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Lassa Surveillance & Ongoing Research in Nigeriaby

Elsie IloriTeam lead: Lassa Fever Technical Working Group

@Preparing for Lassa Vaccine Clinical Trials withTargeted Epidemiology Studies Workshop

8th November 2018Accra, Ghana

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• Surveillance structure introduced in 1988

• Evaluated and reviewed in 2000 with the introduction of the Integrated Disease Surveillance and Response (IDSR) strategy

• Surveillance activities include monitoring of 41 priority diseases, events and conditions in Nigeria

Disease Surveillance in Nigeria

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Data Collection Tools

• Case-based Form (IDSR 001A) : used for collecting data on each new case of a suspected outbreak/diseases for case based surveillance

• Lab Form (IDSR 001B): used for sample collection and sample test results

• Line-lists Form (IDSR 001C): used for listing some basic patient information, lab results, disease outcome during outbreaks

• IDSR Form 002 (weekly): used for capturing data on epidemic-prone diseases and lab confirmation on routine weekly basis

• IDSR form 003 (Monthly): used for capturing data on monthly basis

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Data Flow: Duration and Deadline

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Lassa Fever Surveillance (Past and Present)Variable Past Present

Data Flow

Thresholds

Data Collection/

investigation

Reporting

Lab Component

▪ Data flow structure defined but not well understood

▪ Structure of IDSR data flow in place for coordinated flow of data

▪ Significant engagement of the community

▪ Threshold not understood (probably due to little knowledge about the disease)

▪ Well-defined thresholds for use at the national and state level

▪ Data collection done from mostly traditional sources

▪ Little information on contact tracing and lab activities

▪ Data collection from all possible sources in all LGAs (Traditional and Non-traditional sources)

▪ Data from contact tracing, laboratories and treatment centres

▪ Real time data -- Case investigation forms SORMAS

▪ No formal situation reporting format

Structured format for reporting from the State, daily summary report during outbreak Weekly Sitreps developed for dissemination

nationwide via the NCDC website www.ncdc.gov.ng

▪ Two labs in the country testing for Lassa fever

▪ Four Lassa fever testing labs - quick TAT of 24 hours▪ Improved Lab surveillance i.e. reporting of results,

more involvement with the States▪ National sample transportation system in place

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VHF (Lassa fever) Case Investigation FormVIRAL HEMORRHAGIC FEVERS CASE INVESTIGATION FORM

Epid Number: 2. Reporting State:

Suspected VHF disease: Lassa fever Yellow fever Dengue Fever Ebola Rift Valley fever West Nile fever Chikungunya

Name of person notifying the disease:

Community Informant LGA DSNO Health facility I/C Others: Specify(with designation and name)

Patient Biodata:

Surname Other Names Date of birth (DD/MM/YYYY) Age (months or years) Years Months

Sex Male Female

Educational level No Formal Primary Secondary Tertiary

Permanent Residence Address (Describe with landmark e.g. near school, church, mosque, market)

Village/Town GPS Latitude/Longitude Ward/LGA/State E-mail address Phone Number Owner of Phone (Patient , Family member, friend, Others)

Occupation (Farmer, Butcher, Hunter/trader of game meat, Miner , Religious leader, Housewife ,Pupil/Student, Trader Artisan:, Transporter; type of transport, Civil Servant Healthcare worker; Traditional/spiritual healer, Unemployed)

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VHF (Lassa fever) Case Investigation Form…2

Status of Patient at detection: Alive: Alive & Pregnant Dead

dead : ate of death (DD/MM/YYYY) ace of Death

Mode of Burial ( Safe, Unsafe) nical History

set of Symptoms (DD/MM/YYYY) nset of Symptoms (If different from Permanent

facility/community Symptoms (Tick as appropriate)

