Liberia IDSR Epidemiology Bulletin
2016 Epi Week 44 (October 31 - November 6)
Data Source: CSOs from 15 Counties and Lab
Highlights
 Seventeen neonatal deaths reported from seven counties
 Four maternal deaths reported from four counties
 Twenty clinically confirmed cases of pertussis including one death was reported from Grand Bassa County
Reporting Coverage
100% (745/745) of expected health
facilities reported from 90 health
districts across 15 counties.
99.5% (741/745) of health facilities
submitted timely reports to the district
level.
99% (88/90) of health districts
submitted timely reports to county
level.
100% (15/15) of counties submitted
timely reports to the national level.
Vaccine Preventable Diseases
Measles
 Eight (8) suspected cases reported. Grand Gedeh (2), Margibi (2), Lofa (1), Bomi (1), Sinoe (1), and Montserrado (1).
 Specimens were collected from all cases for laboratory confirmation.
 Four negative results received from the National Reference Laboratory for Epi week 43 and 44. Lofa (2), Montserrado
(1) and Bomi (1).
 Cumulatively, 924 cases have been reported: Lab-confirmed (124), Epi-linked (481), Compatible (137), suspected (33)
and discarded (149) (Figure 2). CFR 1% (n=5).
 Liberia's annualized non-measles febrile rash illness rate stands at 4.3 per 100,000. Grand Cape Mount, Nimba,
Rivercess, River Gee and Sinoe Counties are below the target of 2/100,000 (Table 1).
 Of the total 924 cases reported (Lab confirmed, Epi-linked and suspected), 15% were reportedly previously
vaccinated, 39% were unvaccinated, and 46% had unknown vaccination status.
 41% of the confirmed and suspected cases are below 5 years.
1
Liberia IDSR Epidemiology Bulletin
2016 Epi Week 44 (October 31 - November 6)
Table 1. Distribution of Reported Measles Cases by County and Epi-Classification, Liberia, Week 1 - 44, 2016
Lab
County
Confirmed
Bomi
2
Bong
10
Gbarpolu
0
Grand Bassa
20
Grand Cape Mount
0
Grand Gedeh
0
Grand Kru
0
Lofa
4
Margibi
46
Maryland
0
Montserrado
41
Nimba
1
Rivercess
0
River Gee
0
Sinoe
0
NP
0
Liberia
124
Target Achieved
EpiLinked
0
49
0
116
0
0
0
29
162
0
104
21
0
0
0
0
481
>=2
Compatible
2
0
5
5
1
14
0
70
0
0
34
5
0
0
0
1
137
Suspected Discarded
3
17
3
13
0
3
0
12
0
0
5
5
0
3
8
10
7
41
0
5
5
29
0
8
0
1
1
0
0
2
0
0
33
149
Below Target
Total
24
75
8
153
1
24
3
121
256
5
213
35
1
1
3
1
924
Annualized Non
Measles Febrile
Rash Illness Rate
20.2
3.9
3.6
5.4
0.0
4.0
5.2
3.6
19.5
3.7
2.6
1.7
1.5
0.0
2.0
4.3
<2
Acute Flaccid Paralysis
 Two (2) cases reported. Bong (1) and Nimba (1).
 Cumulatively, 57 cases of AFP have been recorded: Zero confirmed, 49 discarded and 8 pending lab confirmation.
 As of week 44, the annualized non-polio AFP rate is at 3.6 per 100,000 population in less than 15 years of age (Table
2).
Table 2: Non-polio AFP rate/100,000 <15yrs, Liberia, Epi week 1-44, 2016
< 15 years
pop
County
Bomi
Bong
Gbarpolu
Expected
Reported
Non-Polio
AFP Rate
% of stool
