Presentation On Projects 1 & 2 Basic FETP, Liberia PREPARED BY ISAAC B. COLE COHORT I TRAINEE COUNTY SURVEILLANCE OFFICER NIMBA COUNTY

ACKNOWLEDGMENT I will like to acknowledge: –Ministry of Health, Liberia –AFENET –Emory University –CDC. –WHO –My mentors (Justin and Peter)

SUMMARY During the weeks under review the following immediately reportable diseases, conditions and events was: Acute Flaccid Paralysis (AFP) …………………3 Suspected Measles …………………………… 25 Maternal Mortality ……………………………… 2 Neonatal Mortality ……………………………… 1 Suspected EVD ………………………………. 1,351 Acute Watery Diarrhea ……………………….. 782

Figure 1:- Timeliness of Reporting, Week 31-42, Nimba County District WEEK 31 WEEK 32 WEEK 33 WEEK 34 WEEK 35 WEEK 36 WEEK 37 WEEK 38 WEEK 39 WEEK 40 WEE K 41 WEEK 42 % of cum. Week Gbehlay- GehTTTTTTTTTTTT 100 % Sanniquelli e-MahTTTTTTTTTTTT 100 % TappitaLLLLLLLLLLLL 72% Yarwin Mehnsoon ohLLLLTTTLLTLL 79% Zoe-GehLLLLLLLLLLLL 70% Saclepea- MahTTTTTTTTTTTT 100 % The weeksOn Time TLate LNo report received NR % Cumulative ≥80% on Time ≥ % on Time ≤50% on Time Legend

Figure 2: Immediate Reportable Diseases, Weeks , 2015, Nimba County DISEASES CasesDeathCFR Acute Flaccid Paralysis (AFP) 300% Yellow Fever 000% Lassa Fever 000% Neonatal Tetanus 000% Cholera 000% Acute Watery Diarrhea 78200% Bloody Diarrhea 000% Human Rabies 000% Meningitis 000% Measles 2500% Suspected VHF/EVD 1, % Neonatal Mortality 1 Maternal Mortality 2

Figure 3: Timeliness of Reporting, Weeks Nimba County

Trend of Suspected EVD, Week 31-42, 2015,Nimba County

Trend of suspected Measles,Week 31-42, 2015,Nimba County

Project 2 Outbreak of Acute Flaccid Paralysis, Nimba County

INTRODUCTION Poliomyelitis is a highly contagious viral disease The virus infects mostly children < 5years Incubation period is 7 to 14 days – paralytic cases has range of approximately 3 to 35 days AFP Surveillance is an active surveillance system In Nimba County, there was an alert of three cases of AFP in week 40 (week beginning 28 th September and ending 4 th October, 2015)

OBJECTIVES To confirm the existence of the reported Acute Flaccid Paralysis To collect samples from affected patients who have paralysis To commence response

METHODS Nimba County borders two countries (Cote d’Ivoire and Guinea) with population of 534,376 A case is defined as –any AFP < 15 years of age or – case of any age in which a clinician suspects polio followed by onset of paralysis in Nimba County between 15 th September to 8 th October, 2015 The outbreak affected 2 of the 6 health districts (Manbor in Gbehlay-Geh and Yekepa Area K in Sanniquellie-Mah) The parents of each case were orally interviewed Specimens were collected –2 stool samples each patient at Interval of 24 hours

RESULTS 1/3 A total of three (3) cases were reported, all of them are male. Median Age is 77 months (18-95) Case A: - is a 1 year 6 months old male child who started having progressive flaccid paralysis and fever on the 21 st of September, 2015 Paralysis is asymmetrical and affects both lower limbs Patient has had two doses of OPV since birth 2 stool specimens were collected 8 th and 9 th day after the onset of paralysis Result of investigation is being awaited

RESULTS 2/3 Case B: - is a 7 year and 11 months old male child who presented on the 28 th September, 2015 at the Karnplay Health Center, Gbehlay-Geh District with 8 days history of progressive flaccid paralysis and fever Paralysis is symmetrical and affects all limbs Patient has received 2 doses of OPV from birth 2 stool specimens were collected 9 th and 10 th day after the onset of paralysis Result of investigation is being awaited

RESULTS 3/3 Case C: - is a 6 years old male child who started having progressive flaccid paralysis and associated fever from the 24 th of September, 2015 Paralysis is asymmetrical and affects both lower limbs Patient has received three doses of OPV from birth 2 stool specimens were collected 8th and 9 th day after the onset of paralysis Result of investigation is being awaited

Epicurve of Outbreak of Acute Flaccid Paralysis in Nimba County, September, 2015

CONCLUSION Two of the cases live in the same district and one live in a district very close to Guinea The three cases had no travel history outside of their home towns since one year ago each PUBLIC HEALTH ACTIONS  Parents were sensitized on the importance of presenting to the Health center on time  Active case search continue in Nimba County  Specimens were collected and sent to Liberia Institute of Bio-Medical Research (LIBR)