-
Electronic Reporting of Integrated Disease Surveillance and Response: Lessons Learned from Northeast, Nigeria, 2019
Authors: Luka Mangveep Ibrahim, Ifeanyi Okudo, Mary Stephen, Brazzaville, Congo Opeayo Ogundiran, Jerry Shitta Pantuvo, Daniel Rasheed Oyaol, Sisay Gashu Tegegne, Abdelrahim Khalid, Elsie Ilori, Olubunmi Ojo, Chikwe Ihekweazu, Fiona Baraka, Walter Kazadi Mulombo, Clement Lugala Peter Lasuba, Peter Nsubuga
Read Abstract | Read ArticleElectronic reporting of integrated disease surveillance and response (eIDSR) was implemented in two states in North-East Nigeria as an innovative strategy to improve disease reporting. Its objectives were to improve the timeliness and completeness of IDSR reporting by health facilities, prompt identication of public health events, timely information sharing, and public health action. We evaluated the project to determine whether it met its set objectives. Method: We conducted a cross-sectional study to assess and document the lessons learned from the project. We reviewed the performance of the Local Government Areas (LGAs) on rumors identication and reporting of IDSR data on the eIDSR and the traditional system using a checklist. Respondents were interviewed online on the relevance; eciency; sustainability; project progress and effectiveness; effectiveness of management; and potential impact and scalability of the strategy using structured questionnaires. Quantitative data were analyzed and presented as proportions using an MS Excel spreadsheet. Qualitative data was cleaned, converted into an MS Excel database, and analyzed using Epi Info version 7.2 to obtain frequencies. Responses were also presented as direct quotes or word clouds. Results: The number of health facilities reporting IDSR increased from 103 to 228 (117%) before and after implementation of the eIDSR respectively. The completeness of IDSR reports in the last six months before the evaluation was ≥ 85%. Of the 201 rumors identied and veried, 161 (80%) were from the eIDSR pilot sites. The majority of the stakeholders interviewed believed that eIDSR met its predetermined objectives for public health surveillance. The benets of eIDSR included timely reporting and response to alerts and disease outbreaks, improved completeness, and timeliness of reporting, and supportive. supervision to the operational levels. The strategy helped the stakeholders to appreciate their roles in public health surveillance. Conclusion: The eIDSR increased the number of health facilities reporting IDSR, enabled early identication, reporting, and verication of alerts, improved completeness of reports, and supportive supervision on staff at the operational levels. It was well accepted by the stakeholder as a system that made reporting easy with the potential to improve the public health surveillance system in Nigeria.
-
Field notes from the Nigeria Centre for Disease Control 2019 pilot internship program for resident doctors
Authors: Oluwatomi Funbi Iken, Kelly Elimian, Chinwe Ochu, Chikwe Ihekweazu
Read Abstract | Read ArticleThe 10-week internship for the pilot cohort of resident doctors fromvarious teaching hospitals in Nigeria was a very rewarding experience. Theinternship was a beautiful immersion into field epidemiology, rumorsurveillance, risk communication, digital tools for surveillance, developingstrategic documents, line lists interpretation, weekly presentations andoutbreak response coordination alongside working briefly as an incident managerfor the Yellow Fever technical working group. Some of the learning points included:meeting coordination, contributions to ongoing research, review of trainingdocuments for surveillance officers and the mechanisms of escalating andde-escalating technical working groups in the face of outbreaks and working asan incident manager. There is the need to continue this internship tostrengthen the capacity of our emerging health workforce in residency trainingto address our public health priorities in Nigeria
-
A rapid assessment of the implementation of integrated disease surveillance and response system in Northeast Nigeria, 2017
Authors: Luka Mangveep Ibrahim1, Mary Stephen, Ifeanyi Okudo, Samuel Mutbam Kitgakka, Ibrahim Njida Mamadu, Isha Fatma Njai, Saliu Oladele, Sadiq Garba, Olubunmi Ojo, Chikwe Ihekweazu, Clement Lugala Peter Lasuba, Ali Ahmed Yahaya, Peter Nsubuga and Wondimagegnehu Alemu
Read Abstract | Read ArticleIntegrated diseasesurveillance and response (IDSR) is the strategy adopted for public healthsurveillance in Nigeria. IDSR has been operational in Nigeria since 2001 butthe functionality varies from state to state. The outbreaks of cerebrospinalmeningitis and cholera in 2017 indicated weakness in the functionality of thesystem. A rapid assessment of the IDSR was conducted in three northeasternstates to identify and address gaps to strengthen the system. Method: Thesurvey was conducted at the state and local government areas using standardIDSR assessment tools which were adapted to the Nigerian context. Checklistswere used to extract data from reports and records on resources and tools forimplementation of IDSR. Questionnaires were used to interview respondents ontheir capacities to implement IDSR. Quantitative data were entered into an MSExcel spreadsheet, analysed and presented in proportions. Qualitative data weresummarised and reported by thematic area. Results: A total of 34 respondentsparticipated in the rapid survey from six health facilities and six localgovernment areas (LGAs). Of the 2598 health facilities in the three states,only 606 (23%) were involved in reporting IDSR. The standard case definitionswere available in all state and LGA offices and health facilities visited. Only41 (63%) and 31 (47.7%) of the LGAs in the three states had rapid response teamsand epidemic preparedness and response committees respectively. The DiseaseSurveillance and Notification Officers (DSNOs) and clinicians’ knowledge werelimited to only timeliness and completeness among over 10 core indicators forIDSR. Review of the facility registers revealed many missing variables; thecommonly missed variables were patients’ age, sex, diagnosis and laboratoryresults. Conclusions: The major gaps were poor documentation of patients’ datain the facility registers, inadequate reporting tools, limited participation ofhealth facilities in IDSR and limited capacities of personnel to identify,report IDSR priority diseases, analyze and interpret IDSR data for decisionmaking. Training of surveillance focal persons, provision of IDSR reportingtools and effective supportive supervisions will strengthen the system in thecountry.
-
Identification of co-circulating pathogens that are clinically indistinguishable from Lassa Fever during the 2018 Lassa outbreak in Nigeria
Authors: J. Ashcroft, E. Ndodo, C. Dannwafor, B. Gannon, H. Bagnall, N. Mba, E. Ilori, A. Olayinka, C. Ihekweazu
Read Abstract | Read ArticleResults from thisstudy indicate that there was no one specific pathogen responsible for patientsdeveloping clinical presentations indistinguishable from LF. Rather, a varietyof pathogens (both viral and bacterial) were found to be co-circulating at thetime of heightened LF transmission resulting in both single and co-infections(particularly in the immunocompromised).
Conclusion:We anticipate that this study willhelp ensure proper and expedited diagnosis of diseases in the differentialdiagnosis for LF, helping to target treatment of patients with both LF andnon-LF acute febrile illnesses in Nigeria.
-
52. Descriptive epidemiology of coronavirus disease 2019 in Nigeria, 27 February – 6 June 2020
Authors: K. O. Elimian, C. L. Ochu1, E. Ilori, J. Oladejo, E. Igumbor, L. Steinhardt, J. Wagai, C. Arinze, W. Ukponu, C. Obiekea, O. Aderinola, E. Crawford, A. Olayinka, C. Dan-Nwafor, T. Okwor1, Y. Disu1, A. YinkaOgunleye, N. E. Kanu, O. A. Olawepo, O. Aruna, C. A. Michael, L. Dunkwu, O. Ipadeola, D. Naidoo, C. D. Umeokonkwo, A. Matthias, O. Okunromade, S. Badaru, A. Jinadu, O. Ogunbode, A. Egwuenu, A. Jafiya, M. Dalhat, F. Saleh, G. B. Ebhodaghe, A. Ahumibe, R. U. Yashe, R. Atteh, W. E. Nwachukwu, C. Ezeokafor, D. Olaleye, Z. Habib, I. Abdus-Salam, E. Pembi, D. John, U. J. Okhuarobo, H. Assad, Y. Gandi, B. Muhammad, C. Nwagwogu, I. Nwadiuto, K. Sulaiman, I. Iwuji, A. Okeji, S. Thliza, S. Fagbemi, R. Usman, A. A. Mohammed, O. Adeola-Musa, M. Ishaka U. Aketemo, K. Kamaldeen, C. E. Obagha, A. O. Akinyode, P. Nguku, N. Mba and C. Ihekweazu
Read Abstract | Read ArticleTheobjective of this study was to describe the epidemiology of COVID-19 in Nigeriawith a view of generating evidence to enhance planning and response strategies.A national surveillance dataset between 27 February and 6 June 2020 wasretrospectively analysed, with confirmatory testing for COVID-19 done byreal-time polymerase chain reaction (RT-PCR). The primary outcomes werecumulative incidence (CI) and case fatality (CF). A total of 40 926 persons(67% of total 60 839) had complete records of RT-PCR test across 35 states and theFederal Capital Territory, 12 289 (30.0%) of whom were confirmed COVID-19cases. Of those confirmed cases, 3467 (28.2%) had complete records of clinicaloutcome (alive or dead), 342 (9.9%) of which died. The overall CI and CF were5.6 per 100 000 population and 2.8%, respectively. The highest proportion ofCOVID-19 cases and deaths were recorded in persons aged 31–40 years (25.5%) and61–70 years (26.6%), respectively; and males accounted for a higher proportionof confirmed cases (65.8%) and deaths (79.0%). Sixty-six per cent of confirmedCOVID-19 cases were asymptomatic at diagnosis. In conclusion, this paper hasprovided an insight into the early epidemiology of COVID-19 in Nigeria, whichcould be useful for contextualising public health planning.
-
Antimicrobial use and resistance in Nigeria: situation analysis and recommendations, 2017
Authors: Abiodun Egwuenu, Joshua Obasanya, Iruka Okeke, Oladipo Aboderin, Adebola Olayinka, Dooshima Kwange, Abiodun Ogunniyi, Estelle Mbadiwe, Love Omoniyei, Hamzat Omotayo, Mercy Niyang, Fatima Abba, Frank Kudla, AMR-TWG, Chikwe Ihekweazu
Read Abstract | Read ArticleIntroduction:it is projected that by 2050, 40% of 10million deaths from Antimicrobial Resistance (AMR) will occur in Africa.Understanding the AMR situation in Nigeria will provide an excellent case studyof the challenges faced by low-income countries.
Methods:the information was derived from reviewof reports, programmatic data and documents, literature search, key informantinterviews and a series of systematic reviews. Data was entered intopurpose-built templates and synthesized thematically.
Results:in Nigeria, the ratio of licensedpharmacies to over-the-counter medicine stores was 15 to 1 in 2016. Asystematic review determined that median prevalence of persons using antibioticswithout prescription to be 46.8%. In animals, antibiotics such as tetracyclinesconstituted over 80% of antimicrobials sold or used in 2014 and 2015.Antibiotic resistance was documented in humans, to drugs recommended by thecountry’s treatment guidelines for commonlyoccurring infections such as cholera and cerebrospinal meningitis. Majority ofthe studies documented recoveryE. coli, non-typhoidalSalmonellaandantibiotic residues from livestock, pets and animal products, most commonly inpoultry. The drivers of AMR included unregulated antibiotic sales,proliferation of unlicensed medicine stores, shortage of licensed prescribers,poor AMR awareness and use of antibiotics in animals without prescription.
Conclusion:we recommend that the government enforceregulations on antibiotic sales of antibiotics to humans and animals andincrease awareness on AMR in Nigerian communities. Identified gaps from thesituation analysis were used to develop a National Action Plan for AMR.
