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COVID-19, Yellow fever, Lassa fever, three other infectious diseases Nigeria battled in 2020

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Nigeria battles various communicable diseases annually, some of which are vaccine-preventable and on the national priority list for eradication.

The country usually experiences yearly outbreaks that peak during the dry season from November to May.

Cases have been rising rapidly over the past few years, with each year’s outbreak surpassing the last, but with the outbreak of COVID-19 in 2020, it was a different story.

Infecting over 100,000 people in Nigeria and killing over 1,300 since it began spreading about a year ago in Africa’s most populous nation, the COVID-19 pandemic turned the clock back by years in the fight against other infectious diseases. It has interrupted research, trials and other efforts to ease the public health burden.

Nigeria, in 2020, had an unprecedented spate of deaths from some infectious diseases as more focus was channelled towards tackling coronavirus. Aside COVID-19, suspected cases of Yellow fever and Lassa fever claimed nearly 500 people across the country.

There were spates of strange deaths in the year in review, which could not fully be diagnosed, partyly due to priority given to COVID-19.

Just as it affected the economy and almost every facet of life, the pandemic also disrupted efforts to end several non-communicable diseases.

Researchers warned that with disruptions in distribution of long-lasting insecticidal nets due to COVID-19, cases of malaria might increase by 206 million and malaria deaths by 379,000 in sub-Saharan Africa. Scientists also predicted that deaths related to HIV could increase by 10 per cent, tuberculosis by up to 20 per cent and malaria by 36 per cent over the next five years.

Nigeria had been preparing for a pandemic, especially after the Ebola incursion in 2014, but the COVID-19 seems to be the greatest test the country’s health system has faced.

PREMIUM TIMES takes a look at five major infectious diseases that rattled Nigeria in 2020.

COVID-19

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The novel coronavirus was first detected in Nigeria on February 27, in an Italian engineer that travelled from Milan via Istanbul to Lagos on Turkish Airlines.

It took another 11 days for the second case to be confirmed in the country, a contact of the Italian national, on March 9.

The WHO and health professionals had warned African countries to consider shutting their skies and borders against an impending importation of the virus from European and Asian nations where the disease had started to spread.

Nigeria appeared not to have heeded that advice until the country’s caseload was at least 30. International flights were still operating despite rising cases overseas, making Nigeria particularly vulnerable.

On March 21, when the Nigerian government announced it would close its two main international airports in the cities of Lagos and Abuja, 10 additional cases were announced.

The disease went ahead to spread to all 36 states across the country, peaking in June with the country’s highest daily COVID-19 cases of 745 at the time recorded on June 19.

Daily infections plateaued from early August until early December when the second wave began.

The second wave of the coronavirus has continued to sweep across Nigeria with 1, 270 new infections recorded in 22 states across the country on Tuesday.

On Sunday, Nigeria crossed the grim milestone of over 100, 000 infections as health officials call for stricter enforcement of safety measures.

The 1, 270 new cases on Tuesday pushed the total number of infections in the country to 101,331.

One in every six persons (16 per cent) tested for COVID-19 in Nigeria in the past two weeks tested positive for the virus, indicating how far the virus has spread.

PREMIUM TIMES’ review of official data showed that Nigeria set a weekly record of reporting about 10, 000 cases last week.

The spike in infections is also feeding through into fatalities. Twelve people died from the disease on Monday, taken the death toll to 1,373 in total.

In the past 25 days, there have been 161 fatalities as a result of COVID-19 complications in Nigeria.

The government blamed the increasing deaths on late referral of COVID-19 patients to treatment centres.

But health experts believe the lowering of guard on safety and the weak enforcement of protocols, especially in the country’s major airports in Abuja and Lagos, could be responsible for the recent surge, warning that the situation could get worse if citizens keep violating safety protocols.

Active cases in the country rose sharply from about 3,000 about a month ago to about 20, 000, due to a rise in new infections.

Of the over 102,000 cases so far, 81,574 patients have been discharged from hospitals after treatment.

Yellow fever

Since September 2017, when the first case of yellow fever was rediscovered in Kwara State, the country has been recording cases of the disease.

The year 2020, however, witnessed an unprecedented surge in cases and deaths especially in new frontiers.