<14days
% of
NPENT
44700
177210
0.4
1.5
4
6
10.6
4.0
100
100
50%
40%
44312
0.4
1
2.7
100
0%
Grand Bassa
117807
100
20%
67527
66562
30775
147124
3
1
3
2
7
3.0
Grand Cape Mount
Grand Gedeh
Grand Kru
Lofa
1.0
0.6
0.6
0.3
1.2
1.8
5.3
7.7
5.6
100
100
100
100
0%
0%
0%
0%
Margibi
Maryland
Montserrado
Nimba
Rivercess
111552
72237
594229
245519
35492
0.9
0.6
5.0
2.1
0.3
5
2
9
7
1
5.3
3.3
1.8
3.4
3.3
100
100
100
100
100
120%
0%
14%
17%
0%
38000
54410
1847457
0.3
0.5
15.6
2
4
57
6.2
8.7
3.6
100
25
95
0%
50%
32%
River-Gee
Sinoe
Liberia
<2 =
Non-Polio AFP Rate
≥2 =
<80% =
Stool adequacy
≥80% =
<10% =
Non-Polio Enterovirus
≥10% =
Silent
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Liberia IDSR Epidemiology Bulletin
2016 Epi Week 44 (October 31 - November 6)
Neonatal Tetanus
 Three (3) cases reported including one (1) death. Montserrado (2) and Grand Bassa (1).
 The death was reported from Grand Bassa County.
 Cumulatively, 19 cases have been reported. CFR is 32% (n=6).
Viral Hemorrhagic Diseases
Ebola Virus Disease (EVD)
 A total of 121 suspected cases
reported (5 alive and 116
dead) of which samples were
collected from all.
 91 samples tested (12 whole
blood and 79 oral swab). 89
samples were tested negative
and 2 indeterminate. Overall
samples were submitted from
11 counties.
 Cumulatively,
28,993
alerts
have been reported out of
which
three
(3)
were
confirmed. CFR in confirmed
cases is 33.3% (n=1).
Table 3. Count of patient samples tested for EVD by county and samples type, Liberia, Epi-week 41 - 44, 2016
Week 41
Week 42
Week 43
Week 44
Whole
Blood
Oral
Swab
Whole
Blood
Oral
Swab
Whole
Blood
Oral
Swab
Whole
Blood
Oral
Swab
17
98
10
126
10
166
12
79
Bomi
3
9
0
4
6
16
1
3
Bong
3
1
1
3
0
4
1
0
Gbarpolu
0
0
0
3
0
1
0
0
Grand Bassa
1
3
0
5
0
3
0
3
Grand Cape Mount
0
1
0
0
0
0
0
0
Grand Gedeh
0
1
0
5
0
1
0
0
Grand Kru
0
1
1
1
0
0
3
0
Lofa
0
1
1
14
0
10
0
6
Margibi
0
2
0
4
0
5
4
2
Maryland
0
0
0
2
1
2
0
0
Montserrado
0
49
1
77
2
86
0
43
Nimba
8
24
5
5
0
28
3
17
Rivercess
0
1
0
2
0
0
0
1
River Gee
0
3
0
0
0
2
0
2
Sinoe
2
2
1
1
0
8
0
2
Unknown
0
0
0
0
0
0
0
0
Geographical Distribution
All Counties
By County
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Liberia IDSR Epidemiology Bulletin
2016 Epi Week 44 (October 31 - November 6)
Lassa Fever
 One (1) suspected case reported from Grand Bassa County.
 Cumulatively, 68 cases have been reported, of which 12 confirmed, 29 not a case, 27 suspected (13 awaiting lab
confirmation, thus 5 from Epi week 38, 3 for Epi week 39, 2 from Epi week 43 and 1 each from Epi week 40, 42 and
44).
 CFR for suspected and confirmed cases is 61% and for confirmed cases is 33%.
 Bong County accounts for 58% of the total confirmed cases.
Yellow Fever
 Three (3) suspected cases
reported. Bomi (2) and Grand
Kru (1).
 Cumulatively, 40 cases have
been reported, of which
twenty-nine
(29)
tested
negative and ten (10) are
pending
laboratory
confirmation.
Meningitis