-
Real-time Metagenomic Analysis of Undiagnosed Fever Cases Unveils a Yellow Fever Outbreak in Edo State, Nigeria
Authors: Fehintola V. Ajogbasile, Judith U. Oguzie, Paul E. Oluniyi, Philomena E. Eromon, Jessica N. Uwanibe, Samar B. Mehta, Katherine J. Siddle, Ikponmwosa Odia, Sarah M. Winnicki, Nosa Akpede, George Akpede, Sylvanus Okogbenin, Ephraim Ogbaini-Emovon, Bronwyn L. MacInnis, Onikepe A. Folarin, Kayvon Modjarrad, Stephen F. Schaffner, Oyewale Tomori, Chikwe Ihekweazu, Pardis C. Sabeti & Christian T. Happ
Read Abstract | Read ArticleFifty patients with unexplained fever and pooroutcomes presented at Irrua Specialist Teaching Hospital (ISTH) in Edo State,Nigeria, an area endemic for Lassa fever, between September 2018 - January2019. After ruling out Lassa fever, plasma samples from theseepidemiologically-linked cases were sent to the African Centre of Excellencefor Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, OsunState, Nigeria, where we carried out metagenomic sequencing which implicatedyellow fever virus (YFV) as the etiology of this outbreak. Twenty-nine of the50 samples were confirmed positive for YFV by reversetranscriptase-quantitative polymerase chain reaction (RT-qPCR), 14 of whichresulted in genome assembly. Maximum likelihood phylogenetic analysis revealedthat these YFV sequences formed a tightly clustered clade more closely relatedto sequences from Senegal than sequences from earlier Nigerian isolates,suggesting that the YFV clade responsible for this outbreak in Edo State doesnot descend directly from the Nigerian YFV outbreaks of the last century, butinstead reflects a broader diversity and dynamics of YFV in West Africa. Herewe demonstrate the power of metagenomic sequencing for identifying ongoingoutbreaks and their etiologies and informing real-time public health responses,resulting in accurate and prompt disease management and control.
-
Epidemiologic and Clinical Features of Lassa Fever Outbreak in Nigeria, January 1–May 6, 2018
Authors: Elsie A. Ilori, Yuki Furuse, Oladipupo B. Ipadeola, Chioma C. Dan-Nwafor, Anwar Abubakar, Oboma E. Womi-Eteng, Ephraim Ogbaini-Emovon, Sylvanus Okogbenin, Uche Unigwe, Emeka Ogah, Olufemi Ayodeji, Chukwuyem Abejegah, Ahmed A. Liasu, Emmanuel O. Musa, Solomon F. Woldetsadik, Clement L.P. Lasuba, Wondimagegnehu Alemu, Chikwe Ihekweazu
Read Abstract | Read ArticleLassa fever (LF) is endemic to Nigeria, where the disease causessubstantial rates of illness and death. In this article, we report an analysisof the epidemiologic and clinical aspects of the LF outbreak that occurred inNigeria during January 1–May 6, 2018. A total of 1,893 cases were reported; 423were laboratory-confirmed cases, among which 106 deaths were recorded(case-fatality rate 25.1%). Among all confirmed cases, 37 occurred inhealthcare workers. The secondary attack rate among 5,001 contacts was 0.56%.Most (80.6%) confirmed cases were reported from 3 states (Edo, Ondo, andEbonyi). Fatal outcomes were significantly associated with being elderly; noadministration of ribavirin; and the presence of a cough, hemorrhaging, andunconsciousness. The findings in this study should lead to further LF researchand provide guidance to those preparing to respond to future outbreaks.
-
Lay media reporting of monkeypox in Nigeria
Authors: Oyeronke Oyebanji1, Ugonna Ofonagoro2, Oluwatosin Akande3, Ifeanyi Nsofor2, Chika Ukenedo4, Tarik Benjamin Mohammed1, Chimezie Anueyiagu5, Jeremiah Agenyi1, Adesola Yinka-Ogunleye6, Chikwe Ihekweazu
Read Abstract | Read ArticleSummary box
·Risk communication is an important but under-appreciated aspectof outbreak response, therefore, understanding the nature and impact of mediacoverage can assist in modifying messages.
·Media reports from unauthorised sources during the ongoingmonkeypox outbreak in Nigeria were sensationalised and led to increased anxietyin the population.
·Because of the tendency of the media to amplify, rather thancorrect rumours, media personnel should be trained prior to an outbreak toreduce distorted reporting.
·The Nigerian government should maintain an up-to-datecommunication platform for outbreak reporting, to routinely provide accurateinformation to the public.
·There should be a well-defined approach of using event-basedsurveillance for decision-making, effective communication and for informing howdisease outbreaks are reported by the media.
-
47. Use of Surveillance Outbreak Response Management and Analysis System for Human Monkeypox Outbreak, Nigeria, 2017-2019.
Authors: Silenou, Bernard C; Tom-Aba, Daniel; Adeoye, Olawunmi; Arinze, Chinedu C; Oyiri, Ferdinand; Suleman, Anthony K; YinkaOgunleye, Adesola; Dörrbecker, Juliane; Ihekweazu, Chikwe; Krause, Gérard
Read Abstract | Read ArticleIn November 2017, the mobile digitalSurveillance Outbreak Response Management and Analysis System was deployed in30 districts in Nigeria in response to an outbreak of monkeypox. Adaptation andactivation of the system took 14 days, and its use improved timeliness,completeness, and overall capacity of the response.
-
Human monkeypox - After 40 years, an unintended consequence of smallpox eradication
Authors: Karl Simpson, David Heymann, Colin S Brown, W John Edmunds, Jesper Elsgaard, Paul Fine, Hubertus Hochrein, Nicole A Hoff, Andrew Green, Chikwe Ihekweazu, Terry C Jones, Swaib Lule, Jane Maclennan, Andrea McCollum, Barbara Mühlemann, Emily Nightingale, Dimie Ogoina, Adesola Ogunleye, Brett Petersen, Jacqueline Powell, Ollie Quantick, Anne W Rimoin, David Ulaeato, Andy Wapling
Read Abstract | Read ArticleSmallpox eradication, coordinated by the WHO and certified 40 years ago,led to the cessation of routine smallpox vaccination in most countries. It isestimated that over 70% of the world's population is no longer protectedagainst smallpox, and through cross-immunity, to closely related orthopoxviruses such as monkeypox. Monkeypox is now a re-emerging disease. Monkeypox isendemic in as yet unconfirmed animal reservoirs in sub-Saharan Africa, whileits human epidemiology appears to be changing. Monkeypox in small animalsimported from Ghana as exotic pets was at the origin of an outbreak of humanmonkeypox in the USA in 2003. Travellers infected in Nigeria were at the originof monkeypox cases in the UK in 2018 and 2019, Israel in 2018 and Singaporein2019. Together with sporadic reports of human infections with other orthopoxviruses, these facts invite speculation that emergent or re-emergent humanmonkeypox might fill the epidemiological niche vacated by smallpox. An ad-hocand unofficial group of interested experts met to consider these issues atChatham House, London in June 2019, in order to review available data andidentify monkeypox-related research gaps. Gaps identified by the expertsincluded:The experts further agreed on the need for a better understanding ofthe genomic evolution and changing epidemiology of orthopox viruses, theusefulness of in-field genomic diagnostics, and the best disease control strategies,including the possibility of vaccination with new generation non-replicatingsmallpox vaccines and treatment with recently developed antivirals
-
Large Outbreak of Neisseria meningitidis Serogroup C - Nigeria, December 2016-June 2017
Authors: Chimeremma Nnadi, John Oladejo, Sebastian Yennan, Adesola Ogunleye, Chidinma Agbai, Lawal Bakare, Mohammed Abdulaziz, Amina Mohammed, Mary Stephens, Kyadindi Sumaili, Olivier Ronveaux, Helen Maguire, Debra Karch, Mahmood Dalhat, Martin Antonio, Andre Bita, Ifeanyi Okudo, Patrick Nguku, Ryan Novak, Omotayo Bolu, Faisal Shuaib, Chikwe Ihekweazu
Read Abstract | Read ArticleDuring the West African Ebolavirus disease outbreak in 2014-15, health agencies had severe challenges withcase notification and contact tracing. To overcome these, we developed theSurveillance, Outbreak Response Management and Analysis System (SORMAS). Theobjective of this study was to measure perceived quality of SORMAS and itschange over time. We ran a 4-week-pilot and 8-week-implementation of SORMASamong hospital informants in Kano state, Nigeria in 2015 and 2018 respectively.We carried out surveys after the pilot and implementation asking aboutusefulness and acceptability. We calculated the proportions of users per answertogether with their 95% confidence intervals (CI) and compared whether the 2015response distributions differed from those from 2018. Total of 31 and 74hospital informants participated in the survey in 2015 and 2018, respectively.In 2018, 94% (CI: 89-100%) of users indicated that the tool was useful, 92%(CI: 86-98%) would recommend SORMAS to colleagues and 18% (CI: 10-28%) hadlogin difficulties. In 2015, the proportions were 74% (CI: 59-90%), 90% (CI:80-100%), and 87% (CI: 75-99%) respectively. Results indicate high usefulnessand acceptability of SORMAS. We recommend mHealth tools to be evaluated toallow repeated measurements and comparisons between different versions andusers.
-
Lassa virus RNA detection from suspected cases in Nigeria, 2011-2017
Authors: Salu Olumuyiwa Babalola, James Ayorinde Babatunde, Orenolu Mercy Remilekun, Anyanwu Roosevelt Amaobichukwu, Abdullah Mariam Abiodun, Idris Jide, Abdus-Salam Ismail Adeshina , Ihekweazu Chikwe, Omilabu Sunday Aremu
Read Abstract | Read ArticleIntroduction:The diagnosis of Lassa fever is crucialto confirm cases, as well as to control/prevent nosocomial and community-basedtransmission and initiation of treatment, which is still limited in thecountry. Thus, we aimed at providing some information on the laboratorydetection of Lassa from suspected cases in Nigeria.
Methods:This was a retrospective study ofseasonal Lassa fever outbreaks data from 1,263 samples analyzed using ReverseTranscription-Polymerase Chain Reaction (RT-PCR) at the Virology ResearchLaboratory, College of Medicine, University of Lagos/Lagos University TeachingHospital between year 2011 and 2017. Data were analyzed using the 21steditionof SPSS statistical software (2015).
Results:The RT-PCR test confirmed the presenceof Lassa in 112 (8.9%) comprising 61 (54.4%) males, 48 (42.9%) females and 3(2.7%) individuals without gender information. Those aged between 18 and 49 yearswere mostly affected. There was a decline in the detection of Lassa from 4.7%in 2011/2012 to less than 1% by the 2014/2015. However, during the 2015/2016and 2016/2017 seasons the detection rates increased to 10.4% and 15.1%respectively. The Northern region of Nigeria reported high confirmed cases ofLassa. The South Western region also witnessed an increased Lassa feverpositivity rate of 13.4% of which Lagos and Ogun states being the focal stateof Lassa activity in the region.
Conclusion:These established the need forheightening the continued surveillance for Lassa as well as the establishmentof other testing facilities within these endemic regions for prompt diagnosisof Lassa fever.
-
A description of HIV prevalence trends in Nigeria from 2001 to 2010: what is the progress, where is the problem?
Authors: Adebobola Bashorun, Patrick Nguku, Issa Kawu, Evelyn Ngige, Adeniyi Ogundiran, Kabir Sabitu, Abdulsalam Nasidi, Peter Nsubuga
Read Abstract | Read ArticleIntroduction:Nigeria's population of 160 million andestimated HIV prevalence of 3.34% (2011) makes Nigeria the second highest HIVburden worldwide, with 3.2 million people living with HIV (PLHIV). In 2010, USgovernment spent about US$456.5 million on the Nigerian epidemic. Antenatalclinic (ANC) HIV sero-prevalence sentinel survey has been conducted bienniallyin Nigeria since 1991 to track the epidemic. This study looked at the trends ofHIV in Nigeria over the last decade to identify progress and needs.
Methods:We conducted description of HIVsero-prevalence sentinel cross-sectional surveys conducted among pregnant womenattending ANC from 2001 to 2010, which uses consecutive sampling andunlinked-anonymous HIV testing (UAT) in 160 sentinel facilities. 36,000 bloodsamples were collected and tested. We used Epi-Info to determine national andstate HIV prevalence and trends. The Estimation and Projection Package withSpectrum were used to estimate/project the burden of infection.
Results:National ANC HIV prevalence rose from1.8% (1991) to 5.8% (2001) and dropped to 4.1% (2010). Since 2001, states inthe center, and south of Nigeria had higher prevalence than the rest, withBenue and Cross Rivers notable. Benue was highest in 2001 (14%), 2005 (10%),and 2010 (12.7%). Overall, eight states (21.6%) showed increased HIV prevalencewhile six states (16.2%) had an absolute reduction of at least 2% from 2001 to2010. In 2010, Nigeria was estimated to have 3.19 million PLHIV, with thegeneral population prevalence projected to drop from 3.34% in 2011 to 3.27% in2012.
Conclusion:Examining a decade of HIV ANCsurveillance in Nigeria revealed important differences in the epidemic instates that need to be examined further to reveal key drivers that can be usedto target future interventions.