In early October last year, reports emerged of multiple deaths from a ‘strange disease’ in Enugu and Delta states.

The authorities in Enugu and Delta reportedly put the figure of strange deaths in the states at 50 and 22 respectively as of early November, 2020.

The Director-General of the Nigeria Centre for Disease Control (NCDC), Chikwe Ihekweazu, in a statement on November 8, said initial investigations confirmed the strange disease was Yellow Fever.

The fatalities were unprecedented for both states. According to NCDC data detailing trends of Yellow Fever outbreaks from 2018 to early 2020, both states, until last year, had reported only a few cases, with no fatalities.

Following the emergencies, the state governments, mid-November, flagged off a ‘massive Yellow Fever vaccination’ campaign.

While the disease was also spreading in other states amid the fight against COVID-19, Enugu and Delta reported the most cases in the 2020 Yellow Fever outbreak.

According to the latest NCDC Yellow Fever situation report from January 1 to December 25, cases were reported in 13 states including Akwa Ibom, Bauchi, Benue, Borno, Delta, Ebonyi, Enugu, Gombe, Kogi, Osun, Oyo, Plateau and Taraba.

A total of 3,112 suspected cases and 109 confirmed cases were reported from 30 LGAs in the 13 states. A total of 17 deaths was recorded among the confirmed cases with a (Case Fatality Rate) CFR of 17 per cent from Enugu (9), Delta (6), Bauchi (1) and Ebonyi (1).

Meanwhile, there were 249 deaths overall from suspected yellow fever infections, the highest yearly tally since the resurgence of the disease in 2017.

Yellow Fever is an acute viral hemorrhagic disease that can kill within 10 days if symptoms become severe.

Nigeria’s earliest outbreak of the fever was reported in Lagos in 1864, with subsequent regular outbreaks reported until 1996.

No confirmed cases were then reported for 21 years, until September 2017 when the viral infection was rediscovered in Kwara State.

The Yellow Fever vaccination was introduced in Nigeria in 2004 as one of the routine vaccines expected to be given to children during routine immunisation. In spite of this, the country is still witnessing outbreaks of the disease.

The increasingly regular occurrence of outbreaks is largely because many people are not immunised, according to the NCDC. Vaccine hesitancy — a reluctance or refusal to be immunised — was named by the World Health Organisation as one of the top 10 threats to global health in 2019.

Lassa fever

Vector of Lassa fever2017, 633 in 2018, and 833 in 2019, which was previously the year with the highest number of cases.

In total for 2020, 27 states recorded at least one confirmed case across 131 Local Government Areas. The predominant age-group affected is 21-30 years.

Meanwhile, no new healthcare worker was affected in the reporting week 52.

Cholera

Last year, Nigeria witnessed a drastic drop in cholera cases in the country. This could be largely connected to the immunisation campaign conducted by the government and international partners in cholera hotspots across the country.

Nigeria, through Gavi, the Vaccine Alliance, had benefited from the rollout of nearly 18 million doses of Oral Cholera Vaccine (OCV) which were shipped to 11 countries in 2018.

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It affects both children and adults and can kill within hours if left untreated.

NCDC figures for epidemiological week 50 showed that from January 1 to December 8, a total of 1,801 suspected cases with 55 confirmed cases were reported across the country.

This is far lower than what was obtained in the same reporting week of 2018 where the number of suspected cases was 50,662, with 956 confirmed cases and 1135 deaths and in 2019 when 3,499 suspected cases and 595 confirmed cases were reported.

However, the 95 fatalities recorded from the disease in 2020 is slightly higher than the 71 deaths in 2019.

Some of the states where cholera incidence and deaths were reported are Ogun, Adamawa, Bauchi, Kastina among others.

If Nigeria can continue with the trend of reduction in cholera cases in the country, it might be able to achieve the 2030 Global Roadmap aimed to reduce cholera deaths by 90 per cent and eliminate transmission in up to 20 countries.

Measles

The outbreak of measles in Nigeria in 2019 dwarfed that of 2020.

According to the NCDC situation report on measles, as of week 50, there were 25,370 suspected cases and 2,470 confirmed positive cases in 2020.

Meanwhile, in 2019 Nigeria recorded one of its annual sharpest rise in measles infections with 61,438 suspected cases with 22,361 confirmed positive cases.