Zero case reported.

Cumulatively, 26 suspected cases have been reported.
Events of Public Health Importance
Maternal Mortality
 Four
(4)
maternal
deaths
reported. Bomi (1), Lofa (1)
Margibi (1) and Nimba (1).
 Primary causes of deaths were
post-partum
hemorrhage
(2),
ectopic pregnancy and anemia.
 All of the deaths were reported
from health facilities.
 Cumulatively,
258
maternal
deaths have been reported, of
which 80% (206) were reported
from health facilities and 20%
(51) from communities.
 Annualized maternal mortality
ratio is at 173 per 100,000 live
births (Table 3). The expected
MMR
based
Demographic
(DHS)
is
on
2013
Health
Survey
1072
deaths
per
100,000 live births.
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Liberia IDSR Epidemiology Bulletin
2016 Epi Week 44 (October 31 - November 6)
Table 4: Cumulative Maternal Deaths Reported by Counties, Liberia, Epi week 1-44, 2016
No. of Maternal Deaths
Reported
% of Deaths
Reported
Annualized Maternal
Mortality Ratio
Bomi
14
5
387
Sinoe
12
5
273
Grand Cape Mount
14
5
256
Grand Kru
6
2
241
Bong
34
13
237
Margibi
19
7
211
River Gee
6
2
209
Maryland
12
5
205
Gbarpolu
7
3
195
Rivercess
5
2
163
Grand Gedeh
8
3
149
Grand Bassa
14
5
147
Nimba
27
10
136
Lofa
16
6
135
64
258
25
100
133
173
Counties
Montserrado
Liberia
Neonatal Mortality
 Seventeen (17) neonatal deaths were
reported. Montserrado (8), Maryland
(3), Grand Gedeh (2), Bomi (1), Bong
(1), Lofa (1), and Grand Bassa (1).
 Primary causes of deaths were birth
asphyxia (7), neonatal sepsis (5),
prolonged labor, hepatitis B and
unknown cause.
 One (1) of the deaths was also
reported
as
Neonatal
tetanus
attributable death from Grand Bassa.
 All reported deaths
occurred in
health facilities.
 Cumulatively, 450 neonatal deaths
have been reported.
 Annualized neonatal mortality rate is
6 per 1,000 live births. The expected
NNMR based on 2013 DHS is 26
deaths per 1,000 live births.
5
Liberia IDSR Epidemiology Bulletin
2016 Epi Week 44 (October 31 - November 6)
Counties
Table 5: Cumulative Neonatal Deaths reported by counties, Liberia, Epi week 1-44, 2016
Cumulative number of
% of Deaths
Annualized Neonatal Mortality Rate
Neonatal Deaths Reported
Reported
Per 1,000 Live Births
Grand Kru
River Gee
Grand Gedeh
Bong
Rivercess
Maryland
Gbarpolu
Montserrado
Sinoe
Lofa
Bomi
Grand Cape Mount
Grand Bassa
Margibi
Nimba
Liberia
19
16
29
71
13
22
13
154
13
31
9
12
20
10
18
450
4
4
6
16
3
5
3
34
3
7
2
3
4
2
4
100
15
11
11
10
8
8
7
6
6
5
5
4
4
2
2
6
Human Exposure to Animal Bites (Suspected Rabies)
 Nine (9) suspected cases reported. Grand Bassa (3), Montserrado (3), Grand Kru (2) and Margibi (1).
 Cumulatively, 911 suspected cases have been reported including 8 deaths. CFR is <1%.
 Laboratory confirmation of rabies is currently unavailable in Liberia.
Bloody Diarrhea (Shigellosis)
 Six (6) suspected cases
reported. Margibi (3),
Bomi, Grand Kru and
Rivercess (1) each.
 Specimens
were
collected from all cases
for
laboratory
confirmation.
 Cumulatively,
322
suspected cases have
been reported.
Severe Acute Watery Diarrhea (Cholera)

Zero case reported.

Cumulatively, 147 suspected cases have been reported including 2 deaths.
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Liberia IDSR Epidemiology Bulletin
2016 Epi Week 44 (October 31 - November 6)
Whooping Cough (Pertussis)

Twenty (20) clinically confirmed cases including (1) death were reported from Grand Bassa.

Out of the 20 cases, 8 are males and 12 females. 19 of the cases are less than 5 years.

Whooping cough cases were not treated due to antibiotics stock out.

Overall, Grand Bassa County has a Penta-3 vaccine <1year coverage of 96% January to September in 2016,
however, Campwood district has reported coverage of <0.1%.
Public Health Measures
National level
i. Border counties are encouraged to heighten surveillance activities at PoEs and border communities due to
reported outbreak of Rift Valley fever in Niger.
ii. Counties encouraged to collect adequate samples for bacteriology testing from all suspected cases of cholera and
bloody diarrhea with appropriate specimen collection kits.
iii. Preparations are underway for IDSR National Training of Trainers.
iv. Counties are encouraged to collect oral swab and report appropriately
County Level



Information sharing is continuing between Nimba County Health Team and neighboring country (Guinea).
Active surveillance ongoing at all border crossings, communities and health facilities.
Health education ongoing for Cholera, Measles and other notifiable diseases.
Diarrhea Diseases
Clinical management of all suspected bloody diarrhea cases reported were prioritized in those counties with
cases.
Maternal and Neonatal deaths
 Maternal and newborn death review ongoing in Counties.

