NCDC Weekly Epidemiological Report: Volume 7, No. 21 - 9 June 2017

Lessons Learnt from the 2016/2017 CSM Outbreak

The severity of the ongoing Cerebro-spinal meningitis outbreak has gradually reduced in the last few weeks, with fewer cases being reported. As at 30th May, 2017, the number of affected LGAs still remains 230 in 25 affected states, including the Federal Capital Territory. Total number of suspected cases reported so far is 14,473. Of this, 998 samples have been tested. 460 (46.6%) of the samples tested have been confirmed positive for Neisseria meningitides and 80.6% (371) have been positive for Neisseria meningitides serogroup C. The total number of deaths recorded so far is 1,155 with a case fatality rate (CFR) of 8%.

As the outbreak declines gradually, it is important that every State, affected or not, reviews lessons from preparedness and response activities during the outbreak. Conducting reviews will provide insight into levels reached for preparedness, details of outbreak response, identify gaps and areas that need to be strengthened, identify areas of collaboration and support the evaluation of systems. Reports from this can be channelled into preparedness plans for the next outbreak season.

The 2016/2017 CSM outbreak season was peculiar, given the number of suspected cases reported and the strain of the causative organism, which had never been reported before. Furthermore, the outbreak was caused by multiple serogroups with about 20% of confirmed cases caused by other serogroups besides Neisseria meningitides serogroup C. All these tested our preparedness levels and response systems at the Local, State and National Levels.

Lessons to be learnt from this outbreak cuts across all thematic areas in outbreak response.

1. Coordination: Development of Preparedness plans for disease outbreaks which should also be used as a tool for advocating for resource allocation. Constitution of Rapid Response Teams (RRTs); Early engagement of key stakeholders and partners with leadership from the State Government.

2. Surveillance: Improvement in the surveillance systems starting from the health facility level to the National for immediate case detection, notification and subsequent investigation; Improved data management systems at all levels; Improve bio surveillance activities for rumour capturing and verification; Capacity building for healthcare workers and disease surveillance and notification officers.

3. Case Management: Development or review of disease guidelines and protocols, Capacity building for case management team.

4. Laboratory: Improved turn-around-time for sample confirmation and result sharing; Capacity building on sample preservation and transportation, Improve stockpiling of testing commodities 5. Logistics; Early forecast of outbreak commodities, Mapping and Pre-positioning of commodities in States, LGAs or Wards based on data review of previous outbreaks 6. Risk Communication: Early community sensitization and mobilization in States and at the National level, Early engagement of the mass media for sensitization programs and extended use of diverse communication tools Disease-specific outbreak reviews should be a routine activity following an outbreak as it provides guidance on improvement opportunities and next steps to take. The Nigeria Centre for Disease Control (NCDC) will continue to support and collaborate with States as they plan to prepare for subsequent seasons of CSM outbreaks, and indeed, other outbreaks and events of public health concern. It is expected that States take ownership of outbreak preparedness and ensure that all efforts put into preparedness translate to meaningful action for response.