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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 week 17 (20-26 April 2020 ). Health Press Zambia Bull. 2020; 4(3); pp 3-6

Weekly Summary

Current outbreaks and public health threats

 COVID-19 (Coronavirus): 27 confirmed cases, 0 deaths and 9 recoveries were reported in the week under review. Cumulatively as of the 26th of April, a total of 88 confirmed cases,3 deaths and 42 recoveries have been recorded.

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

Immediately notifiable diseases

 COVID-19 (Coronavirus): The country has recorded a cumulative total of 88 confirmed cases from Lusaka (82), Copperbelt (5) and Central(1) provinces.

 Acute Flaccid Paralysis (AFP): Three cases were reported in the week under review in the Copperbelt (2) and Northern (1) provinces.

 Maternal Deaths: Seventeen maternal deaths were recorded in Central (4), Western (3), Lusaka (3) Northwestern (2), Southern (2), Northern (1), Copperbelt (1) and Eastern (1) provinces.

 Measles: Two suspected cases were reported in Northern (1) and Muchinga (1) provinces.

Other diseases/events

 Anthrax: Two suspected cases were reported from Luampa (1) and Kalabo (1) district of Western province.

 Neonatal Tetanus: Two suspected cases were reported in the week under review Northern province.

 Typhoid: Eight suspected cases were reported in the week under review in Luapula (4), Central (3) and Lusaka (1) provinces. Four samples were collected and sent for Laboratory investigation.

Paper and Electronic Timeliness and Completeness, Health Facility Level

Provincial Report Timeliness

Maternal Deaths

Week 17

Cumulative Number of Maternal Deaths by Province

 17 maternal deaths were registered in the week under review.

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

 Lusaka province (53) has cumulatively recorded the highest number of maternal deaths.

 In total 222 maternal deaths have been recorded in the year 2020.

Vaccine Preventable Diseases

AFP Surveillance

Districts with reported AFP Cases Week 1-17 2020

Week 17

 Three cases of AFP were reported in the week under review from Kitwe(2) districts of Copperbelt province and Kaputa (1) district of Northern province.

 All samples habe been collected and sent for laboratory investigation

 Cumulatively, 64 AFP cases have been recorded from 34 districts.

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

 All results received 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, 27 suspected cases have been reported since the outbreak was declared.

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

 The affected health facilities in the district are Mulenga Mapesa and Mukupa Kaoma.  The outbreak appears to have come under control.

Measles & Rubella surveillance

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

 Suspected measles specimens are collected and sent for laboratory investigations.

 Cumulatively, 95 suspected measles cases , 12 measles Igm confirmed cases and 5 confirmed measles rubella cases have been recorded.

COVID-19

 27 confirmed cases, 0 death and 9 recoveries of COVID–19 were reported in the week under review from Lusaka (24) and Copperbelt (3) provinces. Cumulatively, 88 confirmed cases have been recorded, 3 deaths and 42 recoveries.

 The confirmed cases are distributed across Lusaka (82), Copperbelt (5) and Central (1) provinces.

 The confirmed cases are in quarantine at designated health facilities in strategic districts and are receiving medical care.

 A total of 10,322 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), the School of Veterinary Medicine (UNZA-VET) and Tropical Diseases Research Centre (TDRC) are conducting tests for suspected cases and has to date received 5,932 samples, 5,284 have been processed with 88 confirmed positive for COVID-19.

Epi-curve COVID-19 Confirmed cases N=88, Deaths=3(CFR 3.41%), Recoveries = 42

Non-Bloody Diarrhoea

 Cumulatively, 227,866 cases of non-bloody diarrhea were reported from week 1 to week 17.

 The highest number of cases reported are from Central province representing 16% (36,167).

 The highest cumulative incidence reported is from Central province at 2,085 per 100,000 of the population at risk.

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

Ebola	Measles	Cholera	Poliovirus (c VDPD)	CoronaVirus (COVID
DRC : 3,461 CFR 66.00%	DRC: 361,935 CFR 1.80%	DRC: 7,207 CFR 1.10% Moz: 1,506 CFR 1.0%	Angola: 131 CFR 0.0% DRC: 110 CFR 0.0%	Global:2,989,175 CFR7.03% Africa: 20,652 CFR 4.2%

COVID-19 WHO African Region

 Countries in the WHO African Region have been affected by the current coronavirus disease 2019 (COVID- 19) global pandemic, with 45 of the 47 countries in region reporting confirmed cases.

 6,245 new confirmed cases and 203 deaths of COVID-19 were reported across all affected countries in epi week 17.

 Cumulatively, a total of 20,652 confirmed cases and 861 deaths have been reported in the WHO African region.

 Of the 20,652 confirmed COVID-19 cases reported, 7,155 (35%) cases have been documented as recovered. A total of 325 (1.57%) health care workers have been infected by the pandemic.

Ebola Virus, DRC 2018-2020

 There has been no new confirmed EVD cases in the week under review since the resurgence of the outbreak.

 Cumulatively, 3,461 suspected cases, 3,316 confirmed cases, 147 probable cases and 2,277 deaths (CFR is 66%) have occurred since the outbreak started earlier in 2018.

 The total number of health workers affected remains at 171, representing 5% of confirmed and probable cases.

***For more information look up the WHO Weekly Bulletin on Outbreaks and Other Emergencies and for Global updates on the coronavirus COVID 19 look up John Hopkinsdashboard on

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html?***

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)