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Surveillance and Disease Intelligence Unit Zambia National Public Health Institute

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Citation Style For This Article: Surveillance and Disease Intelligence Unit. Intergrated Disease Surveillance and Response. Health Press Zambia Bull 2020; 04(2); pp 16-20.

Weekly Summary

Current outbreaks and public health threats

 cVDPV Outbreak: No new confirmed cases were recorded this week.

 Measles Outbreak: Cumulatively, 5 suspected cases and One confirmed Measles positive IgM were reported from Lunte district but no new cases were reported from Kasama district in the week under review. Both of these districts are in Northern province.

 Poliovirus: Two AFP specimens tested positive for PV2 and have been sent for sequencing.

 Coronavirus (COVID-19): surveillance ongoing, especially at points of entry. For the week under review # of high risk arrivals screened are as follows: 288# of contacts: 288, # high risk persons/contacts monitored: 191, # suspected COVID-19: 4, # Probable COVID-19: 00, # Confirmed COVID-19: 00

Immediately notifiable diseases

 Acute Flaccid Paralysis (AFP): Seven cases were reported from Northern (5), Central (1) and North western (1) provinces.

 Maternal Deaths: Sixteen maternal deaths were recorded in Central (4), Lusaka (3), Southern (3) Copperbelt (2), Western (2) , North western (1) and Eastern (1) provinces.  Measles: Seven suspected measles cases were reported in Northern (4), Eastern (2) and Lusaka (1) provinces.

Other diseases/events

 Typhoid: Seven suspected cases were reported from North western (6) and Eastern (1) provinces.

 Rabies: One suspected rabies death was recorded from Mporokoso district in Northern province .

Paper and Electronic Timeliness and Completeness, Health Facility Level

Provincial Report Timeliness

Summary Report Priority Diseases, Conditions and Events (Week 13)

Maternal Deaths

Week 13

Cumulative Number of Maternal Deaths by Province

 14 maternal deaths were registered this week.

 Obstetric hemorrhages and Indirect causes continue to be the leading cause of maternal deaths.

 Lusaka province (45) has cumulatively recorded the highest number of deaths thus far.

 In total 166 maternal deaths have been recorded since week 1.

Vaccine Preventable Diseases

AFP Surveillance

Districts with reported AFP Cases Week 1-13 2020

 Three cases of AFP were reported from Chavuma (1) and Kabompo (1) districts of North Western province and Vubwi (1)distrct of Eastern province. All three samples were collected for laboratory investigation.

 Cumulatively, 48 AFP cases have been recorded from 26 districts.

 As a result of the cVDPV outbreak, non-AFP target rate has been increased to 4/100, 000 population below 15.

 One case of PV1 has been isolated and sent for sequencing from Nchelenge district in Luapula province.

 All results received so far from specimens submitted to the regional lab came out negative for cVDPV

 The risk of cVDPV2 transmission in Zambia is high in districts that are: 1) Silent, 2) Not attaining Non-Polio AFP Rates of 4/100,000 or 80% stool adequacy, 3) Neighboring to countries with active outbreaks and 4) Having low IPV vaccination coverages.

Poliovirus Environmental Surveillance (ES)

Measles Outbreak

 No new cases were recorded from the ongoing Measles outbreak in Northern Province affecting Lunte district.

 Cumulatively, 25 suspected cases have been reported since the outbreak was declared.

 1 Igm positive case was reported in the affected district.

 The affected health facilities in the district are Mulenga Mapesa and Mukupa Kaoma.

Measles & Rubella surveillance

 2 suspected measles cases were reported in the week under review.

 1 sample was collected and sent for laboratory investigations.

 Cumulatively, 89 suspected measles cases , 9 measles Igm confirmed cases and 4 confirmed measles rubella cases have been recorded.

COVID-19

 27 confirmed cases of COVID–19 were reported in the week under review from Lusaka (25)province and on the Copperbelt (2) province.

 There have been no deaths recorded from the COVID–19 cases.

 The confirmed cases are in quarantine at Levy Mwanawasa Hospital and Masaiti district hospital respectively and are receiving medical care.

 A total of 3,142 high risk persons are under observation, this includes travelers from high risk countries as well as persons that may have come in contact with the confirmed cases.

 The University Teaching Hospital Virology Lab (UTHVL) is conducting tests for suspected cases and has to date received 475 samples, 400 have been processed with 29 confirmed positive for COVID-19.

Non-Bloody Diarrhoea

 Cumulatively, 181,621 cases of non-bloody diarrhea were reported from week 1 to week 13.

 The highest number of cases reported are from Central province representing 15.8% (28,664).

 The highest cumulative incidence reported is from Central province at 1,653 per 100,000 population.