Yes No Unknown Symptoms Yes No Unknow 13 Difficulty swallowing/ Sore throat ting/Nausea 14 Jaundice (yellow eyes/gums/skin) hea 15 Conjunctivitis (red eyes) se fatigue/general

ness 16 Pain behind eyes/sensitive to

light

exia/Loss of appetite 17 Hiccups minal pain 18 Skin rash pain 19 Coma/unconscious e pain 20 Confused or disoriented pain 21 Unexplained bleeding from any

site

ache a. Bleeding of the gums h b. Bleeding from injection site ulty breathing c. Nose bleeding (epistaxis)

Laboratory Yes No Unknown

ample collected 5 Name of Testing Laboratory sample was collected

M/YYYY) 6 Date sample received at the

laboratory (DD/MM/YYYY

sent to Laboratory M/YYYY)

7 Date result released from Lab (DD/MM/YYYY)

e of sample portation (hand delivery, , post

8 Result Positive Negative

Case Management

Yes No unknown Yes No Unknow ion: 5 Treatment with Ribavirin

of Isolation M/YYYY)

6 Date of commencement with Ribavirin (DD/MM/YYYY)

e of isolation Center 7 Is the patient being treated for other disease conditions?

erature at point of ion(Axillary, Oral, Anal)

8 If yes, list conditions and medications being used

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VHF (Lassa fever) Case Investigation Form….3 EMIOLOGICAL RISKS FACTORS OR EXPOSURES

Yes No Unknown Yes No Un

pitalized or attended a lth facility or visited one in the health lity in the last 3 weeks ore becoming sick:

4 Direct contact (hunt, touch, eat) with animals or uncooked meat:

a) Rodent or rodent feces/urine b) Bats or bat feces/urine c) Pigs d) Chickens or wild birds e) Cows, goats, or sheep f) Others specify

tact with a known or pect case, or with any person 3 weeks before ness:

5 Did the patient participate in burial (carry or touch body) in the last 3 weeks before sickness

ory of travel in the past eeks

6 Previous vaccination for Yellow fever

es where If yes Date of last vaccination

T OUTCOME INFORMATION

VHF Confirmed (Tick one only) Case classification (Tick one only)

1 Lassa fever 2 Yellow fever 3 Dengue fever 4 Ebola 5 Rift valley fever 6 West Nile fever 7 Chikungunya 8 No VHF isolated utcome

Alive Dead

If alive : Date of discharge (DD/MM/YYYY)

If dead : Date of death (DD/MM/YYYY)

Mode of Burial ( Safe, Unsafe)

REPORTING OFFICER

1 Confirmed 2 Probable 3 Discarded (Not a case)

Name Designation Phone Number E-mail address LGA State Signature Date (DD/MM/YYYY)

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State Lassa Fever Outbreak Situation Report templateHighlights

• Xxxx • Xxx • Xxx

Epi Summary

No. Description New(Daily) Reporting epi week xx (Monday-Sunday)

Cumulat (Jan till d

Cases Suspected cases 0 Lab-confirmed positive cases 0 Lab-confirmed positive cases in Health care

Worker(s) 0

Probable cases 0 Rumours under investigation 0 Number of confirmed cases on admission 0 Number of confirmed cases discharged 0 Number of deaths in confirmed cases 0 Number of deaths in Health care workers 0

Number of reported deaths in suspected cases

0

Contacts Contacts listed 0 Contacts seen 0 Contacts currently under follow up 0 Contacts symptomatic 0 Contacts confirmed positive 0 Contacts who completed 21 days follow up 0 Contacts lost to follow Up 0

Laboratory Number of specimen collected 0 Number of specimens tested negative 0 Number of pending laboratory samples 0

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State situation report template….2Summary of distribution of cases across LGA-template

