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

Implementation of the world health organization regional office for africa stepwise laboratory quality improvement process towards accreditation

Background: The increase in disease burden has continued to weigh upon health systems in Africa. The role of the laboratory has become increasingly critical in the improvement of health for diagnosis; management and treatment of diseases. In response; the World Health Organization Regional Office for Africa (WHO AFRO) and its partners created the WHO AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) program.SLIPTA implementation process: WHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1-5 stars were issued. Preliminary results: By March 2015; 27 of the 47 (57%) WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries; competent in the Portuguese (3); French (12) and eng (83) languages; were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62-77). Of these audited laboratories; 70% achieved 55% compliance or higher (2 or more stars) and 1% scored at least 95% (5 stars). The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit) and 10 (Corrective Action); which both had mean scores below 50%.Conclusion: The WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment; ownership and investment in continuous quality improvement are integral components of the process

Strengthening public health laboratories in the WHO African Region: a critical need for disease control

Despite the progress and efforts being made to strengthen laboratory capacities in the Region; challenges remain. The purpose of this document is to raise awareness on the need to strengthen public health laboratory services and propose actions for building national laboratory capacity

Implementation of the International Health Regulations (2005) in the African Region

The International Health Regulations (IRH; 2005) are a legally binding international instrument for preventing and controlling the spread of diseases internationally while avoiding unnecessary interference with international travel and trade. Under the IHRs that were adopted on 23 May 2005 and entered into force on 15 June 2007; Member States have agreed to comply with the rules therein in order to contribute to regional and international public health security. Obligations also include the establishment of IHR National Focal Points (NFP) defined as a national centre designated by each Member State; and accessible at all times for communication with WHO IHR Contact Points. Furthermore; Member States were requested to designate experts for the IHR roster; enact appropriate legal and administrative instruments and mobilize resources through collaboration and partnership building. The Fifty-sixth session of the WHO Regional Committee for Africa called for the implementation of the IHR in the context of the regional Integrated Disease Surveillance and Response (IDSR) strategy considering the commonalities and synergies between IHR (2005) and the IDSR. They both aim at preventing and responding to public health threats and/or events of national and international concern. This document discusses the issues and challenges and proposes actions that Member States should take to ensure the required IHR core capacities are acquired in the WHO African Region

Laboratory Capacity in 2012 for Diagnosis of Epidemic Prone Diseases in the Context of Integrated Disease Surveillance and Response in the WHO African Region

This paper provides the status of laboratory capacity for diagnosis of epidemic prone diseases in the context of Integrated Disease Surveillance and Response (IDSR) in 46 countries in the WHO African Region as of end of 2012 through self-assessment questionnaires. The findings from this assessment revealed that 98 (45/46) of the countries have the capacity for isolation; identification and antimicrobial susceptibility testing of common bacterial causes of enteric diseases and meningitis in the Region. Forty three countries performed standard enzyme-linked immunosorbent assay (ELISA) for confirming suspected cases of pathogens such as Morbillivirus responsible of measles through the detection of specific immunoglobulin M (IgM) and 30 countries had at least polymerase chain reaction (PCR) capacity for detection of influenza viruses. However; the number of countries with an appropriate department of virology providing comprehensive diagnostic services is still limited especially for dangerous viral pathogens requiring high-level containment facilities. The collection and analysis of critical information on the existing diagnostic capacity were used to propose key recommendations for strengthening the laboratory confirmation of outbreaks in line with the IDSR Strategy and the International Health Regulations (IHR; 2005). The proposed key actions were focused in the following areas: high-level advocacy for country ownership; human resource development; laboratory space and equipment; quality assurance and laboratory networking