-
Knowledge, Care-Seeking Behavior, and Factors Associated With Patient Delay Among Newly-Diagnosed Pulmonary Tuberculosis Patients, Federal Capital Territory, Nigeria, 2010
Authors: Oladayo Biya, Saheed Gidado, Ajibola Abraham, Ndadilnasiya Waziri, Patrick Nguku, Peter Nsubuga, Idris Suleman, Akin Oyemakinde, Abdulsalami Nasidi, Kabir Sabitu
Read Abstract | Read ArticleIntroduction: Early treatment of Tuberculosis (TB) cases isimportant for reducing transmission, morbidity and mortality associated withTB. In 2007, Federal Capital Territory (FCT), Nigeria recorded low TB casedetection rate (CDR) of 9% which implied that many TB cases were undetected. Weassessed the knowledge, care-seeking behavior, and factors associated withpatient delay among pulmonary TB patients in FCT.
Methods: We enrolled 160 newly-diagnosed pulmonary TB patientsin six directly observed treatment short course (DOTS) hospitals in FCT in across-sectional study. We used a structured questionnaire to collect data onsocio-demographic variables, knowledge of TB, and care-seeking behavior.Patient delay was defined as > 4 weeks between onset of cough and firsthospital contact.
Results: Mean age was 32.8 years (± 9 years). Sixty two percentwere males. Forty seven percent first sought care in a government hospital, 26%with a patent medicine vendor and 22% in a private hospital. Forty one percenthad unsatisfactory knowledge of TB. Forty two percent had patient delay. Havingunsatisfactory knowledge of TB (p = 0.046) and multiple care-seeking (p = 0.02)were significantly associated with patient delay. After controlling for traveltime and age, multiple care-seeking was independently associated with patientdelay (Adjusted Odds Ratio = 2.18, 95% CI = 1.09-4.35).
Conclusion: Failure to immediately seek care in DOTS centers andhaving unsatisfactory knowledge of TB are factors contributing to patientdelay. Strategies that promote early care-seeking in DOTS centers and sustainedawareness on TB should be implemented in FCT.
-
Importance of Epidemiological Research of Monkeypox: Is Incidence Increasing
Authors: Chikwe Ihekweazu, Adesola Yinka-Ogunleye, Swaib Lule, Abubakar Ibrahim
Read Abstract | Read Article -
The Prevalence of Noma in Northwest Nigeria
Authors: Elise Farley, Modupe Juliana Oyemakinde, Jorien Schuurmans, Cono Ariti, Fatima Saleh, Gloria Uzoigwe, Karla Bil, Bukola Oluyide, Adolphe Fotso, Mohana Amirtharajah, Jorieke Vyncke, Raphael Brechard, Adeniyi Semiyu Adetunji, Koert Ritmeijer, Saskia van der Kam, Denise Baratti-Mayer, Ushma Mehta, Shafi\'u Isah, Chikwe Ihekweazu, Annick Lenglet
Read Abstract | Read ArticleBackground: Noma, a rapidly progressing infection of the oralcavity, mainly affects children. The true burden is unknown. This study reportsestimated noma prevalence in children in northwest Nigeria.
Methods: Oral screening was performed on all ≤15 year olds,with caretaker consent, in selected households during this cross-sectionalsurvey. Noma stages were classified using WHO criteria and caretakers answeredsurvey questions. The prevalence of noma was estimated stratified by age group(0-5 and 6-15 years). Factors associated with noma were estimated usinglogistic regression.
Results: A total of 177 clusters, 3499 households and 7122children were included. In this sample, 4239 (59.8%) were 0-5 years and 3692(52.1%) were female. Simple gingivitis was identified in 3.1% (n=181; 95% CI2.6 to 3.8), acute necrotising gingivitis in 0.1% (n=10; CI 0.1 to 0.3) andoedema in 0.05% (n=3; CI 0.02 to 0.2). No cases of late-stage noma weredetected. Multivariable analysis in the group aged 0-5 years showed having awell as the drinking water source (adjusted odds ratio (aOR) 2.1; CI 1.2 to3.6) and being aged 3-5 years (aOR 3.9; CI 2.1 to 7.8) was associated withbeing a noma case. In 6-15 year olds, being male (aOR 1.5; CI 1.0 to 2.2) wasassociated with being a noma case and preparing pap once or more per week (aOR0.4; CI 0.2 to 0.8) was associated with not having noma. We estimated that129120 (CI 105294 to 1 52 947) individuals <15 years of age would have anystage of noma at the time of the survey within the two states. Most of thesecases (93%; n=120 082) would be children with simple gingivitis.
Conclusions: Our study identified a high prevalence of children atrisk of developing advanced noma. This disease is important but neglected andtherefore merits inclusion in the WHO neglected tropical diseases list.
-
Knowledge and Risk Perception Towards Lassa Fever Infection Among Residents of Affected Communities in Ebonyi State, Nigeria: Implications for Risk Communication
Authors: Ifeoma Sophia Usuwa, Christian Obasi Akpa, Chukwuma David Umeokonkwo, MaryJoy Umoke, Chukwuemeka Steve Oguanuo, Abdulhakeem Abayomi Olorukooba, Eniola Bamgboye, Muhammad Shakir Balogun
Read Abstract | Read ArticleBackground: Lassa fever (LF) is an epidemic-prone zoonotic diseaseprevalent in Nigeria and Ebonyi State is a high burden area in Nigeria. Lowrisk perceptions have been reported to prevent appropriate preventivebehaviours. We investigated the knowledge and risk perception of residentstowards LF and determined the factors influencing their risk perception incommunities that have reported confirmed cases of LF.
Methods: We conducted a cross-sectional study in the affectedwards in Abakaliki Local Government Area (LGA). We interviewed 356 adultrespondents recruited across 6 settlements in 3 of the affected wards throughmultistage sampling technique. Information on participants' knowledge of LF,their risk perception using the health belief model as well as factors influencingrisk perception were obtained. We estimated the proportions of respondents withgood knowledge and high risk perceptions. We also explored the relationshipbetween risk perception, knowledge and sociodemographic characteristics usingChi Square and logistic regression at 5% level of significance.
Results: The mean age of the participants was 33.3 ± 12.2years, 208 (63.2%) were females, 230 (69.9%) were married and 104 (31.6%) hadattained tertiary education. Though 99.1% were aware of LF infection, 50.3%among them had poor knowledge of LF symptoms and risk factors, 92.9% had highrisk perception of severity, 72.4% had a high feeling of susceptibility towardsLF infection, 82.5% had a high perceived self-efficacy towards LF infection,63.5% had a low perceived benefit of LF preventive practices and 31.8% had highperceived barrier towards LF preventive practices. Good knowledge of LF was theonly significant factor influencing risk perception; perceived severity: (COR:3.0, 95%CI: 1.2-7.8), perceived susceptibility (AOR: 2.0, 95%CI: 1.25-3.3) andperceived benefit (COR: 2.1, 95%CI: 1.3-3.3).
Conclusions: Good knowledge of LF influences risk perceptiontowards LF which has great import on LF preventive practices. A gap exists inthe content and acceptance of LF risk communication information in the LGA.There is a need to review the risk communication messages in the state towardsLF in the community with special focus on the males and younger population
-
Action-Based Costing for National Action Plans for Health Security: Accelerating Progress Toward the International Health Regulations (2005)
Authors: Christopher T Lee, Rebecca Katz, Stephanie Eaneff, Michael Mahar , Olubunmi Ojo
Read Abstract | Read ArticleMultiple costing tools have been developed tounderstand the resources required to build and sustain implementation of theInternational Health Regulations (IHR), including a detailed costing tooldeveloped by WHO ("WHO Costing Tool") and 2 action-based costingtools, Georgetown University's IHR Costing Tool and CDC's Priority ActionsCosting Tool (PACT). The relative performance of these tools is unknown.Nigeria costed its National Action Plan for Health Security (NAPHS) using theWHO Costing Tool. We conducted a desktop review, using the other tools tocompare the cost estimates generated using different costing approaches.Technical working groups developed activity plans and estimated component costsusing the WHO Costing Tool during a weeklong workshop with approximately 60participants from various ministries, departments, and federal agencies. Weretrospectively applied the IHR Costing Tool and PACT to generate rapid costestimates required to achieve a Joint External Evaluation (JEE) score of"demonstrated capacity" (level 4). The tools generated similar activitiesfor implementation. Cost estimates varied based on the anticipated procurementand human resources requirements and by the level of implementation (eg, healthfacility-level versus local government area-level procurement). The desktop IHRCosting Tool and PACT tools required approximately 2 and 8 person-hours tocomplete, respectively. A strategic costing approach, wherein governmentsselect from a menu of recommended and costed actions following the JEE todevelop a NAPHS, could accelerate implementation of plans. Major cost drivers,including procurement and human resources, should be prioritized based onanticipated resource availability and countries' priorities.
-
Are Patients With Pulmonary Tuberculosis Who Are Identified Through Active Case Finding in the Community Different Than Those Identified in Healthcare Facilities?
Authors: S T Abdurrahman, L Lawson, M Blakiston, J Obasanya, M A Yassin, R M Anderson, O Oladimeji, A Ramsay, L E Cuevas
Read Abstract | Read ArticleThe lack of healthcare access contributes to largenumbers of tuberculosis (TB) cases being missed and has led to renewed interestin outreach approaches to increase detection. It is however unclear whetheroutreach activities increase case detection or merely identify patients beforethey attend health facilities. We compared adults with cough of >2 weeks'duration recruited in health facilities (1202 participants) or in urban slums(2828 participants) in Nigeria. Participants provided demographic and clinicalinformation and were screened using smear microscopy. The characteristics ofsmear-positive and smear-negative individuals were compared stratified by placeof enrolment. Two hundred nine health facility participants (17.4%) and 485community-based participants (16.9%) were smear positive for pulmonary TB.Community-based smear-positive cases were older (mean age, 36.3 vs. 31.8years), had longer cough duration (10.3 vs. 6.8 weeks) and longer duration ofweight loss (4.6 vs. 3.6 weeks) than facility-based cases; and they complainedmore of fever (87.4% vs. 74.6%), chest pain (89.0% vs. 67.0%) and anorexia(79.5% vs. 55.5%). Community smear-negative participants were older (mean, 39.4vs. 34.0 years), were more likely to have symptoms and were more likely to havesymptoms of longer duration than smear-negative facility-based participants.Patients with pulmonary TB identified in the community had more symptoms andlonger duration of illness than facility-based patients, which appeared to be dueto factors differentially affecting access to healthcare. Community-basedactivities targeted at urban slum populations may identify a different TB casepopulation than that accessing stationary services.
-
Ebola Virus Disease - Gaps in Knowledge and Practice Among Healthcare Workers in Lagos, August 2014
Authors: Abisola M Oladimeji, Saheed Gidado, Patrick Nguku, Iruoma Genevieve Nwangwu, Nikhil D Patil, Femi Oladosu, Alero Ann Roberts, Ndadilnasiya E Waziri, Faisal Shuaib, Olukayode Oguntimehin, Emmanuel Musa, Abdulsalami Nasidi, Peter Adewuyi, Adebola Olayinka, Oladoyin Odubanjo, N-FELTP Residents; Gabriele Poggensee
Read Abstract | Read ArticleObjective: Healthcare workers (HCWs) play pivotal roles inoutbreak responses. Ebola virus disease (EVD) outbreak spread to Lagos,Nigeria, in July 2014, infecting 11 HCWs (case fatality rate of 45%). Thisstudy was conducted during the outbreak to assess HCWs' EVD-related knowledgeand practices.
Methods: A health facility-based cross-sectional study wasconducted among HCWs across Lagos State using stratified sampling technique. Aninterviewer-administered questionnaire was administered to elicit respondents'socio-demographic characteristics, knowledge and practices. A checklistassessing health facility's level of preparedness and HCWs' EVD-relatedtraining was employed. HCWs' knowledge and practices were scored and classifiedas either good or poor. Multivariate analysis was performed with confidenceinterval set at 95%.
Results: A total of 112 health facilities with 637 HCWs wererecruited. Mean age of respondents was 40.1 ± 10.9 years. Overall, 72.5% hadgood knowledge; doctors knew most. However, only 4.6% of HCWs reported goodpractices. 16.6% reported having been trained in identifying suspected EVDpatient(s); 12.2% had a triaging area for febrile patients in their facilities.Higher proportions of HCWs with good knowledge and training reported goodpractices. HCWs with EVD-related training were three times more likely to adoptgood practices.