S/N Name of LGA

No of confirmed cases

No of Negatives

No of Pending

Total case

Total Contacts not seen

Total contacts under follow up

Total Contacts who tested positive

Total contact to follo

Total

1. State Epicurve (Alive & deaths -confirmed cases only) 2. State Dot/choropleth Map (weekly) 3. High burden LGA specific Epi-curves (weekly) 4. Age sex distribution chart (weekly) 5. Table- Summary of samples/cases by state of residence (Edo state RRT only)

Pillar response summary

1. Coordination 2. Surveillance

a. Summary of contact tracing b. Summary of active case finding

3. Laboratory 4. Case management/IPC/Safe burial 5. Risk communication/Social mobilisation 6. Logistics

Challenges

Response activities

Planned activities for next day

Team Composition

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Active Case SearchACTIVE CASE SEARCH

STATE: ______________________ MONTH:_______________ EPI WEEK NO.:________

Name of Health Facility/ Community/Traditional Healer

LGA WARD Date of visit

No. of cases fulfilling ALERT LF case definition

No. deaths

No. of cases becoming SUSPECT LF case definition

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Lassa fever National Technical Working Group Pillars

• Coordination• Surveillance• Laboratory• Logistics• Case management• Infection Prevention and Control/Safe burial• Risk Communication• Data management• Research

MDAs• Ministry of Agriculture• Ministry of Environment

Partners• WHO, MSF, UNICEF, CDC, ALIMA, UMB, AFENET

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NIGERIA CENTRE FOR DISEASE CONTROL

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One Health - Environmental and Animal factors

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Weekly Sitreps developed and disseminated

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Guidelines disseminated to States and treatment Centres

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Situation Overview: Week 01 – 44, 20182950 Suspected cases

553 Confirmed cases

17 Probable cases

2380 Negative/ not cases of Lassa fever

143 Deaths in confirmed cases (Case Fatality Rate: 25.9%)

22 States have reported at least a confirmed case, 4 active states42 Health Care workers affected in seven states –Ebonyi (16), Edo (13),

Ondo (6), Kogi (2), Nasarawa (1), Taraba (1), and Abia (1) with 10deaths in Ebonyi (5), Kogi (1) Abia (1) Ondo (2) and Edo(1)

8587 Contacts identified nationally; 7946(94.0%) completed 21 days follow up 512 (6%) contacts currently being followed up and symptomatic positive 36(0.5%)

82% Confirmed cases are from Edo (46%), Ondo (23%), and Ebonyi (13%) states

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National Epicurve as at Week 44, 2018

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Trends of confirmed Lassa fever cases by 2016 to week 44/2018

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Confirmed Lassa Fever cases in Nigeria as at 4th November, 2018

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Confirmed cases with State specific CFR as at 4th November, 2018

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Challenges▪Some traditional and cultural practices propagate spread of the disease▪Some myths about the disease discourages disclosure ▪Stigmatization of affected persons/families▪Poor health seeking behavior▪Human resource▪Real time reporting – partial coverage▪Poor index of suspicion among HCWs▪Poor/inadequate documentation and archiving▪Poor coordination at sub national level (improved in states with PHEOC )

▪Limited knowledge about the disease

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Recommendations

▪Strengthen risk communication activities – involvement of anthropologists▪Increased sensitization on Lassa fever for all communities▪Capacity building for Health workers on Lassa fever management▪Implement real time (SORMAS) reporting across all LGAs and states▪Establishment of EOC in all states▪Research to provide answers to unanswered questions and increase knowledge about the disease

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Prevent right, Detect right and Treat right!Reduction of CFR to one digit percentage!

• Prevention - Risk communication, Vector and Environment (FMARD & FMoE) Infection Prevention and Control (Human to human)

• Detection - Laboratory, Surveillance and research• Treatment - Case management and research

Next step- National Strategic Plan for Lassa fever Control 2019 – 2023

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Lassa fever International Conference

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We are stronger together

Nigeria Centre for Disease Control

be a world-class, science based organisation with the competence to protect the Nigerian people from the threats from diseases of public health

importance

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THANK YOU!!!!

STATES