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Background• MontserradoCountyborderedbyBomi,Margibi andBongCounties:– 7healthdistricts:CentralMonrovia,Bushrod,SomaliaDrive,Commonwealth,St.Paul,Careysburg,Todee
– TotalPopulation=2,056,511– Under-fivepopulation=349,607
• FETPtraining(6weeksafterworkshop2)– Weeklysurveillancereports– Expandedsurveillancereport(Epi weeks31-42)– Measlesoutbreakinvestigation
ExpandedSurveillanceReportMontserradoCounty,Liberia, EPI
Week 31-422015
1. Summary2. Reportingquality3. Diseasereports
Summaryofsurveillancereport(Epi week31-42)
• IMRD:• 232suspectedMeaslescases(2death),• 292Acutewaterydiarrhea(AWD),• 342suspectedEVD(85death),• 4suspectedNeonataltetanus(2death),• 5suspectedMeningitis,• 33suspectedHumanrabies,• 28suspectedBloodydiarrhea,• 1suspectedYellowfever,• 4AFP
Summary
• Nosilentdistricts• EVD– Alltested,noneconfirmed
• Publichealthactions– IDSRtrainings– MeaslesOutbreakinvestigationsandmassimmunizations
– AFPcaseinvestigation
Graphshowingcumulativetimelinessandcompletenessofdistrictreports,MontserradoCounty
Liberia,EpiWk31to42,2015
0%
20%
40%
60%
80%
100%
120%
Districts
Timeliness
Complteness
Commentonreportingquality
• DSOscomplainedofdelayingettingreportsfromhealthfacilities.
• ActionTaken:DSOswereverballywarnedtoimprovetheirreportingmechanism,adhereto6pmdeadlineSundays.
Diseasereport,MontserradoCountyDisease Cumulative:Week31– 42,2015
Cases Deaths Case Fatality RateCFR
Acute Flaccid Paralysis(AFP)
4 0 0%
Suspected Yellow Fever 1 0 0%Suspected Lassa Fever 0 0 0%Neonatal Tetanus 4 2 50%Suspected Cholera 0 0 0%AcuteWatery Diarrhea 300 0 0%SuspectedMeningitis 5 0 0%SuspectedMeasles 232 2 0.9%Bloody Diarrhea 28 0 0%Suspected Human Rabies 34 0 0%Suspected VHF/EVD 342 85 25%NeonatalDeathMaternal Death
Publichealthaction
• WaterandSanitationhealtheducation• Chlorinationofwells• Minimeaslesimmunizationcampaigns• IPCtrainingforhealthfacilitiesstaff• IDSRtrainingforsupervisorsandsurveillancefocalpersons.
• Safeburial,swapandbloodsamplecollectionforsuspectedEVDareongoing.
PublicHealthAction:• OutbreakinvestigationinCentralMonrovia,
SomaliaDriveandCareysburgdistrictsWK33-36(55cases3confirmed).Miniimmunizationcampaignimplementedinaffectedcommunities
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wk31 wk32wk33wk34 wk35 wk36 wk37 wk38 wk39 wk40 wk41 wk42
Numbe
rofCases
Epiweeks
ThetrendofSuspectedmeaslescasesanddeathsinMontserradoCountyLiberia,EpiWk31to422015
Cases
Death
Introduction• Measles - air-borneinfectioncausedbyavirus,usuallyaffectschildren
• Symptoms:fever,rashwithrunningnose,redeyesorcough.
• Transmission:coughing,sneezing,andcontactwithsalivaandnasalsecretionperson.
• Complications:pneumonia,ottitismedia,blindness,death
• Prevention:Immunization• Treatment:Supportivedueitsvirusnature
Introduction…….cont’d• Epiweek33;receivedRumorofmeaslesoutbreakinzone900
• Teamwasconstitutedtoinvestigate• Objectives– Toconfirmtheoutbreak– Todeterminethecause,– Todescribebyperson,placeandtime,– Totakepublichealthactionsforcontrol
Method…..cont’d
• Todeterminethecause:– Interviewedcommunitymembers,– Reviewedvaccinationcards
• Todescribetheoutbreak:– Activecasesearch,linelistedsuspectedcases– Analyed byproportions
• Toconfirmtheoutbreak:– collected5bloodsamplesforanalysis
• Tocontroltheoutbreak– Isolated15Suspectedcaseswithfeverandrash– Immunizedtargetpopulationunderfiveatrisk
Results• FromEpiwk31,gradualriseinsuspectedmeaslescases,fromCentralMonroviaDistrict
• Isolated15casesline-listed– 6maleand9female,allagedunder5years.– Only3outof15hadwerevaccinatedinrecentcampaign
– 5Bloodsamplescollected,oneconfirmed• LackofGOLhealthfacilityinZone900• Miniimmunizationwasconducted– Target:4561childrenunder5,Oldroadcommunity– 3375childrenwereimmunized(74%coverage)
Result……cont’d
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wk31 wk32 wk33 wk34 wk35 wk36 wk37 wk38 wk39 wk40
Dateofonset(Epi Weeks)
EpicurveofmeaslesinCentralMonroviaDistrictMontserradoCounty,LiberiaWk31-40,2015
Cases
Discussion• ThemeaslesoutbreakinZone900Oldroadwascausedby– lowimmunizationcoverage,– lackofpublichealthfacility– fearofmotherstocarrytheirchildrenforvaccinationNIDSMarch2015
– mothersignorantaboutroutineimmunizationforchildren.
Recommendations
• ThattheMinistryofHealthbuildapublichealthfacility inzone900Oldtoenhancewiderroutineimmunizationcoverageofchildrenunderfiveyears.
• ThatcommunitysensitizationonroutineimmunizationforchildrenunderfivebeimplementedbyCentralMonroviaDistrictHealthTeam