Dog Bites

 Cumulatively, 3,851 dog bites have been reported from Week 1 to Week 13.

 Dog bites surveillance serves as a proxy for rabies surveillance both in human and animal health systems.

 Central province has recorded the highest number of dog bites representing 20% (790).

Global/Regional/Public Health Events (Cases/Case Fatality Rate)

Ebola	Measles	Cholera	Poliovirus (c VDPD)	CoronaVirus (COVID–19)
DRC : 3,453 CFR 66.0%	DRC: 29,981 CFR 1.30%	DRC: 4,998 CFR 1.30% Moz: 313 CFR 4.2%	Angola: 131 CFR 0.0% DRC: 108 CFR 0.0%	Global: 724,042 CFR 4.7% Africa: 3,217 CFR 2.1%

COVID-19 WHO African Region

 During the week under review 2 more countries (Guinea Bisau and Mali) have confirmed COVID-19 cases in the WHO African region bringing the total number of African country’s with COVID-19 to 39.

 2477 new confirmed cases of COVID-19 were reported across all affected countries in week 13, the highest number of new cases so far during a single week.

 Cumulatively, a total of 3,217 confirmed cases and 69 deaths have been reported in the WHO African region.

 In addition to sporadic importation of cases, the majority of the countries in the region are now experiencing local transmission of COVID-19,

Ebola Virus, DRC 2018-2020

 No new confirmed EVD case and no deaths were recorded from DRC outbreak in the week under review.

 Cumulatively, 3,453 suspected cases, 3,310 confirmed cases, 134 probable cases and 2,273 deaths (CFR is 66%) have occurred since the outbreak started earlier in 2018.

 The last day of the week under review marked the 40th consecutive day without recording a confirmed EVD case. This outbreak of EVD would appear to be coming under control.

***For more information look up the WHO Weekly Bulletin on Outbreaks and Other Emergencies and for Global updates on the coronavirus

Public Health Actions

Circulating Vaccine Derived Poliovirus Outbreak

 All provinces are further encouraged to strengthen AFP surveillance using available technological tools and geo code all cases detected.

 The national annualized Non Polio AFP detection rate has increased to 4 cases /100,000 of children detected under 15 years for provinces.

 Note all AFP cases are immediately notifiable and require immediate investigation with new case investigation forms.  All districts are expected to conduct health facilities integrated supervisory active searches at priority sites as per recommended schedule.

 Provinces to ensure silent districts not reporting AFP/measles cases are supported for active surveillance of AFP cases.

Ebola Virus Disease Preparedness

 All provinces to strengthen EVD surveillance among all health care providers and raise community awareness of EVD prevention.

 Provide weekly reports in IDSR reports of active searches including zero reporting in at risk districts, including ports of entry.  Ensure epidemic preparedness measures for detecting cases, sample testing/transportation and managing cases are effected.

 All border districts to strengthen point of entry EVD screening including facilitation of cross boarder monitoring and reporting of suspected EVD cases.

Heightened Surveillance in COVID– 19 High Risk Districts

 Surveillance (including Event Based Surveillance) is being actively conducted at POEs, health facilities, and sentinel sites.

 Screening facilities have been set up at POEs; additionally, screening is being done at the dry port in Makeni for all buses coming in from outside the country.

 Additional thermal scanners to be procured and placed at the POEs to avoid over-crowding and enhance social distancing; set up/identification of designated quarantine facilities to enforce guidelines on quarantine.

 Isolation facilities have also been set up in all high risk districts across the ten provinces;

 Provincial epidemic preparedness committees to engage all relevant government stakeholders and multisector partners required to prevent, control and stop transmission of COVID– 19.

Global Alert of the Coronavirus & Preparedness

 Orientation of staff at points of entry on COVID-19 in all provinces is being conducted in cascade

 Screening at all points of entry to be strengthened especially at international points of entry.

 Circulation of awareness materials to the public and health personnel is being done.

 Report all suspected patients to higher authority immediately.

 Daily monitoring & 14 day quarantine of all travelers from high risk countries is mandatory.

 Strengthen surveillance for all Influenza Like Illness (ILI) and Severe Acute Respiratory Illness (SARI)

 Case definitions to be made available and other IEC materials in health facilities and public places.

 A call centre has been established at ZNPHI and all queries should be channeled to the following numbers: 909/+260 96 4638726/+260 974493553/+260 95 3898941.

Reported by Surveillance and Disease Intelligence Unit: Muzala Kapin’a, Nkomba Kayeyi, Moses Banda, Mazyanga M Liwewe, Victor Mukonka and Zambia National Public Health Institute (ZNPHI) 25