Conclusion:LagosState HCWs had good knowledge of EVD without a corresponding level of goodpractices. Training was a predictor of good practices
-
What Are the Drivers of Recurrent Cholera Transmission in Nigeria? Evidence From a Scoping Review
Authors: Kelly Osezele Elimian, Somto Mezue, Anwar Musah, Oyeronke Oyebanji, Ibrahima Soce Fall, Sebastian Yennan, Michel Yao, Patrick Okumu Abok, Nanpring Williams, Lynda Haj Omar, Thieno Balde, Kobina Ampah, Ifeanyi Okudo, Luka Ibrahim, Arisekola Jinadu, Wondimagegnehu Alemu, Clement Peter, Chikwe Ihekweazu
Read Abstract | Read ArticleBackground: The 2018 cholera outbreak in Nigeria affected overhalf of the states in the country, and was characterised by high attack andcase fatality rates. The country continues to record cholera cases and relateddeaths to date. However, there is a dearth of evidence on context-specificdrivers and their operational mechanisms in mediating recurrent choleratransmission in Nigeria. This study therefore aimed to fill this important researchgap, with a view to informing the design and implementation of appropriatepreventive and control measures.
Methods: Four bibliographic literature sources (CINAHL (Pluswith full text), Web of Science, Google Scholar and PubMed), and one journal (AfricanJournals Online) were searched to retrieve documents relating to choleratransmission in Nigeria. Titles and abstracts of the identified documents werescreened according to a predefined study protocol. Data extraction andbibliometric analysis of all eligible documents were conducted, which wasfollowed by thematic and systematic analyses.
Results: Forty-five documents met the inclusion criteria andwere included in the final analysis. The majority of the documents werepeer-reviewed journal articles (89%) and conducted predominantly in the contextof cholera epidemics (64%). The narrative analysis indicates that social,biological, environmental and climatic, health systems, and a combination oftwo or more factors appear to drive cholera transmission in Nigeria. Regardingoperational dynamics, a substantial number of the identified drivers appear tobe functionally interdependent of each other.
Conclusion: The drivers of recurring cholera transmission inNigeria are diverse but functionally interdependent; thus, underlining theimportance of adopting a multi-sectoral approach for cholera prevention andcontrol.
-
Learning From the Epidemiological Response to the 2014/15 Ebola Virus Disease Outbreak
Authors: Maya Holding, Chikwe Ihekweazu, James MacNaughton Stuart, Isabel Oliver
Read Abstract | Read ArticleA large international response was needed to bring the 2014/15 WestAfrican Ebola virus disease outbreak under control. This study sought to learnlessons from this epidemic to strengthen the response to future outbreaks ofinternational significance by identifying priorities for future epidemiologytraining and response. Epidemiologists who were deployed to West Africa wererecruited through a snowball sampling method and surveyed using an onlineanonymous questionnaire. Associations between demographics, training,qualifications, and role while in-country were explored alongside respondents'experience during deployment. Of 128 responses, 105 met the inclusion criteria.Respondents originated from 25 countries worldwide, for many (62%), this wastheir first deployment abroad. The most common tasks carried out while deployedwere surveillance, training, contact tracing, and cluster investigation.Epidemiologists would value more detailed predeployment briefings includingorganizational aspects of the response. Gaps in technical skills reported weremostly about geographical information systems; however, epidemiologistsidentified the need for those deployed in future to have greater knowledgeabout roles and responsibilities of organizations involved in the response,better cultural awareness, and leadership and management skills. Respondentsfelt that the public health community must improve the timeliness of theresponse in future outbreaks and strengthen collaboration and coordinationbetween organizations.
-
Building a Public Health Workforce in Nigeria Through Experiential Training
Authors: Akin Oyemakinde, Patrick Nguku, Rebecca Babirye, Sheba Gitta, Peter Nsubuga, Joseph Nyager, Abdulsalami Nasidi
Read Abstract | Read Article -
Lassa Fever: Epidemiology, Clinical Features, Diagnosis, Management and Prevention
Authors: Danny A Asogun, Stephan Günther, George O Akpede, Chikwe Ihekweazu, Alimuddin Zumla
Read Abstract | Read ArticleLassa fever outbreaks West Africa have caused up to 10,000 deathsannually. Primary infection occurs from contact with Lassa virus-infectedrodents and exposure to their excreta, blood, or meat. Incubation takes 2 to 21days. Symptoms are difficult to distinguish from malaria, typhoid, dengue,yellow fever, and other viral hemorrhagic fevers. Clinical manifestations rangefrom asymptomatic, to mild, to severe fulminant disease. Ribavirin can improveoutcomes. Overall mortality is between 1% and 15%. Lassa fever should beconsidered in the differential diagnosis with travel to West Africa. There isan urgent need for rapid field-friendly diagnostics and preventive vaccine.
-
Meningococcal Meningitis Outbreaks in the African Meningitis Belt After Meningococcal Serogroup A Conjugate Vaccine Introduction, 2011-2017
Authors: Katya Fernandez, Clément Lingani, Olaolu Moses Aderinola, Kadadé Goumbi, Brice Bicaba, Zewdu Assefa Edea, Clément Glèlè, Badu Sarkodie, Agbeko Tamekloe, Armelle Ngomba, Mamoudou Djingarey, Ado Bwaka, William Perea, Olivier Ronveaux
Read Abstract | Read ArticleBackground: In 2010-2017, meningococcal serogroup A conjugatevaccine (MACV) was introduced in 21 African meningitis belt countries.Neisseria meningitidis A epidemics have been eliminated here; however, non-Aserogroup epidemics continue.
Methods: We reviewed epidemiological and laboratory WorldHealth Organization data after MACV introduction in 20 countries. Informationfrom the International Coordinating Group documented reactive vaccination.
Results: In 2011-2017, 17 outbreaks were reported (31 786suspected cases from 8 countries, 1-6 outbreaks/year). Outbreaks were of 18-14542 cases in 113 districts (median 3 districts/outbreak). The most affectedcountries were Nigeria (17 375 cases) and Niger (9343 cases). Cumulativeaverage attack rates per outbreak were 37-203 cases/100 000 population (median112). Serogroup C accounted for 11 outbreaks and W for 6. The median proportionof laboratory confirmed cases was 20%. Reactive vaccination was conductedduring 14 outbreaks (5.7 million people vaccinated, median response time 36days).
Conclusion: Outbreaks due to non-A serogroup meningococci continueto be a significant burden in this region. Until an affordable multivalentconjugate vaccine becomes available, the need for timely reactive vaccinationand an emergency vaccine stockpile remains high. Countries must continue tostrengthen detection, confirmation, and timeliness of outbreak controlmeasures.
-
The Multi-Sectorial Emergency Response to a Cholera Outbreak in Internally Displaced Persons Camps in Borno State, Nigeria, 2017
Authors: Moise Chi Ngwa, Alemu Wondimagegnehu, Ifeanyi Okudo, Collins Owili, Uzoma Ugochukwu, Peter Clement, Isabelle Devaux, Lorenzo Pezzoli, Chikwe Ihekweazu, Mohammed Abba Jimme, Peter Winch, David A Sack
Read Abstract | Read ArticleIntroduction: In August 2017, a cholera outbreak started in Muna GarageInternally Displaced Persons camp, Borno state, Nigeria and >5000 casesoccurred in six local government areas. This qualitative study evaluatedperspectives about the emergency response to this outbreak.
Methods: We conducted 39 key informant interviews and focusgroup discussions, and reviewed 21 documents with participants involved withsurveillance, water, sanitation, hygiene, case management, oral cholera vaccine(OCV), communications, logistics and coordination. Qualitative data analysisused thematic techniques comprising key words in context, word repetition andkey sector terms.
Results: Authorities were alerted quickly, but outbreakdeclaration took 12 days due to a 10-day delay waiting for cultureconfirmation. Outbreak investigation revealed several potential transmissionchannels, but a leaking latrine around the index cases' house was not repairedfor more than 7 days. Chlorine was initially not accepted by the community dueto rumours that it would sterilise women. Key messages were in Hausa, althoughKanuri was the primary local language; later this was corrected. Planning wouldhave benefited using exercise drills to identify weaknesses, and inventorysharing to avoid stock outs. The response by the Rural Water Supply andSanitation Agency was perceived to be slow and an increased risk from areligious festival was not recognised. Case management was provided attreatment centres, but some partners were concerned that their work was notrecognised asking, 'Who gets the glory and the data?' Nearly one million peoplereceived OCV and its distribution benefited from a robust infrastructure forpolio vaccination. There was initial anxiety, rumour and reluctance about OCV,attributed by many to lack of formative research prior to vaccine implementation.Coordination was slow initially, but improved with activation of an emergencyoperations centre (EOC) that enabled implementation of incident managementsystem to coordinate multisectoral activities and meetings held at 16:00 hoursdaily. The synergy between partners and government improved when eachrecognised the government's leadership role.
Conclusion: Despite a timely alert of the outbreak, delayedlaboratory confirmation slowed initial response. Initial responses to theoutbreak were not well coordinated but improved with the EOC. Understandingbehaviours and community norms through rapid formative research should improvethe effectiveness of the emergency response to a cholera outbreak. OCVdistribution was efficient and benefited from the polio vaccine infrastructure.
-
Complete Genome Sequence of a Hepatitis E Virus Genotype 1e Strain From an Outbreak in Nigeria, 2017
Authors: Olusola Anuoluwapo Akanbi, Dominik Harms, Bo Wang, Oluyinka Oladele Opaleye, Olufisayo Adesina, Folakemi Abiodun Osundare, Abiodun Ogunniyi, Dhamari Naidoo, Isabelle Devaux, Alemu Wondimagegnehu, Clement Peter, Okudo Ifeanyi, Opeayo Ogundiran, Uzoma Ugochukwu, Nwando Mba, Sunday A Omilabu, Chikwe Ihekweazu, C-Thomas Bock
Read Abstract | Read ArticleHepatitis E virus genotype 1 (HEV-1) is associated with large epidemics.Notably, HEV subtype 1e (HEV-1e) has caused HEV outbreaks in sub-SaharanAfrica. We report here the second full-length genome sequence of an HEV-1estrain (NG/17-0503) from a recent outbreak in Nigeria in 2017. It shares 94.2%identity with an HEV-1e strain from Chad
-
Association of Blood Lead Level With Neurological Features in 972 Children Affected by an Acute Severe Lead Poisoning Outbreak in Zamfara State, Northern Nigeria
Authors: Jane Greig, Natalie Thurtle, Lauren Cooney, Cono Ariti, Abdulkadir Ola Ahmed, Teshome Ashagre, Anthony Ayela, Kingsley Chukwumalu, Alison Criado-Perez, Camilo Gómez-Restrepo, Caitlin Meredith, Antonio Neri, Darryl Stellmach, Nasir Sani-Gwarzo, Abdulsalami Nasidi, Leslie Shanks, Paul I Dargan
Read Abstract | Read ArticleBackground: In 2010, Médecins Sans Frontières (MSF) investigatedreports of high mortality in young children in Zamfara State, Nigeria, leadingto confirmation of villages with widespread acute severe lead poisoning. In aretrospective analysis, we aimed to determine venous blood lead level (VBLL)thresholds and risk factors for encephalopathy using MSF programmatic data fromthe first year of the outbreak response.
Methods and findings: We included children aged ≤5 years withVBLL ≥45 µg/dL before any chelation and recorded neurological status. Oddsratios (OR) for neurological features were estimated; the final model wasadjusted for age and baseline VBLL, using random effects for village ofresidence. 972 children met inclusion criteria: 885 (91%) had no neurologicalfeatures; 34 (4%) had severe features; 47 (5%) had reported recent seizures;and six (1%) had other neurological abnormalities. The geometric mean VBLLs forall groups with neurological features were >100 µg/dL vs 65.9 µg/dL forthose without neurological features. The adjusted OR for neurological featuresincreased with increasing VBLL: from 2.75, 95%CI 1.27-5.98 (80-99.9 µg/dL) to22.95, 95%CI 10.54-49.96 (≥120 µg/dL). Neurological features were associatedwith younger age (OR 4.77 [95% CI 2.50-9.11] for 1-<2 years and 2.69 [95%CI1.15-6.26] for 2-<3 years, both vs 3-5 years). Severe neurological featureswere seen at VBLL <105 µg/dL only in those with malaria.
Interpretation:IncreasingVBLL (from ≥80 µg/dL) and age 1-<3 years were strongly associated withneurological features; in those tested for malaria, a positive test was alsostrongly associated. These factors will help clinicians managing children withlead poisoning in prioritising therapy and developing chelation protocols.
