1. Presentation on Field Work Careysburg District, Montserrado county By John S. Yarngrorble. DSO

2. Outline Introduction Expanded Surveillance Report Measles Outbreak Investigation Report

3. Introduction Careysburg District One of the 7 districts in Montserrado county Population- 65850 – since 2008 national census Male- 29012 estimated, Female- 25644 estimated, Under 5 : 11,194 Zone: one ( 1700) Field work for 6 weeks after workshop 2 Project 1: Weekly and expanded surveillance reporting (Week 31 to 42) Project 2: Disease outbreak investigation

4. EXPANDED SURVEILLANCE REPORT: Epi Weeks 31-42,2015, Careysburg District

5. Expanded Weekly Surveillance Report for EPI Week 31 To 42, 2015 Summary: Total IMRD= 83 AWD 16 (Bensonville Hospital-5, Careysburg Clinic-3, Kingsville Clinic- 8), 53 dysentery( Bensonville Hospital-23, Kingsville Clinic-11, Harrisburg Clinic-13, Crozierville Clinic-3, Slemp-3)cases, 8 suspected measles and 6 suspected EVD cases The EVD and measles samples were collected, all tested negative. 1 out of 10 reporting facilities was often silent The DHT continues to work with reporting health facilities as active and passive surveillance continue.

6. Timeliness and completeness of Reports from Reporting Health Facilities in Careysburg District, Epi week 31 to 42, 2015 No. Health Facilities % Cumulative timeliness % Cumulative completeness 1. Bensonville Hospital100 2. Kingsville Clinic7591 3. Careysburg Clinic8391 4. Crozierville Clinic66 5. Harrisburg Clinic8391 6. White Plains Clinic100 7. Camp Sandee Ware25 8. Slemp Medical Clinic7591 9. Exclusive Executive Clinic6683 10. Faith Medical Clinic6675 TLNR >8%0 0n Time >50-80% On Time <50% On Time Cumulative Completeness Cumulative Timeliness Legend

7. Timeliness and completeness of facility Surveillance Weekly reporting, Careysburg District, EPI wks 31-42, 2015 40% of facilities achieved national target for timeliness and 70% for completeness

8. Comments on Reporting Quality: Defaulting facilities complained about long distance to district office to submit report. Public health action: DHT held meeting with defaulting facilities for improvement

9. Disease Reports Summary of Notifiable Diseases for EPI week 31 to 42, 2015 for Careysburg District Legend: S= Suspected Disease Cumulative: Week 31 – 42, 2015 CasesDeathsCase Fatality Rate Acute Flaccid Paralysis (AFP) 0 00% Yellow Fever000% Lassa Fever000% Neonatal Tetanus000% Cholera (S)000% Acute Watery Diarrhea1600% Meningitis000% Measles (S)900% Dysentery530 0% Human Rabies (S)000% Suspected VHF/EVD6 00% Neonatal Death09100% Maternal Death150%

10. Trend of AWD and Dysentery cases, Careysburg District, EPI wks 31-42,2015 All cases received case management, no deaths No samples taken for lab analysis Public Health action: Surveillance kept on all reported cases

11. MEASLES OUTBREAK INVESTIGATION: EPI WEEK 40, 2015

12. Background- Measles Highly contagious viral illness Common and often fatal in developing areas Paramyxovirus (RNA) Preventable by vaccine Features – Incubation period 10-12 days – Fever, rash – Cough, coryza or conjunctivitis

13. Background- Outbreak investigation Rapid rise in suspected cases during Epi week 40, 2015 following long standing zero reporting Objectives – To confirm the outbreak – To describe the outbreak( in person, place and time) – To determine the cause of the outbreak – To control the outbreak

14. Methods Surveillance data reviewed Blood specimens collected for laboratory analysis Active case search Line listing Reviewed vaccination record Interviewed community leaders and parents of affected children Public health action

15. Results Surveillance reports Showed a sharp rise in suspected measles cases,zero reporting since Epi wk 1,2015 Blood samples collected from 6 of 8 cases(results negative) 8 cases line-listed; all from Binda Ballah Town, 6 females and 2 males; all aged under 5 years About 70% vaccination coverage in affected community

16. Reasons Contributing to the Outbreak Rejection of measles vaccine on account of fear of EVD Low immunization coverage

18. Outbreak Control (Public Health Action) All cases received case management. Massive measles immunization, October 3-5,2015 Public health education done Media education Fliers with symptoms and signs Early reporting No new cases reported so far

19. Discussion Suspected measles outbreak in Careysburg District from September 30- October 3, 2015 Children affected aged 1-5yrs at Binda Ballah Town Contributing cause of outbreak: Low immunization coverage Mass immunization was effective in controlling the suspected outbreak

20. Acknowledgement Ministry of Health CDC WHO Emory University AFENET MCHT FETP mentors (Stephen, Dr Maame)

21. Thank you