Strengthening healthcare workforce capacity during and post Ebola outbreaks in Liberia : an innovative and effective approach to epidemic preparedness and response

Introduction: the 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017.Methods: data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained.Results: the ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events.Conclusion: no infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings

Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017

Introduction: measles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia.Methods: we conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017.Results: from January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown.Conclusion: revitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible

Rapid response to meningococcal disease cluster in Foya district, Lofa County, Liberia January to February 2018

Introduction: early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods: the county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis.Results: sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered.Conclusion: this cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis

Polio Eradication in the African Region: Progress and Way Forward

In 2012 the declaration of global polio eradication as a programmatic emergency for public health targets resulted in the setting of objectives and a schedule for eradication. Innovative approaches were taken to address the polio situation in the African Region. Supplementary immunization activities; planning; monitoring and surveillance have all been stepped up; and technological advances such as GPS and the use of polio dashboards to monitor key performance data have been employed. Key priority countries (Angola; Chad; Democratic Republic of the Congo; Nigeria) and communities (including nomadic groups) have been targeted.Great progress has been documented; for example routine immunization has risen from less than10 in 1980 to 77 in 2013. However; there are still some challenges to overcome; notably wild poliovirus outbreaks and three remaining foci of transmission - Nigeria; the Central Africa subregion and the Horn of Africa. This article charts the steps taken and the continuing action needed to realise the aim of polio eradication

Overview of the WHO Polio Laboratory Network in the African Region

The Polio Laboratory Network has always played a critical role in diagnosing poliovirus disease (poliomyelitis) and the detection of poliovirus transmission. In the new millennium; the strength of the laboratory network is often a direct reflection of the success of the Polio Eradication Initiative (PEI) programme. The network has taken advantage of new technologies that provide speedy turnaround times for results reporting thus contributing to the success of the PEI programme. This article presents a brief overview of the work of the network

Immunization Monitoring and Vaccine-Preventable Diseases Surveillance Data Management in the African Region

Countries in the WHO African Regionhave well-established national immunization programmes and disease control programmes working towards the different goals for the control of vaccine-preventable diseases; and generating coverage and surveillance data. WHO provides technical support to standardize the approaches; methodology; and tools used for data management. The datasets are shared with WHO for purposes of monitoring the coverage and disease trends across the Region. This article reviews the methods WHO employs to build capacity in this field of data management across the Region and the resultant achievements and gaps. Despite the recent improvements in some aspects of data quality; important policy; technical and managerial gaps remain; which need to be addressed in order to ensure that the data coming out of these national programmes are of optimal quality

Role of Operational Research in Accelerating Progress towards Attainment of Poliomyelitis Targets in the African Region

The Polio Eradication Initiative (PEI) has made significant progress towards attaining the poliomyelitis targets in the African Region and research; among other activities; has played a critical role. An overview of the contribution of a select few operational research (OR) activities undertaken is given in this article. These mainly concern social research targeted at understanding and changing behaviour to enhance effective intervention uptake. Lessons learned from this research for the planning and implementation of interventions are also discussed