-
Caseload and Case Fatality of Lassa Fever in Nigeria, 2001-2018: A Specialist Center\'s Experience and Its Implications
Authors: George O Akpede, Danny A Asogun , Sylvanus A Okogbenin, Simeon O Dawodu, Mojeed O Momoh, Andrew E Dongo, Chiedozie Ike, Ekaete Tobin, Nosa Akpede, Ephraim Ogbaini-Emovon, Adetunji E Adewale, Oboratare Ochei, Frank Onyeke, Martha O Okonofua, Rebecca O Atafo, Ikponmwosa Odia, Donatus I Adomeh, George Odigie, Caroline Ogbeifun, Ekene Muebonam, Chikwe Ihekweazu, Michael Ramharter, Andres Colubri, Pardis C Sarbeti, Christian T Happi, Stephan Günther, Dennis E Agbonlahor
Read Abstract | Read ArticleBackground:The general lack of comprehensive data on the trends of Lassa fever (LF)outbreaks contrasts with its widespread occurrence in West Africa and is animportant constraint in the design of effective control measures. We reviewedthe contribution of LF to admissions and mortality among hospitalized patientsfrom 2001 to 2018 in the bid to address this gap.
Methods: Observational study of LF caseload andmortality from 2001 to 18 in terms of the contribution of confirmed LF toadmissions and deaths, and case fatality (CF) among patients with confirmed LFat a specialist center in Nigeria. The diagnosis of LF was confirmed usingreverse transcription polymerase chain reaction (RT-PCR) test, and medians andfrequencies were compared using Kruskal-Wallis, Mann-Whitney and χ2 tests, withp-values <0.05 taken as significant.
Results: The contribution of confirmed LF to deaths(362/9057, 4.0%) was significantly higher than to admissions (1,298/185,707,0.7%; OR [95% CI] = 5.9 [5.3, 6.7], p < 0.001). The average CFamong patients with confirmed LF declined from 154/355 (43%) in 2001–09 to183/867 (21.1%) (OR [95% CI] = 2.9 [2.2, 3.7], p < 0.001) in2011–18. The annual CF declined from 94% in 2001 to 15% in 2018 whereas thecaseload increased from 0.3 to 3.4%. The outbreaks were characterized byirregular cycles of high caseload in 2005–2007, 2012–2014, and 2016–2018, andprogressive blurring of the seasonality.
Conclusion:LF outbreaks in Nigeria have upgraded spatially and temporally, with thepotential for cycles of increasing severity. The strategic establishment of LFsurveillance and clinical case management centers could be a pragmatic andcost-effective approach to mitigating the outbreaks, particularly in reducingthe associated CF. Urgent efforts are needed in reinvigorating extant controlmeasures while the search for sustainable solutions continues.
-
Lessons Learnt From the Management of a Case of Lassa Fever and Follow-Up of Nosocomial Primary Contacts in Nigeria During Ebola Virus Disease Outbreak in West Africa
Authors: Michael O Iroezindu, Uche S Unigwe, Celestine C Okwara, Gladys A Ozoh, Anne C Ndu, Martin E Ohanu, Ugochukwu O Nwoko, Uwadiegwu W Okoroafor, Esinulo Ejimudo, Ekaete A Tobin , Danny A Asogun
Read Abstract | Read ArticleObjective: To describe our experiences in the management of acase of Lassa fever (LF) and follow-up of nosocomial primary contacts duringthe 2014 Ebola outbreak in West Africa.
Methods: Clinical management of the index case and infectioncontrol/surveillance activities for primary contacts are described. Laboratoryconfirmation was by Lassa virus-specific reverse-transcriptase PCR.
Results: A 28-year-old man with a 10-day history of febrileillness was referred to a major tertiary hospital in south-east Nigeria from acity that previously experienced a LF outbreak and was recently affected byEbola. On observation of haemorrhagic features, clinicians were at acrossroads. Diagnosis of LF was confirmed at a National Reference Centre. Thepatient died despite initiation of ribavirin therapy. Response activitiesidentified 121 primary contacts comprising 78 (64.5%) hospital staff/interns,19 (15.7%) medical students, 18 (14.9%) inpatients and 6 (5.0%) relatives.Their mean age was 32.8 ± 6.6 years, and 65.3% were women. Twenty (16.5%) hadhigh-risk exposure and were offered ribavirin as post-exposure prophylaxis. Nosecondary case of LF occurred. Fatigue (43.8%) and dizziness (31.3%) were thecommonest side effects of ribavirin.
Conclusions: Response activities contained nosocomial spread of LF,but challenges were experienced including lack of a purpose-built isolationfacility, absence of local Lassa virus laboratory capacity, failure to useappropriate protective equipment and stigmatisation of contacts. A key lessonis that the weak health systems of Africa should be comprehensivelystrengthened; otherwise, we might win the Ebola battle but lose the one againstless virulent infections for which effective treatment exists.
-
Improving Cross-Border Preparedness and Response: Lessons Learned From 3 Lassa Fever Outbreaks Across Benin, Nigeria, and Togo, 2017-2019
Authors: Clement Glèlè Kakaī, Oyeladun Funmi Okunromade, Chioma Cindy Dan-Nwafor, Ali Imorou Bah Chabi, Godjedo Togbemabou Primous Martial, Mahmood Muazu Dalhat, Sarah Ward, Ouyi Tante, Patrick Mboya Nguku, Assane Hamadi, Elsie Ilori, Virgil Lokossou, Carlos Brito, Olubunmi Eyitayo Ojo, Idrissa Kone, Tamekloe Tsidi Agbeko, Chikwe Ihekweazu, Rebecca D Merrill
Read Abstract | Read ArticleLong-standing cultural, economic, and political relationships amongBenin, Nigeria, and Togo contribute to the complexity of their cross-borderconnectivity. The associated human movement increases the risk of internationalspread of communicable disease. The Benin and Togo ministries of health and theNigeria Centre for Disease Control, in collaboration with the Abidjan LagosCorridor Organization (a 5-country intergovernmental organization) and the USCenters for Disease Control and Prevention, sought to minimize the risk ofcross-border outbreaks by defining and implementing procedures for binationaland multinational public health collaboration. Through 2 multinationalmeetings, regular district-level binational meetings, and fieldwork tocharacterize population movement and connectivity patterns, the countriesimproved cross-border public health coordination. Across 3 sequentialcross-border Lassa fever outbreaks identified in Benin or Togo between February2017 and March 2019, the 3 countries improved their collection and sharing ofpatients' cross-border travel histories, shortened the time between caseidentification and cross-border information sharing, and streamlinedmultinational coordination during response efforts. Notably, they refinedcollaborative efforts using lessons learned from the January to March 2018Benin outbreak, which had a 100% case fatality rate among the 5laboratory-confirmed cases, 3 of whom migrated from Nigeria across porousborders when ill. Aligning countries' expectations for sharing public healthinformation would assist in reducing the international spread of communicablediseases by facilitating coordinated preparedness and responses strategies.Additionally, these binational and multinational strategies could be made moreeffective by tailoring them to the unique cultural connections and populationmovement patterns in the region.
-
Accelerating Action in Global Health Security: Global Biosecurity Dialogue as a Model for Advancing the Global Health Security Agenda
Authors: Sabrina Brizee, Katherine Budeski, Wilmot James, Michelle Nalabandian, Diederik A Bleijs, Scott J Becker, Sacha Wallace-Sankarsingh, Anthony Ahumibe, Emmanuel Agogo, Chikwe Ihekweazu, Simo Nikkari, Maureen Ellis, Ernesto Gozzer, Immaculate Sware Semesi, Zibusiso M Masuku, Aamer Ikram, Faheem Tahir, Irma Makalinao, Hayley Anne Severance, Mark W J van Passel, Elizabeth E Cameron
Read Abstract | Read ArticleBiosecurity and biosafety measures are designed tomitigate intentional and accidental biological risks that pose potentiallycatastrophic consequences to a country's health system, security, and politicaland economic stability. Unfortunately, biosecurity and biosafety are oftenunder-prioritized nationally, regionally, and globally. Security leaders oftendeemphasize accidental and deliberate biological threats relative to otherchallenges to peace and security. Given emerging biological risks, includingthose associated with rapid technological advances and terrorist and stateinterest in weapons of mass destruction, biosecurity deserves stronger emphasisin health and security fora. The Global Biosecurity Dialogue (GBD) wasinitiated to align national and regional donor initiatives toward a common setof measurable targets. The GBD was launched by the Nuclear Threat Initiative(NTI), with support from Global Affairs Canada's Weapons Threat ReductionProgram and the Open Philanthropy Project, and in coordination with thegovernment of The Netherlands as the 2018-19 Chair of the Global HealthSecurity Agenda (GHSA) Action Package Prevent-3 (APP3) on Biosafety andBiosecurity. The GBD provides a multisectoral forum for sharing models,enabling new actions to achieve biosecurity-related targets, and promotingbiosecurity as an integral component of health security. The GBD hascontributed to new national and continent-wide actions, including the AfricanUnion and Africa Centres for Disease Control and Prevention's new regionalInitiative to Strengthen Biosafety and Biosecurity in Africa. Here we presentthe GBD as a model for catalyzing action within APP3. We describe how thebenefits of this approach could expand to other GHSA Action Packages andinternational health security initiatives.
-
A New Hepatitis E Virus Genotype 2 Strain Identified From an Outbreak in Nigeria, 2017
Authors: Bo Wang, Olusola Anuoluwapo Akanbi, Dominik Harms, Olufisayo Adesina, Folakemi Abiodun Osundare, Dhamari Naidoo, Isabel Deveaux, Opeayo Ogundiran, Uzoma Ugochukwu, Nwando Mba, Chikwe Ihekweazu, C-Thomas Bock
Read Abstract | Read ArticleBackground: In 2017 the Nigerian Ministry of Health notifiedthe World Health Organization (WHO) of an outbreak of hepatitis E located inthe north-east region of the country with 146 cases with 2 deaths. The analysisof the hepatitis E virus (HEV) genotypes responsible for the outbreak revealedthe predominance of HEV genotypes 1 (HEV-1) and 2 (HEV-2). Molecular data ofHEV-2 genomes are limited; therefore we characterized a HEV-2 strain of theoutbreak in more detail.
Finding: The full-length genome sequence of an HEV-2 strain(NG/17-0500) from the outbreak was amplified using newly designed consensusprimers. Comparison with other HEV complete genome sequences, including theonly HEV-2 strain (Mex-14) with available complete genome sequences and theavailability of data of partial HEV-2 sequences from Sub-Saharan Africa,suggests that NG/17-0500 belongs to HEV subtype 2b (HEV-2b).
Conclusions: We identified a novel HEV-2b strain fromSub-Saharan Africa, which is the second complete HEV-2 sequence to date, whosenatural history and epidemiology merit further investigation.
-
A New Twenty-First Century Science for Effective Epidemic Response
Authors: Juliet Bedford, Jeremy Farrar, Chikwe Ihekweazu, Gagandeep Kang, Marion Koopmans, John Nkengasong
Read Abstract | Read ArticleWith rapidly changing ecology, urbanization,climate change, increased travel and fragile public health systems, epidemicswill become more frequent, more complex and harder to prevent and contain. Herewe argue that our concept of epidemics must evolve from crisis response duringdiscrete outbreaks to an integrated cycle of preparation, response andrecovery. This is an opportunity to combine knowledge and skills from all overthe world-especially at-risk and affected communities. Many disciplines need tobe integrated, including not only epidemiology but also social sciences,research and development, diplomacy, logistics and crisis management. Thisrequires a new approach to training tomorrow's leaders in epidemic preventionand response.
