No District in either alert or epidemic phase for …...VOLUME 4 WEEK 46 17TH NOVEMBER, 2019 No...

VOLUME 4 WEEK 46 17TH NOVEMBER, 2019

No District in either alert or epidemic

phase for Meningitis

Circulating Vaccine Derived Type 2

Polio Virus (cVDPV2) Outbreak in the

Jaman North District-Bono Region,

Ghana

Summary of Weekly Epidemiological Data, Week 46, 2019

Ghana Weekly Epidemiological Report Vol. 4 Week 46 17 November 2019

i

The Ghana Weekly Epidemiological Report is a publication of the Ghana Health Service and the

Ministry of Health, Ghana

© Ghana Health Service 2019

ISSN - 2579-0439



ii

Acknowledgement

This publication has been made possible with technical and financial support from the Bloomberg Data

for Health Initiative (www.bloomberg.org), the CDC Foundation and the World Health Organisation

http://www.bloomberg.org/



1

Summary of Weekly Epidemiological Data for Week 46, 2019

Table 1: Ranking of Regional Performance based on selected Surveillance reporting indicators, Ghana, Week 46, 2019

Region

Timeli-

ness (%)

Week

46

A

Complete-

ness (%)

Week

46

B

Measles YF Average

Score %

(A+B+C+

D+E)/5

Cum.

AFP

Cases

Week 46

Annualized

Non-Polio

AFP Rate

AFP

Score

(%)

C

%

District

reporting

D

%

District

reporting

E

Position

Northern 100 100 97 4.0 100 100 100 100 1st

Upper East 100 100 41 4.3 100 100 100 100 1st

Brong-Ahafo 73.4 73.4 57 2.0 100 100 100 89.4 3rd

Upper West 62.3 62.3 40 7.8 100 100 100 84.9 4th

Greater Accra 49.2 49.2 69 1.8 89 100 100.0 77.5 5th

Ashanti 44 44 72 2.0 100 100 96.7 76.9 6th

Volta 41.1 41.1 54 3.4 100 100 100 76.4 7th

Western 33.5 33.5 49 3.0 100 100 100 73.4 8th

Central 47.2 47.2 51 3.2 100 90.0 75.0 71.9 9th

Eastern 33.3 33.3 36 1.7 83 100 92.3 68.4 10th

Ghana 50.7 50.7 566 2.6 100 99.0 96.4 79.4

Highlights:

No District hits either alert or epidemic threshold for Meningitis

SUMMARY OF PRIORITY

DISEASES AND EVENTS - WEEK

46, 2019

The total all-cause notifiable disease

morbidity for the week (as per IDSR

Weekly Summary Reporting Form)

was 909 with three maternal deaths.

Influenza-like Illnesses has the largest

numbers contributing 66% of the

notifiable diseases’ caseload during

Week 46 [See Figure 1 and Annex 1]

Figure 1: Reported cases/notifiable disease conditions, Ghana, Week 46, 2019

7

9

11

36

47

191

608

0 200 400 600 800

Meningitis

AFP (suspected polio)

Yellow fever (suspected)

Diarrhoea with blood

Measles

Acute watery diarrhoea in persons aged …

Influenza-like illness

Number of Cases

Dis

ease

/Hea

lth

Even

t

REGIONAL PERFORMANCE BASED ON

REPORTING

Northern and Upper East with the perfect score of 100% were the best

performing regions in the week under review whilst Eastern region was

the least performing with a mean score of 68.4%. All regions achieved

the expected targets (70.8%) for percentage of districts reporting at

least a suspected case of either Measles or Yellow Fever [Table 1].

Timeliness and Completeness of reporting for all

notifiable conditions for the Week were both

50.7% and was below the expected target (85%)

due to technical challenges with the District

Health Information Management Systems

(DHIMS).

.

.



2

INFLUENZA-LIKE ILLNESS (IDSR Weekly

Report)

A total of 608 cases with no deaths were reported

through IDSR weekly reporting [Table 2]. Laboratory

samples were sent from sentinel sites to Noguchi

Memorial Institute for Medical Research (NMIMR) for

testing and awaiting results.

