Surveillance and Disease Intelligence Unit
Zambia National Public Health Institute
Weekly Summary
Current outbreaks and public health threats
Vaccine Derived Poliovirus 2 Event: Fourteen (14) samples from contacts in Chiengi, district Luapula province tested negative for polioviruses. Eighteen (18) results are pending.
A 22 year old AFP case residing in village of index case absconded without full investigation
Cholera: Four (4) suspected cholera cases from Northern (3) and Lusaka (1) province were investigated for cholera. Two cases from Nsama District tested positive for V. Cholerae O1 Inaba
Immediately notifiable diseases
Acute Flaccid Paralysis (AFP): Eight (8) cases were reported from Western (4), Luapula (3) and Copperbelt (1) provinces. Samples are under investigation for poliovirus
Measles: A total of nine (9) cases were reported this week from Lusaka (6), Copperbelt (1), Central (1) and Luapula Province (1). Six (6) specimens were investigated for measles & rubella
Maternal Deaths: Twenty (20) maternal deaths were registered in Lusaka (4), Copperbelt (4), Muchinga (3), Northern (2), Western (2), Eastern (1), Southern (1), Luapula (1), North Western (1) and Central (1) Provinces
Other diseases /Events
Rabies: One (1) rabies death was reported from Kalabo district Western province
Typhoid: Four (4) suspected typhoid cases in Lusaka district tested negative for S Typhi
Regional Public Health Events
HEALTH FACILITY REPORTING TIMELINESS/ COMPLETENESS
PROVINCIAL TIMELINESS
PROVINCIAL TIMELINESS
SUMMARY REPORT PRIORITY DISEASES, CONDITIONS AND EVENTS (WEEK 39)
SUMMARY REPORT PRIORITY DISEASES, CONDITIONS AND EVENTS (WEEK 39)
EVENTS/ OUTBREAKS
Vaccine Derived Polio Virus Type 2 Event (Currently no Evidence of Circulation)
• One (1) VDPV2 was confirmed on September 18 2019, blood samples are being investigated for an immunodeficiency VDPV
• Results currently show no country transmission from the eleven (11) negative results including a close contact. Eighteen results from the remaining contacts are pending results.
• Heightened surveillance and line listing for AFP cases and contacts has continued . The district continue to promote social mobilization and sensitization for AFP in the affected area (s)
• There have been no reported deaths
CHORELA
• Two cases of Vibrio Cholerae O1 Inaba were confirmed from Nsama district
• This is the third (3) outbreak of cholera in Nsama dstrict this year
• Plans for a reactive vaccination response campaign are underway
VACCINE PREVENTABLE DISEASES
Poliovirus Surveillance
Poliovirus Surveillance
• Eight (8) cases were reported this week
• Of the 141 laboratory investigated AFP cases this year 59% have had ≥ 3 or more doses of OPV
• 113 adequate tested samples have been discarded for polioviruses, 10 are pending results
• Provinces are to conduct 60 day follow ups for inadequate samples
Poliovirus Environmental Surveillance
Scheduled collections from the Lusaka Province was conducted a day late.
Non Polio Enteroviruses detection for environmental surveillance polio virus is ≥50% isolation while the rate among AFP cases is 8.5% (12/141).
Measles & Rubella surveillance
• Nine (9) cases were reported
• Only 29% of the 685 IDSR reported cases have been tested
• Positivity among tested cases for measles IgM is 13.3%(target 10%) and 1.01% for rubella
• 28 % (55) have history of vaccination
• 85% of the positive cases are under 10 years
HIGH BURDEN DISEASES
Non Bloody Diarrhoea
Countrywide incidence of reported suspected non-bloody diarrheas this week is 108/ 100,000 population
North Western, Central and Southern Provinces have respectively recorded the highest incidence of reported weekly cases since week 1.
Following a seasonal increase in cases reported from week 24 , the epi curve this week showed a decline cases similar to trends seen in 2018 and 2017. There is a notable continued increase in reported cases this year compared to the previous two years.
North Western, Central, and Luapula Provinces have reported the highest cases of non bloody diarrhoea from week 1
HIGH PRIORITY DISEASES
Maternal Deaths
Twenty (20) maternal deaths were registered this week
Obstetric hemorrhages continue to be the leading cause of death.
Lusaka province has cumulatively recorded the highest number of deaths since week 1.
HIGH BURDEN DISEASES
Malaria
Malaria is the leading cause of morbidity accounting for 72% of all reported cases
92,929 suspected cases were reported this week; with a positivity rate of 34 % among the 92, 929 tested cases.
Northwestern and Luapula provinces recorded the highest cumulative incidence of malaria cases from week 1 to 39
HIV
34,324 people were tested for HIV in the week under review, with a positivity rate of 6.78%.
Central, Lusaka and Luapula provinces have cumulatively reported the highest incidence of confirmed HIV of 880, 679 and 503 cases per 100,000 population, respectively, from week 1.
Ebola Virus, DRC and Uganda, 2018-2019
The EVD outbreak was declared a Public Health Emergency of International Concern in DRC on 17 July 2019
21 new confirmed cases and 14 new deaths were reported in the current week.
Cumulative cases stand at 3188 of which 3074 are confirmed and 2129 deaths occurred (CFR is 67%).
Active transmission is ongoing with 13 of the 29 health reporting zones confirming cases in the last 21 days.
The regional risk of spread remains high
Partners and Zambia continue preparing EVD surveillance & preparedness in at risk districts
PUBLIC HEALTH ACTIONS
General Recommendations
Response pillars at ZNPHI to continue working with partners to strengthen surveillance, laboratory and epidemic preparedness for EVD, Polioviruses, Cholera , Measles and other public heath threats
Provincial health and veterinary municipalities to quickly respond to suspected rabies cases, promote vaccination of dogs and sensitize communities on rabies prevention /treatment
Provinces to oversee that epidemic preparedness consumables (including vaccines, water testing kits and chlorine distribution ) are distributed to districts at risk of outbreaks
Provinces should ensure that epidemic preparedness committees (provincial and districts) are functional, represented by all key multisector stakeholders & hold regular meetings
Heightened Vaccine-Preventable Disease Surveillance in Silent Districts
Chiengi district is to increase the annualized Non Polio AFP rate from 2 to 4 cases /100,000 of detected children under 15 years
All district in Luapula Province to ensure timely reporting from all health facilities
Conduct and report active geocoded searches at priority sites as per recommended schedule
Provinces to ensure silent districts not reporting AFP/measles cases are supported for active surveillance of cases
Provinces are to ensure health workers are sensitized for improved detection, reporting and investigation of suspected measles and AFP cases
Provincial health offices to ensure sub regional attainment of the Non-Polio AFP and non Febrile Rash rate of 2 cases per 100,000
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 Cholera Hotspots
Nsama and neighbouring districts to continue to support the response to the ongoing outbreak through heightened active surveillance, management of cholera cases and timely reporting of epidemiological changes
Health education to sensitize communities and health workers on cholera preventative measures
WASH continue water monitoring and distribution of chlorine in identified at risk populations
Provincial epidemic preparedness committee’s to engage all relevant government stakeholders and multisector partners required to prevent cholera outbreaks
Case is to continues at established Cholera treatment center, rapid response teams are
Writers: Chanda Groeneveld, Muzala Kapin’a, Moses Banda, Nkomba Kayeyi, Mazyanga M Liwewe, Victor Mukonka, Edward Chentulo, Paul Simusika, Mwaka Monze and Zambia National Public Health Institute (ZNPHI)