-
Epidemiology and Case-Control Study of Lassa Fever Outbreak in Nigeria From 2018 to 2019
Authors: Oladipupo Ipadeola, Yuki Furuse, Elsie A Ilori, Chioma C Dan-Nwafor, Kachikwulu O Akabike, Anthony Ahumibe, Winifred Ukponu, Lawal Bakare, Gbenga Joseph, Muhammad Saleh, Esther Namukose Muwanguzi, Adebola Olayinka, Geoffrey Namara, Dhamari Naidoo, Akanimo Iniobong, Michael Amedu, Nkem Ugbogulu, Favour Makava, Olawunmi Adeoye, Chukwuemeka Uzoho, Chimezie Anueyiagu, Tochi J Okwor, Nwando G Mba, Adejoke Akano, Abiodun Ogunniyi, Amina Mohammed, Ayodele Adeyemo, Dike K Ugochukwu, Emmanuel Agogo, Chikwe Ihekweazu
Read Abstract | Read Article -
The Reactive Vaccination Campaign Against Cholera Emergency in Camps for Internally Displaced Persons, Borno, Nigeria, 2017: A Two-Stage Cluster Survey
Authors: Moise Chi Ngwa, Wondimagegnehu Alemu, Ifeanyi Okudo, Collins Owili, Uzoma Ugochukwu, Peter Clement, Isabelle Devaux, Lorenzo Pezzoli, James Agada Oche, Chikwe Ihekweazu, David A Sack
Read Abstract | Read ArticleIntroduction: In 2017, amidst insecurity and displacements posedby Boko Haram armed insurgency, cholera outbreak started in the Muna Garagecamp for Internally Displaced Persons (IDPs) in Borno State, Nigeria. Inresponse, the Borno Ministry of Health and partners determined to provide oralcholera vaccine (OCV) to about 1 million people in IDP camps and surroundingcommunities in six Local Government Areas (LGAs) including Maiduguri, Jere,Konduga, Mafa, Dikwa, and Monguno. As part of Monitoring and Evaluation, wedescribed the coverage achieved, adverse events following immunisation (AEFI),non-vaccination reasons, vaccination decisions as well as campaign informationsources.
Methods: We conducted two-stage probability cluster surveyswith clusters selected without replacement according toprobability-proportionate-to-population-size in the six LGAs targeted by thecampaign. Individuals aged ≥1 years were the eligible study population. Datasources were household interviews with vaccine card verification and memoryrecall, if no card, as well as multiple choice questions with an open-endedoption.
Results: Overall, 12 931 respondents participated in thesurvey. Overall, 90% (95% CI: 88 to 92) of the target population received atleast one dose of OCV, range 87% (95% CI: 75 to 94) in Maiduguri to 94% (95%CI: 88 to 97) in Monguno. The weighted two-dose coverage was 73% (95% CI: 68 to77) with a low of 68% (95% CI: 46 to 86) in Maiduguri to a high of 87% (95% CI:74 to 95) in Dikwa. The coverage was lower during first round (76%, 95% CI: 71to 80) than second round (87%, 95% CI: 84 to 89) and ranged from 72% (95% CI:42 to 89) and 82% (95% CI: 82 to 91) in Maiduguri to 87% (95% CI: 75 to 95) and94% (95% CI: 88 to 97) in Dikwa for the respective first and second rounds.Also, coverage was higher among females of age 5 to 14 and ≥15 years than malesof same age groups. There were mild AEFI with the most common symptoms beingfever, headache and diarrhoea occurring up to 48 hours after ingesting thevaccine. The most common actions taken after AEFI symptoms included 'didnothing' and 'self-medicated at home'. The top reason for taking vaccine was toprotect from cholera while top reason for non-vaccination was travel/work. Themain source of campaign information was a neighbour. An overwhelming majority(96%, 95% CI: 95% to 98%) felt the campaign team treated them with respect.While 43% (95% CI: 36% to 50%) asked no questions, 37% (95% CI: 31% to 44%)felt the team addressed all their concerns.
Conclusion: The campaign achieved high coverage usingdoor-to-door and fixed sites strategies amidst insecurity posed by Boko Haram.Additional studies are needed to improve how to reduce non-vaccination,especially for the first round. While OCV provides protection for a few years,additional actions will be needed to make investments in water, sanitation andhygiene infrastructure.
-
Sharing Experiences From the Field: Updates From the Nigeria Field Epidemiology and Laboratory Training Program
Authors: Patrick Mboya Nguku, Chukwuma David Umeokonkwo, Muhammad Shakir Balogun, Ndadilnasiya Endie Waziri, Adebobola Toluwalashe Bashorun, Godwin Ntadom, Chikwe Ihekweazu
Read Abstract | Read ArticleField Epidemiology and Laboratory TrainingPrograms (FELTP) or Applied Epidemiology Training Programs (AETP) is based onthe philosophy of “learning while doing†and application of epidemiologymethods to improve public health and health care [1]. Trainees or residents in FELTP are required toconduct field investigations, data analysis, surveillance evaluations and otherfield-based activities while being mentored by experienced epidemiologists.Residents' work is not completed until they have shared their unique fieldexperiences, findings and recommendations with relevant public healthauthorities for action. Additionally, publishing their field experiences andevidence based public health actions ensures that these training experiencesare shared with the wider scientific and public health audience. In this secondsupplement from the Nigeria Field Epidemiology and Laboratory Training Program(NFELTP), we present investigations and studies carried out by these earlycareer epidemiologists as a way of disseminating important public healthfindings [2, 3]. The supplement covers summaries of asurveillance system evaluation, secondary data analyses and severalprotocol-based studies. The output represents the product of field-basedinteractions that the residents had in the course of their experientialtraining in applied epidemiology. This builds up on the first NFELTP supplementpublished in July 2014 [3] and the progress that the program has made sinceits inception in 2008. This collection of articles comprises a wide variety ofsubjects ranging from infectious disease epidemiology (malaria, HIV, measles,rubella, tuberculosis, Ebola virus disease, pertussis) to non-communicablediseases and injuries (road traffic crashes, intimate partner violence). Italso represents the work carried out in nine states and the Federal CapitalTerritory in Nigeria (Abuja, Anambra, Enugu, Gombe, Kano, Kaduna, Niger, Ogun& Ondo) and Sierra Leone. Most of the studies involving HIV, tuberculosisand malaria were conducted in response to national priorities set bystakeholders in Nigeria [4]. This demonstrates the integration of the FETPin the national health system and ensures that it continues to be relevant inprotecting the health of the populace. The NFELTP is part of the newly createdNigeria Centre for Disease Control, the country's National Public HealthInstitute [5]. We expect that these articles will stimulatefurther discussion and help to identify other relevant research questions to beaddressed across Nigeria and the African region on these important publichealth issues. We also hope that the wider public health audience will find inthem the needed information to provide solutions to various public healthchallenges. We appreciate the leadership the Federal Ministry of Health insupporting the ongoing training and utilization of field epidemiologiststhrough the NFELTP. We also acknowledge the funding and technical supportprovided by the African Field Epidemiology Network and the US Centers forDisease Control and Prevention.
-
The Response to Re-Emergence of Yellow Fever in Nigeria, 2017
Authors: William E Nwachukwu, H Yusuff, U Nwangwu, A Okon, A Ogunniyi, J Imuetinyan-Clement, M Besong, P Ayo-Ajayi, J Nikau, A Baba, F Dogunro, B Akintunde, M Oguntoye, K Kamaldeen, O Fakayode, O Oyebanji, O Emelife, J Oteri, O Aruna, E Ilori, O Ojo, N Mba, P Nguku, C Ihekweazu
Read Abstract | Read ArticleYellow fever (YF) is an acute viral hemorrhagicdisease caused by the YF virus (arbovirus) which continues to cause severemorbidity and mortality in Africa. A case of YF was confirmed in Nigeria on the12th of September 2017, 21 years after the last confirmed case. The patientbelongs to a nomadic population with a history of low YF vaccination uptake, inthe Ifelodun Local Government Area (LGA) of Kwara State, Nigeria. An activecase search in Ifelodun and its five contiguous LGAs led to the listing of 55additional suspect cases of YF within the period of the outbreak investigationbetween September 18 to October 6, 2017. The median age of cases was 15 years,and 54.4% were males. Of these, blood samples were collected from 30 cases;nine tested positive in laboratories in Nigeria and six were confirmed positivefor YF by the WHO reference laboratory in the region; Institut Pasteur, Dakar.A rapid YF vaccination coverage assessment was carried out, resulting in acoverage of 46% in the LGAs, with 25% of cases able to produce theirvaccination cards. All stages of the yellow fever vector, Aedes mosquito wereidentified in the area, with high larval indices (House and Breteau) observed.In response to the outbreak, YF surveillance was intensified across all Statesin Nigeria, as well as reactive vaccination and social mobilisation campaignscarried out in the affected LGAs in Kwara State. A state-wide YF preventivecampaign was also initiated
-
Lay Media Reporting of Monkeypox in Nigeria
Authors: Oyeronke Oyebanji, Ugonna Ofonagoro, Oluwatosin Akande, Ifeanyi Nsofor, Chika Ukenedo, Tarik Benjamin Mohammed, Chimezie Anueyiagu, Jeremiah Agenyi, Adesola Yinka-Ogunleye, Chikwe Ihekweazu
Read Abstract | Read Article·Riskcommunication is an important but under-appreciated aspect of outbreakresponse, therefore, understanding the nature and impact of media coverage canassist in modifying messages.
·Mediareports from unauthorised sources during the ongoing monkeypox outbreak inNigeria were sensationalised and led to increased anxiety in the population.
· Becauseof the tendency of the media to amplify, rather than correct rumours, mediapersonnel should be trained prior to an outbreak to reduce distorted reporting.
·TheNigerian government should maintain an up-to-date communication platform foroutbreak reporting, to routinely provide accurate information to the public.
· Thereshould be a well-defined approach of using event-based surveillance fordecision-making, effective communication and for informing how diseaseoutbreaks are reported by the media.
-
Outbreak of Human Monkeypox in Nigeria in 2017-18: A Clinical and Epidemiological Report
Authors: Adesola Yinka-Ogunleye, Olusola Aruna, Mahmood Dalhat, Dimie Ogoina, Andrea McCollum, Yahyah Disu, Ibrahim Mamadu, Afolabi Akinpelu, Adama Ahmad, Joel Burga, Adolphe Ndoreraho 8 , Edouard Nkunzimana 8 , Lamin Manneh 8 , Amina Mohammed 6 , Olawunmi Adeoye, Daniel Tom-Aba, Bernard Silenou, Oladipupo Ipadeola, Muhammad Saleh, Ayodele Adeyemo, Ifeoma Nwadiutor, Neni Aworabhi, Patience Uke, Doris John, Paul Wakama, Mary Reynolds, Matthew R Mauldin, Jeffrey Doty, Kimberly Wilkins, Joy Musa, Asheena Khalakdina, Adebayo Adedeji, Nwando Mba, Olubunmi Ojo, Gerard Krause, Chikwe Ihekweazu
Read Abstract | Read ArticleBackground: In September, 2017, human monkeypox re-emerged inNigeria, 39 years after the last reported case. We aimed to describe theclinical and epidemiological features of the 2017-18 human monkeypox outbreakin Nigeria.
Methods: We reviewed the epidemiological and clinicalcharacteristics of cases of human monkeypox that occurred between Sept 22,2017, and Sept 16, 2018. Data were collected with a standardised caseinvestigation form, with a case definition of human monkeypox that was based onpreviously established guidelines. Diagnosis was confirmed by viralidentification with real-time PCR and by detection of positiveanti-orthopoxvirus IgM antibodies. Whole-genome sequencing was done for sevencases. Haplotype analysis results, genetic distance data, and epidemiologicaldata were used to infer a likely series of events for potential human-to-humantransmission of the west African clade of monkeypox virus.
Findings: 122 confirmed or probable cases of human monkeypoxwere recorded in 17 states, including seven deaths (case fatality rate 6%).People infected with monkeypox virus were aged between 2 days and 50 years(median 29 years [IQR 14]), and 84 (69%) were male. All 122 patients hadvesiculopustular rash, and fever, pruritus, headache, and lymphadenopathy werealso common. The rash affected all parts of the body, with the face being mostaffected. The distribution of cases and contacts suggested both primaryzoonotic and secondary human-to-human transmission. Two cases ofhealth-care-associated infection were recorded. Genomic analysis suggestedmultiple introductions of the virus and a single introduction along withhuman-to-human transmission in a prison facility.
Interpretation: This study describes the largest documented humanoutbreak of the west African clade of the monkeypox virus. Our results suggestendemicity of monkeypox virus in Nigeria, with some evidence of human-to-humantransmission. Further studies are necessary to explore animal reservoirs andrisk factors for transmission of the virus in Nigeria
-
Performance of the Public Health System During a Full-Scale Yellow Fever Simulation Exercise in Lagos State, Nigeria, in 2018: How Prepared Are We for the Next Outbreak?
