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

Presentation on Field WorkCareysburg District, Montserrado

county

By John S. Yarngrorble. DSO

Outline

• Introduction• Expanded Surveillance Report• Measles Outbreak Investigation Report

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

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

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.

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 Hospital 100 100

2. Kingsville Clinic 75 91

3. Careysburg Clinic 83 91

4. Crozierville Clinic 66 66

5. Harrisburg Clinic 83 91

6. White Plains Clinic 100 100

7. Camp Sandee Ware 25 25

8. Slemp Medical Clinic 75 91

9. Exclusive Executive Clinic 66 83

10. Faith Medical Clinic 66 75

T L NR>8%0 0n Time

>50-80% On Time

<50% On Time

Cumulative Completeness

Cumulative TimelinessLegend

Timeliness and completeness of facility Surveillance Weekly reporting, Careysburg District, EPI wks 31-42, 2015

Benso

nville

Hospita

l

Kingsville

Clinic

Careysb

urg Clin

ic

Crozie

rville

Clinic

Harrisb

urg Clin

ic

White

Plains C

linic

Camp Sa

ndee W

are

Slemp M

edica

l Clin

ic

Exclu

sive E

xecu

tive Clin

ic

Faith

Med

ical C

linic

0

20

40

60

80

100

120

TimelinessCompleteness

Reporting Facilities

Perc

enta

ge

• 40% of facilities achieved national target for timeliness and 70% for completeness

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

Disease Reports Summary of Notifiable Diseases for EPI week 31 to 42, 2015 for

Careysburg District Legend: S= SuspectedDisease Cumulative: Week 31 – 42, 2015

Cases Deaths Case Fatality Rate

Acute Flaccid Paralysis (AFP) 0

0 0%

Yellow Fever 0 0 0%Lassa Fever 0 0 0%Neonatal Tetanus 0 0 0%Cholera (S) 0 0 0%Acute Watery Diarrhea 16 0 0%Meningitis 0 0 0%Measles (S) 9 0 0%Dysentery 53 0 0%Human Rabies (S) 0 0 0%Suspected VHF/EVD 6 0 0%Neonatal Death 0 9 100%Maternal Death 1 5 0%

Trend of AWD and Dysentery cases, Careysburg District, EPI wks 31-42,2015

wk 31 Wk 32 Wk 33 Wk 34 Wk 35 Wk 36 Wk 37 Wk 38 Wk 39 Wk 40 Wk 41 Wk 420123456789

10

AWD CasesDysenteryCases

Epi Weeks

Num

ber o

f cas

es

• All cases received case management, no deaths• No samples taken for lab analysis• Public Health action: Surveillance kept on all reported

cases

MEASLES OUTBREAK INVESTIGATION:EPI WEEK 40, 2015

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

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

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

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

Reasons Contributing to the Outbreak

• Rejection of measles vaccine on account of fear of EVD

• Low immunization coverage

29th sept

30th sept

1st Oct 2nd Oct 3rd oct 4th Oct 5th Oct 6th Oct0

0.5

1

1.5

2

2.5

3

3.5

Epicurve of suspected measles outbreak, Caryesburg District, 30th Sept to Oct 5th 2015

suspected measles cases

Date of onset

num

ber o

f cas

es

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

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

Acknowledgement

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

Thank you