Table 2: Reported Influenza-Like Illness cases by

Region and District, Ghana, Week 46, 2019

Region District Cases Deaths

Brong-Ahafo Sunyani 12 0

Central Mfantseman 71 0

Greater Accra Accra 22 0

Ada East 11 0

Ashaiman 11 0

Ga Central 7 0

Ga East 1 0

La-Dade-Kotopon 4 0

La-Nkwantanang-Madina 93 0

Shai-Osudoku 192 0

Tema 179 0

Upper East Bolgatanga 4 0

Total 608 0

CHOLERA

No cholera case was reported during the Week.

MEASLES

During the Week, 47 cases of suspected Measles were recorded

across the country [Table 3]. Samples were taken and sent to the

National Public Health and Reference Laboratory [NPHRL] for

testing and awaiting results.

Table 3: Suspected Measles cases by Region and District,

Ghana, Week 46, 2019 Region District Cases Deaths

Ashanti Afigya-Kwabre 1 0

Atwima Mponua 1 0

Kumasi 3 0

Brong Ahafo Abura-Asebu-Kwamankese 1 0

Asunafo North 1 0

Asutifi North 1 0

Atebubu-Amanten 1 0

Dormaa West 1 0

Kintampo North 1 0

Nkoranza North 2 0

Wenchi 1 0

Sunyani 3 0

Eastern Asuogyaman 2 0

Birim Central 1 0

East Akim 1 0

Kwahu East 1 0

Kwaebibirem 3 0

Yilo-Krobo 1 0

Suhum 1 0

Kwahu South 1 0

Greater-Accra Accra 1 0

Ga East 2 0

Ledzokuku-Krowor 2 0

Lower Manya-Krobo 1 0

Shai-Osudoku 1 0

Upper West Lambussie-Karni 1 0

Sissala West 2 0

Wa 1 0

Upper East Pusiga 1 0

Volta Akatsi South 1 0

Ho 1 0

Kpando 1 0

North Tongu 1 0

Ketu South 2 0

Western Tarkwa-Nsuaem 1 0

Total 47 0

Table 4: Meningitis cases and deaths by Region, Ghana, Week 46, 2019

Region Cases Cerebrospinal

Fluid (CSF)

Cerebrospinal

Fluid (CSF) Lab

Test Positive

Deaths CFR

(%)

District in

Alert

District in

Epidemic

Ashanti 0 0 0 0 - 0 0

Brong-Ahafo 1 1 0 0 0 0 0

Central 0 0 0 0 - 0 0

Eastern 0 0 0 0 - 0 0

Greater Accra 0 0 0 0 0 0 0

Northern 2 2 0 0 0 0 0

Upper East 0 0 0 0 0 0 0

Upper West† 3 3 0 0 0 0 0

Volta 1 1 0 0 - 0 0

Western 0 0 0 0 - 0 0

Total (Ghana) 7 7 0 0 0 0 0

MENINGITIS

During the week, 7 cases of meningitis were recorded

with no deaths across the country. No district was in

either alert or epidemic phase. Lumbar Punctures were

done for all cases [Table 4].

NEONATAL TETANUS

One case of neonatal tetanus was reported during the

week in the New Juaben Municipality

.



3

ACUTE FLACCID PARALYSIS (SUSPECTED

POLIOMYELITIS) Nine cases of Acute Flaccid Paralysis (AFP) were reported

in Week 46 [Table 7]. The stool specimens were tested at the

Polio Laboratory at NMIMR and were negative for wild

poliovirus.