Authors: Oyeladun Funmi Okunromade, Virgil K Lokossou, Ike Anya, Augustine Olajide Dada, Ahmad M Njidda, Yahya O Disu, Mahmood Muazu Dalhat, Carlos Faria De Brito, Muhammad Shakir Balogun, Patrick Nguku, Olubunmi Eyitayo Ojo, Chikwe Ihekweazu, Stanley Okolo
Read Abstract | Read ArticleRecurring outbreaks of infectious diseases have characterizedthe West African region in the past 4 decades. There is a moderate to high riskof yellow fever in countries in the region, and the disease has reemerged inNigeria after 21 years. A full-scale simulation exercise of the outbreak ofyellow fever was conducted to assess preparedness and response in the event ofa full-scale outbreak. The exercise was a multi-agency exercise conducted inLagos, and it involved health facilities, points of entry, state and nationalpublic health emergency operation centers, and laboratories. An evaluation ofthe exercise assessed the capability of the system to identify, respond to, andrecover from the emergency using adapted WHO tools. The majority ofparticipants, observers, and evaluators agreed that the exercise waswell-structured and organized. Participants also strongly agreed that theexercise helped them to identify strengths and gaps in their understanding ofthe emergency response systems and plans. Overall, the exercise identifiedexisting gaps in the current capabilities of several thematic areas involved ina yellow fever response. The evaluation presented an opportunity to assess theresponse capabilities of multisectoral collaborations in the national publichealth system. It also demonstrated the usefulness of the exercise inunderstanding public health officials' roles and responsibilities; enablingknowledge transfer among these individuals and organizations; and identifyingspecific public health systems-level strengths, weaknesses, and challenges.
-
1. Is Africa Prepared for Tackling the COVID-19 (SARS-CoV-2) Epidemic? Lessons from Past Outbreaks, Ongoing Pan-African Public Health Efforts, and Implications for the Future;
Authors: Nathan Kapata, Chikwe Ihekweazu, Francine Ntoumi, Tajudeen Raji, Pascalina Chanda-Kapata, Peter Mwaba, Victor Mukonka, Matthew Bates, John Tembo, Victor Corman, Sayoki Mfinanga, Danny Asogun, Linzy Elton, Li ˜a B´arbara Arruda, Margaret J Thomason, Leonard Mboera, Alexei Yavlinsky, Najmul Haider, David Simons, Lara Hollmann, Swaib A Lule, Francisco Veas, Muzamil Mahdi Abdel Hamid, Osman Dar, Sarah Edwards, Francesco Vairo, Timothy D McHugh, Christian Drosten, Richard Kock, Giuseppe Ippolito, Alimuddin Zumla
Read Abstract | Read ArticleCoronavirusdisease 2019, (now officially named COVID-19) has been declared by the WorldHealth Organisation (WHO) to be a disease of Public Health Emergency ofInternational Concern. It has been a matter of great concern as the potentialfor the virus to spread to countries with weaker health systems is high. Intime past, other preventable emerging and re-emerging infectious diseases withepidemic potential have taken their toll on the health systems of many Africancountries. Therefore, the question surfaces, ‘Is Africa prepared and equippedto deal with yet another outbreak of a highly infectious disease – COVID-19? Itis noteworthy that with the experience gained so far from handling of pastepidemics and the high degree of awareness of COVID-19, Africa is betterprepared than ever before. The continent now has stronger national publichealth institutes, the rapid scale-up of testing capacity, better coordinationat the continental level, and the capacity of built-in surveillance and contacttracing which has occurred since the 2013–2016 West African Ebola outbreak. Itis believed that all the measures put in place so far will result in prolongedcontainment phase of COVID-19.
doi: 10.1016/j.ijid.2020.02.049
-
Notes from the Field: Responding to an Outbreak of Monkeypox Using the One Health Approach — Nigeria, 2017–2018
Authors: Womi-Eteng Eteng, MSc; Anna Mandra, DVM; Jeff Doty; Adesola Yinka-Ogunleye, DDS; Sola Aruna, MD; Mary G. Reynolds, PhD; Andrea M. McCollum, PhD; Whitni Davidson, MPH; Kimberly Wilkins; Muhammad Saleh, MPH; Oladipupo Ipadeola, MSc; Lamin Manneh; Uchenna Anebonam, MPH; Zainab Abdulkareem, DVM; Nma Okoli, DVM; Jeremiah Agenyi; Chioma Dan-Nwafor, MPH; Ibrahim Mahmodu, MPH; Chikwe Ihekweazu, MD
Read Abstract | Read ArticleOn September 22, 2017, a suspected human case of monkeypox was reported to the Nigeria Centre for Disease Control (NCDC) from Bayelsa State in southern Nigeria. Because monkeypox had not been reported in Nigeria since 1978 (1), the case raised national and international concern. A multisectoral, international outbreak investigation was undertaken to identify sources and risk factors, establish surveillance, and enhance preparedness. A suspected case was defined as the sudden onset of fever, followed by a vesiculopustular rash primarily on the face, palms, and soles. A confirmed case was any suspected case with laboratory confirmation (by serology, molecular detection of viral DNA, or virus isolation). A probable case was a suspected case epidemiologically linked to a confirmed case. As of February 25, 2018, a total of 228 suspected cases (including 89 confirmed and three probable cases) had been investigated in 24 of Nigeria’s 36 states and the Federal Capital Territory. Six deaths (6.7%) were recorded among the 89 confirmed cases. The outbreak has not been declared over, and NCDC continues to collect data to develop a baseline level for this disease, which had not been reported in 40 years and now might be endemic to Nigeria. Given the zoonotic nature of the disease, this outbreak has required a robust One Health outbreak collaboration among human, animal, and environmental health institutions.
-
The Nigeria Centre for Disease Control
Authors: Ahmad Muhammad Njidda, Oyeronke Oyebanji, Joshua Obasanya, Olubunmi Ojo, Adebayo Adedeji, Nwando Mba, John Oladejo, Chikwe Ihekweazu
Read Abstract | Read ArticleSummary box
Nigeria and several other African countries have been battling with public health challenges for decades. These challenges came to fore during the Ebola virus disease (EVD) crisis that affected many countries in the West African region, including Nigeria.
As a result, many African countries have established their National Public Health Institutes as a focal point to prevent, detect and respond to diseases of public health importance, but currently, only 9 of the 15 countries in West Africa have a designated national public health institute.
Before the EVD crisis, Nigeria established the Nigeria Centre for Disease Control (NCDC), which played a pivotal role in the control of the EVD outbreak in Nigeria, as well as provided support to other countries that were affected by the crisis.
Modelled on the US Centre for Disease Control and Prevention (CDC), the NCDC has institutionalised Nigeria’s capacity to respond to the increasing threats of outbreaks of infectious diseases and other public health emergencies. This is achieved through building collaborations and taking the lead in prevention, preparedness and surveillance, and also coordinating the public health laboratory networks.
African public health institutes are currently in early stages of evolution. Building a national public health institute requires strong commitment, clarity of vision. The experience of setting up the public health institute of Nigeria can inform similar efforts in other African countries.
Only a few African countries like Ethiopia and Mozambique have long standing National Public Health Institutes (NPHI). However, since the large 2014–2016 Ebola virus disease (EVD) outbreak in West Africa, many African countries have been setting up NPHI1 2to optimise the use of scarce resources to prevent, detect and respond to infectious disease threats. The Africa Union and the Economic Community of West African States (ECOWAS) have also set up regional disease control centres.3
The Nigeria Centre for Disease Control (NCDC) was conceived much earlier in 2007 as an attempt to establish an institution that can effectively mobilise its resources to respond to these outbreaks and other public health emergencies. Modelled after the US Centre for Disease Control and Prevention (CDC), Atlanta, the first formal step to establish NCDC took place in 2011 when units of Federal Ministry of Health—the Epidemiology Division, the Avian Influenza Project and its laboratories—and the Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) were moved to form the nucleus of NCDC.
Detecting and responding to infectious disease outbreaks has long presented a major public health challenge in Nigeria, given its size and complexity. Several large infectious disease outbreaks have been reported in Nigeria, including the yellow fever outbreak in 19864and 19875that affected 9800 and 1249 people, respectively, the large meningitis outbreak in 1996 with 109 580 cases and 11 717 deaths,6cholera outbreaks in 2001 and 20047and more recently, the meningitis outbreak in 2017.8 9In between these was the muchacclaimed successful response to the outbreak of EVD in September 2014.10
Nigeria’s public health challenges continue to grow—rapid population growth, increasing movement of people and destruction of infrastructure in the North East of Nigeria following the ‘Boko Haram’ insurgency and outbreaks from new and re-emerging pathogens. The year 2017 saw an increase in the rate of infectious diseases like Lassa fever,11yellow fever, monkey pox, cholera and new strains/subtypes/serotypes of existing pathogens like Neisseria meningitidis serogroup C in Nigeria.12In addition, Nigeria has had to address emerging public health threats, such as increasing antimicrobial resistance,13and increasing incidence of non-communicable diseases14and high maternal mortality rates.15
The establishment of NCDC is indeed more justifiable now than when it was conceived in 2007. The value of the NCDC to the country became most obvious from its role in the coordination of the response to the 2014 EVD outbreak in Nigeria16 17and coordinating the support that Nigeria provided to the Governments of Sierra Leone and Liberia during the EVD outbreak in those countries. This outbreak and the need for strong, country-led coordination become the basis for further growth of the NCDC. Notably, NCDC now takes the front seat in preventing and preparing for public health emergencies, and in managing the surveillance and reference laboratory architecture for Nigeria. NCDC has strong partnerships with the WHO and the US CDC, which support various activities at the Centre through grants and technical assistance to support disease surveillance, establishment of reference laboratory systems, outbreak response activities and others.
Together with the African Field Epidemiology Network, NCDC also manages the delivery of the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP). The NFELTP is a 2-year in-service training in applied epidemiology and laboratory practice within the NCDC/Federal Ministry of Health and Federal Ministry of Agriculture. The programme also offers basic epidemiology training to health workers at Local Government levels to improve surveillance and response to priority diseases.18The NFELTP is modelled after the US-CDC Epidemiology Intelligence Service and has been replicated in >80 countries around the world. In Nigeria, NFELTP has developed a pool of Field Epidemiologists and Laboratory experts with skills to gather critical information and turn it into public health action, and it is a major public health asset within Nigeria’s national public health institute.19
The NCDC also has a very strong relationship with the new ECOWAS Regional Centre for Disease control which is also the regional hub for the Africa Centre for Disease Control. Other partnerships that the Centre has recently developed include with the University of Maryland, Baltimore, the Robert Koch Institute, the Global Outbreak and Response Network and Public Health England, all focusing on specific aspects of its mandate.
The NCDC has strengthened its focus on prevention and preparedness; stockpiling and prepositioning of supplies for outbreak response in the states; development of guidelines and checklists for emergency preparedness; and generally increasing its role in supporting the States. NCDC also provides guidance and support to other professionals and sub-national government public health organisations and officials.
One way that NCDC has been able to coordinate preparedness and response activities is the establishment of its Incident Coordination Centre. This serves as a location to review outbreak reports and decide on preparedness and response activities. Dashboards are available to display data from the subnational level, which provides a snapshot of disease trends in the country. The Incident Coordination Centre is also tasked with daily intelligence gathering and risk analysis of public health events to identify potential threats. It serves as an Emergency Operations Centre during outbreaks, with an incident manager leading the response, bringing together the various pillars of outbreak response working in a command and control structure.
The NCDC is also the focal point for the implementation of the International Health Regulations (IHR), which is a global legal agreement that aims to prevent and respond to the spread of diseases and to avoid their becoming international crises. A Joint External Evaluation was carried out in June 2017 to assess Nigeria’s capacity to prevent, detect and respond to treats of public health importance. Several areas of strength were highlighted as well as areas requiring an improvement in capacity.20Subsequently, a National Action Plan is being developed to strengthen areas of weakness.
The journey of NCDC shows that building NPHI takes clarity of vision, perseverance, commitment and a strong legal mandate. Achieving a legal mandate will demonstrate Nigeria’s commitment to providing a strong scientific focus for ensuring the health security of Africa’s most populous nation. Over the next 5 years, the NCDC’s mission is to work in partnership with other arms of Government and partners to protect the health of Nigerians. This will be accomplished through integrated disease surveillance; a linked and connected public health laboratory network within the country and the sub region; and the coordination of emergency preparedness and response activities.
NPHI help to concentrate a country’s resources for the prevention, detection and response to infectious diseases in a single organisation. Nigeria’s experience of setting up its NCDC can inform similar efforts in other African countries.
