1. Liberia Field Epidemiology Training Programme (LFETP)Liberia Field Epidemiology Training Programme LFETP) FETP Field Work 2 Presentation River Cess County Presented By : Lawrence Z. Larway Cohort 1 Trainee

2. Liberia Field Epidemiology Training Programme (LFETP) Acknowledgement The Almighty God MOH/RCHT CDC WHO EMORY UNIVERSITY Dr. Justin Maeda Dr. Peter

3. Liberia Field Epidemiology Training Programme (LFETP)Liberia Field Epidemiology Training Programme LFETP) Expanded Weekly Surveillance Summary Report & Outbreak investigation 3

4. Liberia Field Epidemiology Training Programme (LFETP) Background of River Cess County Rivercess County gained it status as a County in 1985 Located in the South Eastern part (region 4) of Liberia Bounded on the East by Sinoe, West by Ground Bassa, North by Nimba and Ground Geedeh, and South by the Atlantic Ocean Has a population of 82,714 The County has (6) health districts and 19 health facilities presently and all are functional

5. Liberia Field Epidemiology Training Programme (LFETP) Timeliness of Reporting, Week 31-42, 2015, River Cess County DistrictsWk 31 Wk 32 Wk 33 Wk 34 Wk 35 Wk 36 Wk 37 Wk 38 Wk 39 Wk 40 Wk 41 This wee k cumuli tive TimboTTTTTLTTLTTT81.8% Jo-riverTTTTTTTLTTTL72.7% Central CTLTTTTTTTTTL90.9% JoweinTLTTTTLLTLLT54.5% DodainTTTLTTTLLTTT72.7% YarneeTLTNRLTLTLTTT54.5% T ON Time L Late NR No report % Cumulative >80% On Time >50% to 80% On Time < 50 % On Time Legend

6. Liberia Field Epidemiology Training Programme (LFETP) Summary of Key Priority Diseases, Week 31-42, 2015, River Cess County Diseases Current Week: 42Cumulative: Week 31-42 CasesDeaths Case Fatality Rate CasesDeaths Case Fatality Rate Acute Flaccid Paralysis (AFP) 0 0 0 00 0 EVD 63 1 1.5% 251 13 5.2% Lassa Fever 0 0 0 0 0 0 Cholera, suspected or confirmed 0 0 0 0 0 0 Acute watery diarrhea 18 0 0 111 0 0 Diarrhoea with blood (Shigella) 0 0 0 0 0 0 Maternal death 0 1 0 0 0 0 Measles, suspected or confirmed 6 1 16.6% 8 1 12.5% Meningococcal meningitis 0 0 0 0 0 0 Neonatal tetanus 0 0 0 0 0 0 Neonatal Death 0 1 0 0 0 0 Yellow fever, suspected or confirmed 0 0 0 0 0 0

7. Liberia Field Epidemiology Training Programme (LFETP) Timeliness of Reporting, Week 31- 42, 2015 River Cess County

8. Liberia Field Epidemiology Training Programme (LFETP) Comment Central C district had highest timeliness of reporting, followed by Timbo and Jo- river Jowein and yarnee districts are the least in timeliness of reporting – The delay is due to poor network coverage We encourage them to make use of the base radio

9. Liberia Field Epidemiology Training Programme (LFETP) Trend of EVD cases and deaths, Week 31 to 41, 2015, River Cess County

10. Liberia Field Epidemiology Training Programme (LFETP) Cases of EVD and AWD Week 31-42, 2015, River Cess County

11. Liberia Field Epidemiology Training Programme (LFETP)Liberia Field Epidemiology Training Programme LFETP) Measles Outbreak Investigation, Solo village, River Cess County 11

12. Liberia Field Epidemiology Training Programme (LFETP) Introduction Measles is a very contagious disease A priority diseases in Liberia IDSR Since January, 2015 Liberia has been undergoing measles outbreak in various counties River Cess accounted for 24 cases On 28th September 2015, the officer in charge (OIC) informed of two suspected cases of measles from Solo village

13. Liberia Field Epidemiology Training Programme (LFETP) Method 1/2 Study Area – Solo village has a total population of 729 Case definition – measles as any person with fever and maculo papular or generalized rash, cough, coryza or conjunctivitis or any person in whom a clinician suspects measles from solo village and it surrounding from September 1 to 30, 2015

14. Liberia Field Epidemiology Training Programme (LFETP) Methods 2/2  Investigation team was formed  One on one interview was conducted  We collected specimen  Active case search was done

15. Liberia Field Epidemiology Training Programme (LFETP) Methods cont.  We conducted community sensitization meeting with t  The County Health Team (CHT) and partners conducted a four days selective measles campaign in solo village and it surrounding.  We Conducted a follow up visit  We evaluated the immunization status of the people and the trend of the disease.

16. Liberia Field Epidemiology Training Programme (LFETP) Result Five ( 83.3%) of the cases were female Case fertility rate is 16.6% 50% of the cases were under five and above 50%. Case attack rate was 82 per 10,000 populations The index case was connected with the measles outbreak in Ground Bassa County – There was outbreak of measles in compound four Ground Bassa county during the same period

17. Liberia Field Epidemiology Training Programme (LFETP) Epicurve of Measles Outbreak, Solo village, September 2015

18. Liberia Field Epidemiology Training Programme (LFETP) Discussion / conclusion The investigation report shows that the case fertility rate was high more female were affected than male Notification by gCHVs in the community was delayed The investigation team’s response was prompt and effective The selective mass measles campaign was effective There were no new case seen during the follow up visit

19. Liberia Field Epidemiology Training Programme (LFETP) Recommendation I recommend that:: The FETP Program be extended to master level More time be allocated for theoretical part of the program All DSO in Liberia be trained in FETP