Table 7: Suspected Polio cases by Region and District,

Ghana, Week 46, 2019

Region District Cases Death

Ashanti Sekyere Central 1 0

Brong Ahafo Techiman South 1 0

Greater-

Accra Tema 1 0

Western Bia West 1 0

Upper West Sissala West 1 0

Upper East Builsa 1 0

Bolgatanga 1 0

Nabdam 2 0

Total 9 0

Summary on Acute Flaccid Paralysis (AFP)

Indicators, Week 1 – 46, 2019

Eastern (1.7) and Greater Accra (1.9) remain the only two

regions which failed to achieve the annualized Non-Polio

AFP rate of 2.0 per 100,000 population less than 15 years

as at the end of Week 46 [Table 8]. All regions achieved

timeliness and adequacy of stool received by the

laboratory except Greater Accra (78.5%) which failed to

achieve for the expected target.

.

Table 8 Summary on Acute Flaccid Paralysis Surveillance, Ghana, Week 1 – 46, 2019

Region

Population

Under 15

years

Expected

Non-

Polio

AFP for

the year

Reported

AFP Compatible Discarded

cVDPV

Annualized

Non-Polio

AFP Rate

%

Timely

Stools

%

Adequate

Stools

Ashanti 2,466,042 72 72 1 65 0 2.0 91.2 89.5

Brong-Ahafo 1,197,324 59 57 0 51 1 2.0 85.7 83.8

Central 1,076,556 33 51 0 46 0 3.2 96.6 96.6

Eastern 1,384,726 42 36 0 31 0 1.7 96.0 92.0

Greater Accra 2,351,371 73 69 0 57 0 1.8 78.5 78.5

Northern 1,280,890 39 97 1 69 7 4.0 89.6 89.6

Upper East 534972.06 17 41 0 32 0 4.3 96.0 96.0

Upper West 349836.06 11 40 0 38 0 7.8 94.1 94.1

Volta 1095858.96 33 54 0 49 1 3.4 86.8 86.8

Western 1299165.84 36 49 0 48 0 3.0 87.5 84.6

Ghana 13,036,742 415 566 2 486 9 2.6 89.4 88.9

*Circulating Vaccine-Derived Polio Virus

MATERNAL DEATHS

During Week 46, three maternal deaths were recorded, one

each in the New Juaben, Lower Manya-Krobo and Wa

Municipal [Table 5].

Table 5: Maternal deaths by Region and District, Ghana,

Week 46, 2019

Region District Cases

Ashanti New Juaben 1

Lower Manya-Krobo 1

Upper West Wa 1

Total 3

.

YELLOW FEVER

Eleven cases of suspected Yellow Fever were reported across

the country [Table 6]. Samples were sent to the National

Public Health and Reference Laboratory for testing and

awaiting results

Table 6: Suspected Yellow Fever cases by Region, Ghana,

Week 46, 2019

Region District Cases Deaths

Ashanti Atwima Mponua 1 0

Brong Ahafo Techiman South 1 0

Eastern East Akim 1 0

Suhum 1 0

Greater-Accra Ga South 1 0

Upper East Asutifi North 1 0

Builsa 1 0

Talensi 1 0

Upper West Jirapa 1 0

Nadowli-Kaleo 1 0

Western Wassa East 1 0

Total 11 0

.

HUMAN RABIES

No case of Human Rabies was recorded in Week 46.

.



4

ANNEX 1: SUMMARY OF REPORTED CASES/ EVENTS: WEEK 46 (WEEK ENDING 17 NOVEMBER 2019)

Disease/Health Event

(suspected/confirmed)

Week 45 Week 46 Cumulative to Week 46

Cases

(susp)

Deaths CFR

(%)

Cases

(susp)

Deaths CFR

(%)

Cases

(susp)

Deaths CFR

(%)

AFP (suspected polio) 14 0 0 9 0 0 566 0 0

Acute haemorrhagic

fever syndrome

0 0 0 0 0 0 0 0 -

Adverse events

following immunization

0 0 0 0 0 0 281 0 0

Anthrax 0 0 0 0 0 0 0 0 -

Acute watery diarrhoea

in persons aged ≥5 years

510 0 0 191 0 0 41,118 0 0

Cholera 0 0 0 0 0 0 0 0 -

Dengue fever 0 0 0 0 0 0 0 0 -

Diarrhoea with blood 36 0 0 36 0 0 1,840 0 0

Dracunculiasis (Guinea

worm)

