Liberia: 2017 Annual Integrated Disease Surveillance and Response Bulletin, January - December 2017

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The National Public Health Institute of Liberia (NPHIL) is pleased to present the 2017 annual epidemiological bulletin. This bulletin provides information on the progress of IDSR performance in 2017. It highlights the successes and the challenges. The information from this bulletin is important for strengthening IDSR, which not only contributes to the control of communicable diseases in Liberia, but also enhances the capacity to implement the World Health Organization’s International Health Regulations (2005), a legally-binding agreement that provides a new framework for coordinating and managing public health threats, which came into effect in June 2007.

1. IDSR Performance

• Completeness and timeliness of weekly IDSR reports remained well above the 80% national target at all levels of the health system • Immediate notification of suspected cases (within 24 hours) increased from 20% in week 40, 2016 to 100% as of week 52, 2017 • We recorded an increase in reporting of IDSR diseases and events with a total of 4,729 suspected cases reported for 10 immediately reportable diseases and events in 2017 compared to 3,812 in 2016 • Reporting of suspected cases with case-based forms or line list increased from 30% in week 40, 2016 to 90% as of week 52, 2017 • Over 80% of the suspected cases recorded (those requiring laboratory confirmation) were investigated by Laboratory • Joint national supportive supervision/mentorship conducted in 15 (100%) counties showed appreciable level of compliance in the implementation of IDSR core functions

2. Outbreaks and Humanitarian Events

• A total of 39 outbreaks and 3 humanitarian events were detected, investigated, and responded to • There were investigation reports for 85% of outbreaks compared to 53% in 2016 • Eighty-two (82%) of outbreaks were responded to within 48 hours compared to 37% in 2016

3. Public Health Diagnostics

• Sustained public health diagnostic capacity at three laboratories – National Public Health Reference,
Jackson F. Doe, and Phebe hospital laboratories • Improved in-country public health diagnostic capacity from five IDSR priority diseases in 2016 to seven IDSR priority disease by week 52 in 2017 o Added meningitis, Lassa fever o Developed laboratory screening capacity for rabies • Overall laboratory turn-around time improved by 15% from 35% in the first half of the year, to 50% of alerts being confirmed or ruled-out by laboratory testing within 4-days of alert notification, by the end of 2017

4. Electronic Disease Surveillance

• E-IDSR was launched and piloted in two counties (Grand Cape Mount and Margibi) covering all health facilities • AVADAR was launched and piloted in four health districts in Montserrado County • Use of open data kit (ODK) to conduct IDSR supervision commenced thus enhancing visualization, rapid transmission, and validity of reports

5. Training and Capacity Building

• A total of six hundred twenty-two (622) national and county level staff were trained as trainers in IDSR o This comprised 285 local authorities trained in IDSR leadership and coordination and 337 technical staff trained (at least each county has 5 IDSR modular trainers)

• The Liberia Field Epidemiology Training Program (LFETP) has trained 146 surveillance officers at the national, county and district levels of the surveillance system in the Frontline and 14 national and county officers in Intermediate FETP Many other gains have been made in areas of emergency medical services, points-of-entry, and epidemic preparedness and response including the formulation of contingency plans and the conduct of at least one simulation exercise at two points-ofentry.
Despite these strides, key system challenges/constraints include:

• Settling the newly established NPHIL as a specialized institute as well as aggressively responding to over 30 outbreaks is resource intense • System resilience to outbreak response still need the desired coverage of above 90% • Inadequate operational support to surveillance officers However, strong dedication and commitment to excellence in our work to prevent and control public health threats continue to allow us to surmount these hurdles.
We are grateful to the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), and all other valuable partners that continue to provide technical and operational support to facilitate our work.