1. Liberia Field Epidemiology Training Programme (LFETP)Liberia Field Epidemiology Training Programme LFETP) FIELD WORK 2 -Expanded Surveillance Report- -Case Investigation Report- Benjamin Gbuah County Surveillance Officer River Gee County 1

2. Liberia Field Epidemiology Training Programme (LFETP) 2 Expanded Surveillance Report

3. Liberia Field Epidemiology Training Programme (LFETP) Introduction River Gee County; – located in south eastern Liberia – Six health districts and nineteen health facilities. – Ninety-two general community health volunteers – Inhabitants: 77, 248 Immediately reportable diseases (Week 31-42): – Total Suspected cases: 275 – Total Deaths: 20

4. Liberia Field Epidemiology Training Programme (LFETP) Summary All suspected cases of EVD identified between week 31 – 42 were all negative and classified as non- cases. Zero reporting requirements was met by all reporting districts. Five (5) of six suspected measles cases were negative; one result that is still pending. 4

5. Liberia Field Epidemiology Training Programme (LFETP) 5 Fig 1: Timeliness and completeness of reporting by district, River Gee County, 2015 Districts Before FETP (Week 19-30) After FETP (Week 31 – 42) YTD (Week 1 – 42) % Timeliness % Completeness % Timeliness % Completeness % YTD Timeliness % YTD Completeness Chedepo7592100 8395 Tienpo831009210090100 Gbeapo100 97100 Potupo8392100 9095 Sarbo83100831008097 Webbo83100 8592 Means8597961008897 Legend % Cumulative >=80% on time/Complete>=50-79.9% on time/Complete<50% on time/Complete

6. Liberia Field Epidemiology Training Programme (LFETP) All cases are suspected cases C = Cases; D = Deaths; CFR = Case Fatality Rate; Fig 2:Table of reported key notifiable diseases, River Gee County, 2015

7. Liberia Field Epidemiology Training Programme (LFETP) Suspected cases of EVD and deaths in River Gee County, Week31-42, 2015

8. Liberia Field Epidemiology Training Programme (LFETP) Suspected cases of Measles in River Gee county, week 31-42, 2015

9. Liberia Field Epidemiology Training Programme (LFETP) Activities carried out between week 31-42 Suspected measles case investigated in Tienpo district. Investigation of suspected human rabies and maternal death IDSR roll out training conducted for health facilities staff. Two surveillance review meetings held with partners. Routine surveillance supervision was done in all nineteen health facilities.

10. Liberia Field Epidemiology Training Programme (LFETP) 10 Measles Case Investigation

11. Liberia Field Epidemiology Training Programme (LFETP) Measles is a highly contagious disease caused by the measles virus It is one of the leading cause of death among under-five children globally One of immediately reportable diseases in Liberia 11 Introduction 1/2

12. Liberia Field Epidemiology Training Programme (LFETP) Introduction 2/2 12 16-Sep-15 A suspected case of measles of a 2 year old female was reported by a general community health volunteer (gCHV) to the officer in charge (OIC) of cheboken clinic 16-Sep-15 9:15am OIC reported to DHO 16-Sep-15 11:05am DHO reported to CSO 16-Sep-15 2:45pm CSO reported to MoH/DPC 17-Sep-15 Investigation Started Objectives: confirm infection; determining the source of the infection; preventive and control measure to avoid the spread of the disease.

13. Liberia Field Epidemiology Training Programme (LFETP) Methods 1/2 Review of medical records of suspected case Collected blood specimen for lab. confirmation Interviewed guardian of the patient and assessed the travel history of the patient An active case search in the community to identify any additional cases Made recommendation for possible actions based on findings

14. Liberia Field Epidemiology Training Programme (LFETP) Methods 2/2 A case was defined as a resident of cheboken town with generalized rash and fever plus one of the following cough, coryza (running nose) or conjunctivitis (red eyes) from September 04, to September 28 2015. The IDSR generic case base form was used to collect the patient information. 14 Case Definition

15. Liberia Field Epidemiology Training Programme (LFETP) Results 1/2 Patient met case definition for suspected Measles Child was not vaccinated against measles History: – Resident in Monrovia: – Visited cheboken for holidays : September 6, 2015 – Date of Onset: September 13, 2015 Additional information: Was in contact will children with similar symptoms in Monrovia before coming to Cheboken. 15

16. Liberia Field Epidemiology Training Programme (LFETP) Results 2/2 No additional cases were identified from the active case search. The child isolated and contacts followed up for 12 days All contacts were vaccinated against measles Suspected case was treated with vitamin-A, calamine lotion and tetracycline eye ointment. 16

17. Liberia Field Epidemiology Training Programme (LFETP) Discussion 1/2 Measles was identified in cheboken town in River Gee County Probable source of infection is Monrovia Isolation of case and vaccinated contacts contributed to the control of the spread of the infection. The case was followed through visits and showed a positive response to treatment.

18. Liberia Field Epidemiology Training Programme (LFETP) Discussion 2/2 Recommendation Measles vaccination outreach should be conducted in the communities and its surrounding towns Public Health Action Following our recommendation, children under five in the community and its surrounding towns who have not yet been vaccinated were vaccinated against measles after parental consent has been given.

19. Liberia Field Epidemiology Training Programme (LFETP) Acknowledgement Field Epidemiology Training Programme, Liberia Ministry of Health, Liberia Emory University World Health Organization Centers for Disease Control and Prevention World Health Organization My Mentors – Justin and Joseph 19