Analytical summary - Epidemic and pandemic-prone diseases
Disease epidemics are fuelled by factors common to developing countries such as displacement, environment mismanagement and frequent exposure to risk factors. Epidemic diseases have a significant impact on an already weak health system and, if not controlled, can spread quickly across borders.
Liberia has established a mechanism for early detection, confirmation, characterization and prompt information exchange through:
- implementation of a comprehensive Integrated Disease Surveillance and Response
- the county Emergency Preparedness Response Plans
- the revised International Health Regulation Framework.
The Ministry of Health and Social Welfare has established a weekly and monthly surveillance reporting system on diseases of epidemic potential to provide prompt early warning, investigation, preparedness and response. These diseases include acute flaccid paralysis, measles, acute watery diarrhoea (possibly cholera), bloody diarrhoea, meningitis, neonatal tetanus, H1N1 virus, rabies, yellow fever, haemorrhagic fever (Lassa fever), severe acute respiratory distress syndrome and guinea-worm disease.
During phases one and two of implementation of the Essential Package of Health Services, interventions will focus on:
- mapping and risk assessment to identify areas at risk of epidemic-prone diseases;
- strengthening early warning systems;
- strengthening laboratory capacity;
- identifying new factors that will facilitate the emergence and transmission of epidemic-prone diseases through operational research.
The surveillance system in the health sector is moving towards an integrated approach. This approach envisages all surveillance activities in the country as a common public service that carries out many functions using similar structures.
The structure of the surveillance system is based on reporting of cases of priority diseases from community level to health facility, district, county and central level. This is intended to keep central level informed of the occurrence of priority diseases as well as newly emerging diseases with high case fatality and also disseminate information back to the community level.
From 2006 to the present (2011), reported cases of cholera, yellow fever and other epidemic diseases have continued to fall. For example, the number of suspected cholera cases reported decreased from nearly 4500 in 2006 to almost 1000 cases in 2008 (Figure 1). Contrary to the reduction of cholera cases, suspected cases of yellow fever increased from 30 cases in 2006 to 85 in 2008 (Figure 2). Other cases of diseases also saw declining trends since 2006.
During 2010, a total of 3268 suspected cases of priority diseases under active surveillance were reported to the Ministry of Health and Social Welfare through the surveillance officers of the 15 counties. Suspected case samples were collected for laboratory confirmation; 57 were confirmed positive by laboratory diagnosis and 52 deaths were reported related to priority diseases.
Measles constituted a higher proportion of the suspected, confirmed and death cases reported compared with other priority diseases. In 2010, there were 1624 suspected measles cases reported from January to November, compared with 1435 cases of cholera and Lassa fever. With regard to confirmed cases, measles (34 confirmed cases) constituted 59.6% of the 57 confirmed cases of priority diseases reported from January to November 2010, while Lassa fever (12 confirmed cases) constituted 21%.