Vaccine Preventable Diseases
 Investigation and management of suspected Neonatal Tetanus cases from Montserrado County are ongoing.
Human Exposure to Animal Bite
 Cases of animal bites (suspected human rabies) received post-exposure prophylaxis (anti-rabies vaccine) in
affected counties.
Lassa fever

Patient was isolated and managed.
Note

Completeness refers to the proportion of health facilities in the country that reported during the week.

Timeliness of report is based on the proportion of health facilities that submitted reports on or before 12 noon
every Monday to the Division of Disease Prevention and Control (DPC), Ministry of Health (MoH).

Non-polio AFP rate is calculated by dividing the number of reported non-polio AFP cases by the expected cases
per 100,000 populations under 15 years of age.

Non-measles febrile rash illness rate refers to the proportion of discarded cases per 100,000 population.

Annualized maternal mortality ratio refers to the maternal mortality ratio of a given period less than one year and
it is the number of maternal deaths per 100,000 live births.

Epi-linked refers to any suspected case that has not had a specimen taken for serologic confirmation but is linked
to a laboratory confirmed case.

Compatible case refers to a suspected measles case that is not epidemiologically linked to any lab confirmed case
and whose specimen was not tested for laboratory confirmation.

Confirmed case refers to a case whose specimen has tested positive on laboratory testing.

Case Fatality Rate (CFR) is the proportion of deaths among confirmed cases.
7
Liberia IDSR Epidemiology Bulletin
2016 Epi Week 44 (October 31 - November 6)
Epidemiological bulletin published with support of WHO and CDC
For comments or questions, please contact
Thomas K. Nagbe, PA DIP, BSC, MPH
Director, Disease Prevention and Control
National IHR Focal Point
Ministry of Health
Republic of Liberia
Email: [email protected]
Phone: 0886 937386/0777442444
8
Liberia IDSR Epidemiology Bulletin
2016 Epi Week 44 (October 31- November 6)
Cumulative
Reported
57
0
322
Cumulative
Confirmed
0
0
0
D
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
D
D
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
A
0
1
0
0
0
0
0
0
0
0
0
4
0
0
0
5
D
9
1
0
2
0
0
0
6
7
6
53
22
1
6
3
116
A
2
0
0
0
0
0
1
0
0
0
0
0
0
0
0
3
D
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
A
0
0
0
19
0
0
0
0
0
0
0
0
0
0
0
19
D
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
258
442
18
6
22760
6233
37
3
737
3
10
6
2
1
0
0
0
0
A
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
D
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
2
0
1
2
0
1
0
0
0
1
8
D
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
A
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
147
2
911
8
66
28
924
7
24
1
0
0
0
0
0
8
4
599
5
0
0
Other
Diseases/Events
A
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yellow Fever
D
1
1
0
1
0
2
0
1
0
3
8
0
0
0
0
17
A
0
0
0
3
0
0
2
0
1
0
3
0
0
0
0
9
9
VHF (including EVD)
D
1
0
0
0
0
0
0
1
1
0
0
1
0
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Note: A = Alive, D = Dead
A
D
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
A
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Neo-Natal Tetanus
Measles
Lassa Fever
Human Exposure to
Rabies
D
Neonatal Mortality
A
1
0
0
0
0
0
1
0
3
0
0
0
1
0
0
6
Maternal Mortality
D
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Meningitis
A
0
1
0
0
0
0
0
0
0
0
0
1
0
0
0
2
Bomi
Bong
Gbarpolu
Grand Bassa
Grand Cape Mount
Grand Gedeh
Grand Kru
Lofa
Margibi
Maryland
Montserrado
Nimba
Rivercess
River Gee
Sinoe
Total Weekly
Cholera
4
8
5
8
5
6
5
6
4
6
7
6
6
4
10
90
Bloody Diarrhoea
No. of Health
District reported
4
8
5
8
5
6
5
6
4
6
7
6
6
4
10
90
Counties
AFP
No. of Health
Districts
Appendix 1: Summary of suspected cases and conditions by County during Epi week 44 and cumulative numbers, Liberia, 2016