0 0 0 0 0 0 0 0 -

Influenza-like illness 934 0 0 608 0 0 21,629 0 0

Maternal deaths - 2 - - 3 - 93 -

Measles 50 0 0 47 0 0 2,193 0 0

Meningitis 17 0 0 7 0 0 869 23 2.7

Neonatal tetanus 0 0 0 0 0 0 12 3 25.0

Plague 0 0 0 0 0 0 0 0 -

Public health event of

international concern

(PHEIC)

0 0 0 0 0 0 0 0 -

Human rabies 0 0 0 0 0 0 8 8 100

SARS 0 0 0 0 0 0 0 0 -

Smallpox 0 0 0 0 0 0 0 0 -

Yellow fever (suspected) 14 0 0 11 0 0 3,005 0 0

NATIONAL TOTAL 1,575 2 0.1 909 3 0 71,521 127 0.1

*CFR does not include maternal deaths

This report and subsequent ones should be shared with regional and district heads as well as heads of other agencies.

A feedback addressed to the Editor-In-Chief is welcome

Circulating Vaccine-Derived Type 2 Polio Virus (cVDPV2) Outbreak in Jaman North District


5

Circulating Vaccine Derived Type 2 Polio Virus (cVDPV2)

Outbreak in the Jaman North District-Bono Region, Ghana

INTRODUCTION

The Bono Regional Health Directorate was notified of

laboratory confirmation of cVDPV2 in a two-year-old girl

diagnosed as a case of Acute Flaccid paralysis on 13

November 2019. A team was immediately constituted to

investigate the outbreak with the objective to gather

epidemiological, environmental and other clinical

information, and further initiate response to the outbreak.

INVESTIGATION

On receipt of the laboratory results on the 13 November

2019, the Regional Health Directorate convened an

emergency meeting on the 14 November to hold

discussions to conduct further epidemiological and

environmental investigations. Two teams were

subsequently formed to visit the two communities (one to

Asiri in the Jaman North district where the case lived and

the second team to Sunyani Municipality, where the case

resided since the onset of the illness on the 17 October

2019). Interviews were conducted with relatives of the

child, health workers, and members of the community.

The teams reviewed medical records and searched for

cases in the communities based on a working case

definition at the health facility and community level.

There was also an environmental assessment as part of the

investigation.

A section of the Emergency team meeting to discussing the response

measures to be taken

FINDINGS

Case History

According to the mother of the index case, on 16 October

2019 the female twin (2 years of age) woke up with fever

and a day later she was unable to walk. The child was sent

to the nearby health facility, Asiri Health Centre. On 17

October 2019 the child and mother reported to Dawiri

CHPS compound with a history of loss of appetite, joint

pains and inability to walk and further complaints of

cough and fever. An initial diagnosis of malaria and

respiratory tract infection was made after the malaria

rapid diagnostic test proved positive and given

antimalarial medication and analgesics. With no

improvement in her condition, mother sent her to Sunyani

on 23 October, 2019 for further treatment. On the 24

October 2019, on a self-referral basis, the child was seen

at the Dexter Medical Centre where an impression of AFP

was made and duly reported to the Sunyani Municipal

Health Directorate. The Municipal Health team then

referred the child to a paediatrician for specialist

management and also took two stool samples on the 24

and 25 October 2019 to the Polio laboratory at Noguchi

Memorial Institute for Medical Research (NMIMR) in

Accra for laboratory investigations.

Hospital Records Appraisal and Immunization Survey A review of the OPD and consulting room register at both

Dawiri CHPS and Asiri Health Center did not indicate any

missed AFP cases. The immunization records from 2016

to date were not completed to allow an evaluation of

children vaccinated against poliovirus and their

immunization status. An evaluation of the cold change

management system revealed some short gaps: the

refrigerator for the vaccine storage was that of a domestic

type which was not well regulated and temperature

monitoring chart not updated. There was no child out of

the 40 households randomly visited in search of children

with symptoms of paralysis. The parents could not

produce the child’s immunization records even though

response was positive when asked about child

immunization. The child had the BCG scar as evidence of

having received immunization.

