1. Liberia Field Epidemiology Training Programme (LFETP)Liberia Field Epidemiology Training Programme LFETP) FIELD WORK 2 -Expanded Surveillance Report- -Measles Outbreak Investigation- Emmanuel D. Dweh County Surveillance Officer Bong County

2. Liberia Field Epidemiology Training Programme (LFETP) Introduction  Bong County o Location: Central region of Liberia o Population: 377,000 o International border: Republic of Guinea o The county has 8 health districts, 43 peripheral health facilities and three referral hospitals  Reporting flow begins from community to health facilities, district, county and to national level 2

3. Liberia Field Epidemiology Training Programme (LFETP) Reported Key Notifiable Diseases, Bong County, 2015 3 Summary of reported key notifiable diseases, Bong County, 2015 DISEASE WEEK 31-42 CUMMULATIVE -YTD CDCFRCD AFP000%00 AWD700%1600% BLOODY DIARRHEA000%00 CHOLERA000%00 MEASLES15 (s)00%11421.7% LASSA FEVER2 (s)00%5240% RABIES2 (s)00%90 YELLOW FEVER000%00 EBOLA VIRUS DISEASE657 (s)6911%109219818% NEONATAL TETANUS000%11100% OTHER VHF000%00 MATERNAL DEATH400%2200% NEONATAL DEATH000%1300% C = Cases; D = Deaths; CFR = Case Fatality Rate; S = Suspected Case

4. Liberia Field Epidemiology Training Programme (LFETP) Distribution of key notifiable diseases by districts, Bong county week 31-42, 2015 DISTRICTS EVD MEASLES AWD LASSA FEVER RABIES Cumulative Cases &Death CDCDCDCDCDCD FUAMAH66800300000698 SALALA66300000000 3 SANOYEA33200000000 2 SUAKOKO164294000201017129 KOKOYAH33200000000 2 PANTAKPAI98410000000994 ZOTA66000400000700 JORQUELLIE1312110000001014221 TOTAL6576915070202068369 4 KEY: EVD=Ebola virus disease AWD=ACUTE WATERY DIARRHEA MM=MATERNAL MORTALITY C=CASES D=DEATHS

5. Liberia Field Epidemiology Training Programme (LFETP) Timeliness and completeness of reporting by district, Bong County week 31-42, 2015 5

6. Liberia Field Epidemiology Training Programme (LFETP) Trend of suspected cases of measles, Bong County, Epi week 31-42, 2015 6

7. Liberia Field Epidemiology Training Programme (LFETP) Trend of suspected cases of Lassa fever, Bong County, Epi week 31- 42, 2015 7

8. Liberia Field Epidemiology Training Programme (LFETP)  Outbreak investigation was conducted in jorquellie district  Supervisory visits were made to Jorquellie, Kokoyah and Fu amah districts as follow up visit for late reporting  Feedbacks were provided to the district every week on timeliness and completeness of reporting  Community engagement was intensified as a strategy to encourage parents to immunize their children Activities carried out between week 31-42 8

9. Liberia Field Epidemiology Training Programme (LFETP) 9 Outbreak investigation Report Measles outbreak

10. Liberia Field Epidemiology Training Programme (LFETP) Introduction 1/2  Measles is targeted for elimination by World Health Organization (WHO)  Bong County has recorded a total of 114 suspected and 3 confirmed cases in 2015.  The last outbreak of measles in Bong County occurred March 2015, with 66 suspected cases and 2 deaths (CFR = 3.0%) 10

11. Liberia Field Epidemiology Training Programme (LFETP) Introduction 2/2  From 28 th September 2015 - 4 th October2015 o Five suspected cases of measles o Jorquelleh district  A outbreak investigation was conducted; o verify the outbreak o control the outbreak o make recommendations 11

12. Liberia Field Epidemiology Training Programme (LFETP) Methods 1/2  We reviewed medical records at the facility and interviewed parents of affected children  Conducted active case search in affected communities o Case definition: A case was any person who presented with fever and maculopapular rash and cough, runny nose (coryza) or conjunctivitis or any person in whom the clinician suspect measles in Jorquelleh district within the period of 17 th August, 2015 to 18 th October, 2015)  Specimen was collected for laboratory confirmation. 12

13. Liberia Field Epidemiology Training Programme (LFETP) Methods 2/2  Contacts of cases were followed up for possible transmission of the disease  We assessed timeliness of reporting by the facility and the vaccination status of the cases  Public health action based on findings  We analyzed our data using excel 13

14. Liberia Field Epidemiology Training Programme (LFETP)  Ten cases identified (Age: 9mths – 14 yrs.)  Females affected: 6 cases (60%)  Attack rate: 4 cases per 10,000 population  Non of the cases had received measles vaccine o Traditional beliefs  Index case:2 year old seen at facility on 4 th of September, 2015 with fever & rash.  Delay in reporting (batch reporting of 1 st 5 cases ) Results 14

15. Liberia Field Epidemiology Training Programme (LFETP) Epidemic curve: measles outbreak, Jorquellie district, date of onset, 2015 15

16. Liberia Field Epidemiology Training Programme (LFETP) Discussion  An outbreak of measles occurred in Jorquelleh district  Contributing factors: o Low immunization coverage in the district o Misbelief about immunization o Late reporting of index case  No mop up vaccination was conducted in the urban communities of Gbarnga City to find and vaccinate children who were missed. 16

17. Liberia Field Epidemiology Training Programme (LFETP)  The county Health Team  routine measles immunization in communities with low vaccination coverage  reinforce and intensify community engagement activities; o To improve timely reporting o Overcome misbelief  Community health education on measles Recommendation 17

18. Liberia Field Epidemiology Training Programme (LFETP)  Community meeting and health education held with local leaders in the affected communities –strategy to improve immunization coverage and timeliness of reporting  Multi Antigen Catch-up Immunization Campaign(MACUIC) has been suggested by health facilities and proposal submitted for review and approval by CHO Public Health Action 18

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