1. Liberia Field Epidemiology Training Programme (LFETP)Liberia Field Epidemiology Training Programme LFETP) Report on Basic FETP Field Project 2 By Ruth Q. Tomah Cooper, DSO, Central Monrovia District Nov 3, 2015

2. Liberia Field Epidemiology Training Programme (LFETP) Acknowledgement Ministry of Health Faculty of Liberia FETP (my mentors Stephen, Dr Maame) CDC Emory University AFENET WHO My husband and children

3. Liberia Field Epidemiology Training Programme (LFETP) Introduction Central Monrovia District is found in Monrovia, Montserrado County – Population: 50,394 – 5 zones, 48 health facilities Fieldwork – Expanded surveillance(Epi weeks 31-42) – Suspected Measles outbreak investigation

4. Liberia Field Epidemiology Training Programme (LFETP)Liberia Field Epidemiology Training Programme LFETP) Expanded surveillance report weeks 31 – 42, 2015

5. Liberia Field Epidemiology Training Programme (LFETP) Summary Immediately reportable Diseases and conditions: 234 One hundred and seventeen (117) suspected measles, 2 confirmed ; 84 AWD; Diarrhea with Blood 15 cases; Meningitis 2 cases; Human Rabies (dog bite) 2 cases; suspected Yellow Fever 1 case; Neonatal death 2 cases Eleven suspected EVD cases; all tested negative, no death 48 functional H/Facilities, 1silent (under renovation)

6. Liberia Field Epidemiology Training Programme (LFETP) Timeliness and Completeness of Weekly Surveillance Reporting,Central Monrovia District, Epi Week 31-42, 2015 NoZones % Cumulative timeliness % Cumulative completeness 1.500 8365 2.700 8373 3.800 10086 4.900 9181 5.1000 10090 T ON Time L Late NR No report % Cumulative >80% On Time >50% to 80% On Time < 50 % On Time Legend

7. Liberia Field Epidemiology Training Programme (LFETP)

8. Comments Reasons for late and incomplete reporting 43 facilities are private; hard to deal with Refusal to submit reports to ZSOs Prefer ZSO on site to do their reports for them Actions taken: DSO engaged OICs and surveillance focal persons on need for reporting on Time. Defaulting facilities received letters from the county for co-operation

9. Liberia Field Epidemiology Training Programme (LFETP) DISEASESCUMULATIVE WEEK 31-42 CASESDEATHCASE FATALITY RATE (%) Acute Flaccid Paralysis (AFP) 000 Ebola(EVD)suspected 1100 Acute Watery Diarrhea AWD 8400 Human Rabies 200 Lassa Fever 000 Yellow fever, suspected 100 Cholera, suspected or confirmed 000 Neonatal tetanus 000 Neonatal Death 2 Diarrhea with blood (Shigella) 1500 Maternal death 0 0 Measles, suspected or confirmed 11700 Meningococcal meningitis 200 Unexplained Cluster of Death 000 Unexplained Cluster of Health Events 000 Key Notifiable Diseases and Conditions EPI Week 31-42, 2015, Central Monrovia District

10. Liberia Field Epidemiology Training Programme (LFETP)

11. Comments Samples were not taken at the health facilities All cases were treated and discharged (No Death)

12. Liberia Field Epidemiology Training Programme (LFETP) Trend of Suspected Measles Cases, Epi Week 31-42, 2015, Central Monrovia District

13. Liberia Field Epidemiology Training Programme (LFETP) Comments A suspected outbreak occurred from week 34 up to now Outbreak investigation was done (2 nd field project)

14. Liberia Field Epidemiology Training Programme (LFETP) Public Health Actions The Response Team conducted suspected measles outbreak investigation Free treatment and measles vaccinations campaign was done Health education on priority diseases and events was done Training on Timeliness of reporting and immediate disease notification Training for suspected measles and suspected EVD specimen collection

15. Liberia Field Epidemiology Training Programme (LFETP) MEASLES OUTBREAK INVESTIGATION

16. Liberia Field Epidemiology Training Programme (LFETP) Measles Viral disease which commonly affects children under 5 years Spreads through droplet infection Usually fatal, especially in malnourished children Incubation period of 10-12 days Presents as high grade fever with generalized rash and coryza, cough or red conjunctive (red eyes) Measles can be prevented by vaccination In Liberia, measles vaccine is routinely administered at 9 months of age

17. Liberia Field Epidemiology Training Programme (LFETP) Background On 16 August 2015, the DHT was alerted by dispatch 1 about 3 suspected measles cases The DHT constituted a team to investigate the suspected outbreak Objectives of the investigation: –To confirm the outbreak –To describe the outbreak in person, place and time –To know the cause of the outbreak. –To control the outbreak

18. Liberia Field Epidemiology Training Programme (LFETP) Methods Review of facility records and vaccination Cards of the children Active Case Search: Case definition used Line-listing of suspected measles cases Interviewed parents of affected children Environmental observation Laboratory testing of cases

19. Liberia Field Epidemiology Training Programme (LFETP) Spot Map

20. Liberia Field Epidemiology Training Programme (LFETP) Results There were 16 cases By sex, 37.5% female and 62.5% male one of five blood specimen was positive for measles By vaccinations status,81% of cases have never received measles immunization (see table below)

21. Liberia Field Epidemiology Training Programme (LFETP)

22. Measles Outbreak Epicurve, Rock Spring Valley, August 2015, Zone 1000

23. Liberia Field Epidemiology Training Programme (LFETP) Discussion A confirmed measles outbreak Mainly affected children under < 5 years 81% of affected children were not vaccinated Outbreak not subsided yet Possible reason of the outbreak –Close contact among children living areas –Low measles vaccination coverage

24. Liberia Field Epidemiology Training Programme (LFETP) Public Health Action Public education and mass vaccination was conducted Public education on signs and symptoms, means of transmission and prevention. A proposal was made for mass vaccination A proposal was made for free treatment

25. Liberia Field Epidemiology Training Programme (LFETP) Recommendations FETP Training for this class should be taken to the next level Setting up criteria for hard to deal with facilities (Private and Big Hospitals), by County or National Transportation and scratch cards provided on time for ZSOs