A total of 134 people died from measles in 2020, a relatively low figure compared to the 286 deaths recorded in 2019.

WHO, in its global measles report for 2020, said the eradication of the disease has suffered a setback globally as many countries focused more attention on tackling COVID-19.

Measles is a vaccine-preventable disease; unfortunately, Nigeria and the world are struggling to eradicate it. Though the vaccine is safe and cost-effective, there were over 110,000 measles deaths globally, mostly among children under the age of five.

WHO advised routine measles vaccination for children, combined with mass immunisation campaigns so as to reduce the global death from the disease.

Cerebrospinal meningitis

Cerebrospinal Meningitis (CSM) is an acute inflammation of the membranes covering the brain and the spinal cord. It is a very serious infection that can lead to death if left untreated.

In 2020, only 13 deaths were recorded from Cerebrospinal meningitis, a very sharp decrease compared to the 103 people that died from the disease in 2019, according to NCDC data.

The number of deaths recorded from the disease has been on a decline in previous years, indicating that the response strategy to eradicate the disease is paying off.

Many state governments in 2020 prioritized vaccination as a precautionary measure to check the burden of the disease.

The disease which is synonymous with the dry season starts in December and peaks around March and April before subsiding in June/July every year. Nigeria had carried out a massive vaccination exercise during the 2017/2018 outbreak which claimed the lives of over 1,000 persons.

The epidemiological report from NCDC indicates that between January 1 and December 8, 2020, a total of 626 suspected cases with 14 confirmed cases were reported.

The cases reported are much lower when compared with 4,466 and 2, 077 suspected cases, 318 and 626 confirmed cases and 360 and 103 deaths reported during the same period in 2018 and 2019 respectively.

In preparation for the meningitis season, NCDC said the National CSM Technical Working Group (TWG) meets weekly to review reports from states and plans appropriately and surveillance has been enhanced in all states (with focus in states at higher risk).

Monkeypox

Monkeypox in the country was on the low last year as it was in the previous year.

Nobody died of the disease in 2020 while only two deaths were reported from the disease in 2019.

From January 1 to week 50 of 2020, 31 suspected cases and six confirmed cases were reported in a few states across the country. In 2019, 113 suspected cases and 44 confirmed infections were reported.

While there was no major outbreak of the disease in the country when compared to two years ago, the disease poses as an international threat as cases are being exported from Nigeria and other African nations to western climes.

Monkeypox is mostly transmitted to people from wild animals, but human to human transmission also occurs. The disease can be contracted if an individual comes in contact with lesions, body fluids, respiratory droplets and contaminated materials of an infected person.

According to WHO, the smallpox vaccine can protect against monkeypox. The agency has approved a new third-generation vaccine – vaccinia vaccine – for the prevention of smallpox and monkeypox. Antiviral agents are also being developed.

Response

Nigeria’s infectious disease agency (NCDC) provided a summary of ten major highlights of how it responded to infectious disease in the year 2020 as follows:

1. Provided support to states to respond to COVID-19 and other disease outbreaks through timely deployment of Rapid Response Teams, provision of medical and laboratory commodities and supplies, development of relevant guidelines and protocols etc.

2. Conducted COVID-19 household zero-prevalence survey to foster better understanding of the burden of the disease in Nigeria.

3. Established State Public Health Emergency Operations Centres (PHEOCs) in additional seven states as well as integration of two polio PHEOCs in Nigeria. Only two states in Nigeria do not have a PHEOC currently

4. Finalised Nigeria’s National Multi-Hazard Public Health Emergency Preparedness and Response Plan

5. Launched the 3rd edition of the National Integrated Disease Surveillance and Response guidelines

6. Fully deployed Surveillance Outbreak Response Management Analysis System (SORMAS) for digital surveillance to all the 774 LGAs across all the 36 States of the Federation including the FCT

7. Established infection prevention and control programmes at primary, secondary and tertiary health facilities including the military and paramilitary health facilities

8. Implemented various activities of the National Action Plan for Antimicrobial Resistance (AMR) with facilitation of National Technical Working group meetings

9. Established and activated new molecular laboratories across Nigeria. Every state in Nigeria has at least one public health laboratory with molecular testing capacity

10. Strengthened partnerships with local, regional and global institutions.

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