in 2018 and 2019 we do not that massive outbreak as we saw in 2017.

“One thing that we should ask ourselves is that why are we having outbreaks? For example we had recent outbreaks of yellow fever in Bauchi, Katsina and Gombe states. Again this could be traced to the several decades of poor routine immunisation. Immunisation vaccines were supposed to protect against yellow fever. But for so many years we were not vaccinating our children against yellow fever, so many people in our communities do not have vaccination against yellow fever. So immediately the virus enters the population, what happens is that it just spread because there is no immunity. For if there was immunity people can survive the virus, but apart from the fact that people were for whatever reason not being vaccinated appropriately against yellow fever and other vaccine preventable diseases. It now happens that human activity is now pushing us to encroach on where animals live. So human interactions with wild animals like bush rats and monkeys are bringing us close to the virus.

“But we have campaigns against yellow fever that is why we had the recent campaign. We have been working with the NCDC and running campaigns against yellow fever. These are reactive campaigns, of course there are outbreaks, but we have to react to that. We have already planned this preventive package to go ahead of these outbreaks, so we have to carry out preventive campaign to ensure that people live above yellow fever, meningitis, measles disease.”

Chief Executive Officer of the NCDC, Dr. Chikwe Ihekweazu, told The Guardian: “In the year 2017, like never before, Nigeria was faced with several outbreaks – CSM, Lassa fever, Yellow fever, cholera and most recently monkeypox. There was definitely no quiet period for the NCDC – the national public health agency with the responsibility of preventing, detecting and responding to disease outbreaks. From one outbreak into another, this young agency continued to work to respond and protect the country, round the clock while at the same time strengthening its own capacity to effectively protect the health of Nigerians.”

Ihekweazu said the sheer number of deaths lost to CSM in 2017 strengthened NCDC’s resolve to improve its prevention and response capabilities, working with partners and stakeholders. “We knew then that the current state of affairs had to change, the existing procedures/protocols for detecting and reporting disease outbreaks at the state level were not working optimally.

The challenge that we faced also became clearer than ever, we are dependent on a workforce at the state and Local Government Area (LGA) level over whom we had no direct control,” he said.

Ihekweazu added: “Just as we begun to record a decline in the number of cases of meningitis, an outbreak of cholera hit some states in the country – spreading quickly… For the first time in the country, an oral cholera vaccination campaign was implemented in a joint effort led by the Borno State Government and the NPHCDA. A visit to Borno State including cholera treatment centres located mostly at Internally Displaced People (IDP) camps further highlighted the critical need for a stronger response and the strength of partnerships. Unlike the meningitis outbreak where we had a shaky start, we had held a cholera outbreak preparedness meeting with high priority states and stakeholders, developed a preparedness plan, begun an awareness campaign before the rainy season and proactively sent out letters of alerts and other communication with states. This definitely put us in a better position to respond to outbreaks. But, we knew that outbreak preparedness is not an event but a cycle.”

The epidemiologist said for each of these outbreaks, they set up an Emergency Operations Centre (EOC) that their teams worked round the clock- extra hours and often through the weekends. “We deployed Rapid Response Teams (RRT) who travelled at odd hours and over very long distances to better understand the situation and to support the states. Our communications lines were kept open and despite the challenges we faced, we published weekly situation reports. The prepositioning and distribution of medicines, personal protective equipment, consumables, laboratory reagents and other medical supplies to the different states across the country was also a key part of our work, to ensure preparedness and to support response activities,” he said.

Ihekweazu said the response to these outbreaks highlighted opportunities for improvements in the work NCDC does: from surveillance systems to laboratory architecture and other critical areas. He said in June 2017, Nigeria became one of 52 countries globally and the 15th in Africa to carry out a Joint External Evaluation (JEE) of its International Health Regulations (IHR 2005) capacities. The JEE process which is led by the World Health Organisation (WHO) and other external partners, using a peer-review mechanism, was coordinated by the NCDC Surveillance and Epidemiology Directorate which also serves as the IHR desk for the country.

Ihekweazu said this evaluation provided an opportunity for Nigeria as a country to identify the most urgent priorities and opportunities to strengthen the health security through a transparent process. “It also brought together several internal partners with joint responsibilities on health security matters. The output from the assessment will help stakeholders across the relevant roles in Nigeria to develop a plan, which prioritises activities needed for improving the country’s IHR capabilities as well as enhancing its health security. This is one of the NCDC’s top priorities and plans are underway for implementation,” he said.

Ihekweazu said operationalising the National Public Health Reference Laboratory (NPHRL) in Gaduwa, Abuja was a major focus of the new leadership of the NCDC and on the May 13, 2017, the first test was carried out at the NPHRL. “Currently, our national laboratory has the capacity to confirm monkeypox, meningitis, Avian influenza, cholera, Lassa fever, Yellow fever and is building its capacity to test for all other endemic prone diseases in Nigeria,” he said.

The epidemiologist said an Incident Coordination Centre (ICC) was established within the NCDC- this serves as the hub of alert and response operations combining information and communications technologies to inform decision-making for effective investigation and response activities. “We are constantly monitoring, detecting, responding and following up.

Ihekweazu added: “Our vision is to earn the confidence of Nigerians and the global community in our mandate to protect the health of all those living in Nigeria through timely surveillance and an effective response. We stand ready to take on this task, working in partnership with the Nigerian people, while assuring our resolve to strengthen our role and contribution towards improving public health in Nigeria.”


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Chikwe IhekweazuNCDC
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