Residence of the index-case patient

The family resided in 6 room house in Asiri in the Jaman

North. The house was equipped with a pit latrine

constructed behind the house which is used by only adults

with exception of the children who used chamber pots.

The building is near a bushy area where people practice

open defecation. In addition, there is a small gutter at the

back of the house where water runs through whenever it

rains. There is a community bore hole which serves part

of the community members although there is a river in

community but is not used. The area in which they lived

do not have access to pipe borne and all the people

depended on a well at a house nearby. There are five (5)

households in the house made up of five (5) males and ten

(10) females among which are 3 children under fifteen

years old. The people residing in the house use one water

closet toilet.

CONCLUSIONS

A case of circulating Vaccine Derived Polio Virus has

been detected in a two-year female resident in the Asiri

Community in the Jaman North District of the Bono

Region. The onset of the polio disease was on 16 October

2019 and the clinical examination of the child on the 14

November 2019 found a hemiplegic gait in the left lower

limb. The cause of the neurological deficit has been

confirmed by laboratory investigations to be due to

Circulating Vaccine Derived Type 2 Polio Virus

(cVDPV2). The poor environmental conditions within the

Asiri Community is possibly a contributory factor to the

infection in the case.

Circulating Vaccine-Derived Type 2 Polio Virus (cVDPV2) Outbreak in Jaman North District


6

PUBLIC HEALTH ACTIONS

National and regional teams had supported the district to

undertake an investigation of the outbreak. There were

regular district public health emergency committee

meetings. All sub-districts have been informed of the

outbreak and AFP surveillance heightened. The

community has been sensitized on routine vaccination,

WASH and risk communication. Logistics from the

National Public Health Reference Laboratory for AFP

surveillance have been supplied to the Government

Hospital, including 100 stool sample containers with

corresponding zip lock bags and one roll of cotton wool.

RECOMMENDATIONS

National

1. Conduct Outbreak Response Vaccination using

mOPV2 in the Bono East Region

2. Plan for nationwide Inactivated Polio Vaccine

catch-up campaign early 2020

3. Build capacity of staff on Polio Surveillance

4. Engage media and careful sensitization of the

public without causing undue panic to contain

the outbreak

Bono East Region and Jaman North District 1. Refresher training for all staff on AFP

surveillance

2. Enhancement of surveillance in all districts and

all communities

3. Standard procedures for transporting AFP stool

and other surveillance samples to NMIMR

4. Community sensitisation on cause,

transmission and prevention of Polio and other

vaccine-preventable diseases

ACKNOWLEDGMENTS

Director, Public Health Division and team

World Health Organisation, Ghana Country Office

Noguchi Memorial Institute for Medical Research

National Public Health and Reference Laboratory

CDC, Ghana Country office

FELTP Programme, SPH

Regional Director of Health Services and team,

Bono Region

Jaman North District Health Directorate

Editorial Board & Team


7

Editorial Board

Dr. Anthony Nsiah-Asare

Dr. Badu Sarkodie

Dr. Michael Adjabeng

Dr. Emmanuel Kofi Dzotsi

Dr. Kwame Amponsa-Achiano

Dr. David Opare

Dr. Franklin Asiedu-Bekoe

Mr. Kwame Kodom Achempem

Mr. James Addo

Mr. Isaac Baffoe-Nyarko

Prof. Kwadwo Koram

Dr. Ivy Frances Osei

Dr. Ernest Kenu

Dr. Phyllis Antwi

Ms. Selina Ababio

Dr. Dennis Laryea

Dr. Sally-Ann Ohene

Dr. Chastity Walker

Editorial Team

Editor

Mr. Gideon Kwarteng Acheampong

Managing Editor

Mr. Kwame Acheampong Owusu

Editor-In-Chief

Dr. Kenneth Ofosu-Barko

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