-
Tackling Viral Haemorrhagic Fever in Africa
Authors: Chikwe Ihekweazu, Ibrahim Abubakar
Read Abstract | Read ArticleOutbreaks of viral haemorrhagic fevers, such as the Ebola virus disease epidemic in west Africa, have caught the attention of the global health community because of perceived and real threats to local, national, and global health security and their economic impact.1Although viral haemorrhagic fever outbreaks primarily affect settings in which pathogens emerge from animal hosts, they also have the potential to spread worldwide. Consequently, models that accurately predict the emergence and spread of viruses that cause viral haemorrhagic fevers are needed. InThe Lancet, David Pigott and colleagues2use a combination of approaches to assess and understand the threat of viral haemorrhagic fevers across Africa by identifying locations that have the greatest potential for zoonotic spillover, regions that are susceptible to ongoing secondary transmission, and areas with the highest potential for local and global spread. A key strength of this study is the provision of subnational estimates of risks.
The use of models to inform the distribution of resources to prevent or respond to outbreaks requires prospective validation. Gaps and bias in surveillance data on viral haemorrhagic fevers in human beings in most African settings3limit the ability to correctly predict zoonotic spillover. Pigott and colleagues predicted probable zoonotic transmission from animal hosts to human beings by combining geographical information on index cases of outbreaks and viral detection in animals and related this information to drivers in the environment to generate profiles that characterise where disease is likely to be found. In the absence of unbiased prospective surveillance, using similarities between environmental profiles to predict disease spread and which areas to focus surveillance should be used with appropriate caution. Nevertheless, this comprehensive assessment justifies investment in better surveillance and further animal–host surveys.
Projects such as the US Agency for International Development's (USAID's) PREDICT programme4provide an opportunity to improve the quality of viral reservoir data, but these data must be combined with better local disease surveillance and human–animal interaction behavioural data. By contrast, the quality of data on human connectivity, especially for air travel, is more robust and predictions of subsequent spread after emergence are therefore likely to be accurate.
In Pigott and colleagues' study,2countries that have the greatest potential for spillover from animals reflect the original zoonotic niche of the viral haemorrhagic fevers examined, as expected. Analysis of outbreak receptivity, which relates to susceptibility to ongoing secondary transmission, showed that 90% of districts in the Central African Republic, Chad, Somalia, and South Sudan ranked in the top 90th percentile. These countries stand out for their political instability. Strikingly, estimating epidemic potential based on local and international connectivity showed that at-risk districts in Nigeria represented many of those with the highest potential for global spread of viral haemorrhagic fevers.2
Pigott and colleagues suggest that this work should inform investment at each stage of potential epidemic progression and propose areas in which they should be made. However, the authors did not mention where the investment will come from or which institutions should be the primary recipients.
Sustainable action to prevent the emergence and spread of viral haemorrhagic fevers requires investment to include local sources and to strengthen national and local capacity. Science-led national public health institutes (NPHIs) are needed to use complex information to make informed decisions on preparedness and response. NPHIs can provide leadership in disease surveillance and outbreak investigations, reference laboratory services, including specialist diagnostic services for rare organisms, and advise their governments on development and evaluation of public health interventions. These institutes need scientists who are knowledgable in the local context. Many African countries already recognise the need to bring the requisite expertise together into one institute, which led to the establishment of several NPHIs.5Equally pertinent is the need for regional cooperation and resilience, which has led to new regional bodies such as the West African Regional Centre for Surveillance and Disease Control and the Africa Centres for Disease Control. These institutes are supported with modest resources compared with similar entities in high-income countries, despite the increased risk of major outbreaks from zoonotic and human sources.
Not enough emphasis in the post-Ebola narrative has been placed on strengthening NPHIs to fulfil their global health security mandate. Instead, too much responsibility has been placed on WHO, which, despite improvements in technical expertise on emergency response,6does not have sufficient resources—should they be expected—to respond to all threats in a continent as vast as Africa, or the local presence to rapidly deal with emerging viral haemorrhagic fever threats. What if Guinea had a strong NPHI with the right expertise to respond to information on infectious disease risk and use this information to persuade its own government to act? An outbreak of the size and scale experienced might never have happened.
Establishment of NPHIs provides the crucial national resources required to underpin the prevention, detection, and response to outbreaks of emerging infections. These organisations should be designed with relevant disciplines and expertise to ensure they are fit for purpose, such as technical, epidemiological, microbiological, research, and communication skills, and supported by adequate and stable financing.7To build strong, science-based institutions takes time and effort; however, it is the only sustainable way that research can lead to the development of a robust global health response capacity to emerging infections including viral haemorrhagic fevers. Although Pigott and colleagues2did not explore specific interventions, such as the ability to respond to outbreaks or the use of protective equipment with their model, future research using such models should investigate measures to mitigate spread.
CI is the Chief Executive Officer of the Nigeria Centre for Disease Control and acting lead for the West Africa Regional Centre for Surveillance and Disease Control. IA and CI are investigators on the European & Developing Countries Clinical Trials Partnership-funded Pandora consortium and the UK Space Agency-funded scoping study to develop tools for predicting zoonotic infections.
-
Genomic Characterisation of Human Monkeypox Virus in Nigeria
Authors: Ousmane Faye, Catherine B Pratt, Martin Faye, Gamou Fall, Joseph A Chitty, Moussa M Diagne, Michael R Wiley, Adesola F Yinka-Ogunleye , Sola Aruna, Ebitimitula N Etebu , Neni Aworabhi, Dimie Ogoina, Wari Numbere, Nwando Mba, Gustavo PalaciosEmail the author Gustavo Palacios, Amadou A Sall, Chikwe Ihekweazu
Read Abstract | Read ArticleMonkeypox virus (MPXV) is a large, double-stranded DNA virus belonging to the Orthopox genus in the family Poxviridae. First identified in 1958, MPXV has caused sporadic human outbreaks in central and west Africa, with a mortality rate between 1% and 10%.1Viral genomes from west Africa and the Congo Basin separate into two clades, the latter being more virulent.2Recently, MPXV outbreaks have occurred in Sudan (2005), the Republic of the Congo and Democratic Republic of the Congo (2009), and the Central African Republic (2016).
-
A Cluster of Nosocomial Lassa Fever Cases in a Tertiary Health Facility in Nigeria: Description and Lessons Learned, 2018
Authors: Authors: Chioma C. Dan-Nwafor, Oladipupo Ipadeola, Elizabeth Smout, Elsie Ilori, Ayodele Adeyemo, Chukwuma Umeokonkwo, Damian Nwidi, Williams Nwachukwu, Winifred Ukponu, Emeka Omabe, Uchenna Anaebonam, Nneka Igwenyi, Gordon Igbodo, Womi Eteng, Ikemefule Uzoma, Muhammed Saleh, Joseph Agboeze, Samuel Mutbam, Tanyth de Gooyer, Rosie Short, Everistus Aniaku, Robinson Onoh, Emeka Ogah, Patrick Nguku, John Oladejo, Clement Peter, Olubunmi Ojo, Chikwe Ihekweazu
Read Abstract | Read ArticleBackground
Lassa fever is an acute viral haemorrhagic disease endemic in Nigeria. The 2018 Lassa fever outbreak in Nigeria was unprecedented, with 8% of all cases occurring among healthcare workers (HCWs). A disproportionately high number of these infections occurred in HCWs working in a tertiary health facility in Nigeria. This paper describes the cluster of Lassa fever infections among HCWs in a treatment centre and the lessons learnt.
Methods
We analysed clinical, epidemiological and laboratory data from surveillance and laboratory records kept during the 2018 outbreak. Interviews were conducted with surviving HCWs using a questionnaire developed specifically for the investigation of Lassa fever infections in HCWs. Descriptive analysis of the data was performed in Microsoft excel.
Results
The index case was a 15-year-old male who presented at the health facility with fever and uncontrolled nasopharyngeal bleeding, following a recent uvulectomy by a traditional healer. Overall, 16 HCWs were affected (15 confirmed and 1 probable) with five deaths (CFR-31.6%). Of the 15 confirmed cases, five (33.3%) were asymptomatic. Nine HCWs were direct contacts of the index case; the remaining six HCWs had no direct contact with the index case. HCW interviews identified a low index of suspicion for Lassa fever leading to inadequate infection prevention and control (IPC) practices as possible contributing factors to nosocomial transmission.
Conclusion
Maintaining a high index of suspicion for Lassa fever in all patients especially in endemic areas, is essential in maintaining adequate IPC practices in health facilities in order to prevent nosocomial transmission of Lassa fever among HCWs. There is need to continually train and sensitise HCWs on strict adherence to IPC measures while providing care, irrespective of a patient’s provisional diagnosis.
-
The 2017 Human Monkeypox Outbreak in Nigeria - Report of Outbreak Experience and Response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
Authors: Dimie Ogoina, James Hendris Izibewule, Adesola Ogunleye, Ebi Ederiane, Uchenna Anebonam, Aworabhi Neni, Abisoye Oyeyemi, Ebimitula Nicholas Etebu, Chikwe Ihekweazu
Read Abstract | Read ArticleBackground
In September 2017, Nigeria experienced a large outbreak of human monkeypox (HMPX). In this study, we report the outbreak experience and response in the Niger Delta University Teaching Hospital (NDUTH), Bayelsa state, where the index case and majority of suspected cases were reported.
Methods
In a cross-sectional study between September 25th and 31st December 2017, we reviewed the clinical and laboratory characteristics of all suspected and confirmed cases of HMPX seen at the NDUTH and appraised the plans, activities and challenges of the hospital in response to the outbreak based on documented observations of the hospital’s infection control committee (IPC). Monkeypox cases were defined using the interim national guidelines as provided by the Nigerian Centre for Disease Control (NCDC).
Results
Of 38 suspected cases of HMPX, 18(47.4%) were laboratory confirmed, 3(7.9%) were probable, while 17 (18.4%) did not fit the case definition for HMPX. Majority of the confirmed/probable cases were adults (80.9%) and males (80.9%). There was concomitant chicken pox, syphilis and HIV-1 infections in two confirmed cases and a case of nosocomial infection in one healthcare worker (HCW). The hospital established a make-shift isolation ward for case management, constituted a HMPX response team and provided IPC resources. At the outset, some HCWs were reluctant to participate in the outbreak and others avoided suspected patients. Some patients and their family members experienced stigma and discrimination and there were cases of refusal of isolation. Repeated trainings and collaborative efforts by all stakeholders addressed some of these challenges and eventually led to successful containment of the outbreak.
Conclusion
While the 2017 outbreak of human monkeypox in Nigeria was contained, our report reveals gaps in outbreak response that could serve as lessons to other hospitals to strengthen epidemic preparedness and response activities in the hospital setting.
Nigeria Centre for Disease Control and Prevention (2025)
Table of Contents
Electronic Reporting of Integrated Disease Surveillance and Response: Lessons Learned from Northeast, Nigeria, 2019
Field notes from the Nigeria Centre for Disease Control 2019 pilot internship program for resident doctors
A rapid assessment of the implementation of integrated disease surveillance and response system in Northeast Nigeria, 2017
Identification of co-circulating pathogens that are clinically indistinguishable from Lassa Fever during the 2018 Lassa outbreak in Nigeria
52. Descriptive epidemiology of coronavirus disease 2019 in Nigeria, 27 February – 6 June 2020
Antimicrobial use and resistance in Nigeria: situation analysis and recommendations, 2017
Real-time Metagenomic Analysis of Undiagnosed Fever Cases Unveils a Yellow Fever Outbreak in Edo State, Nigeria
Epidemiologic and Clinical Features of Lassa Fever Outbreak in Nigeria, January 1–May 6, 2018
Lay media reporting of monkeypox in Nigeria
Summary box
47. Use of Surveillance Outbreak Response Management and Analysis System for Human Monkeypox Outbreak, Nigeria, 2017-2019.
Human monkeypox - After 40 years, an unintended consequence of smallpox eradication
Large Outbreak of Neisseria meningitidis Serogroup C - Nigeria, December 2016-June 2017
Lassa virus RNA detection from suspected cases in Nigeria, 2011-2017
A description of HIV prevalence trends in Nigeria from 2001 to 2010: what is the progress, where is the problem?
Knowledge, Care-Seeking Behavior, and Factors Associated With Patient Delay Among Newly-Diagnosed Pulmonary Tuberculosis Patients, Federal Capital Territory, Nigeria, 2010
Importance of Epidemiological Research of Monkeypox: Is Incidence Increasing
The Prevalence of Noma in Northwest Nigeria
Knowledge and Risk Perception Towards Lassa Fever Infection Among Residents of Affected Communities in Ebonyi State, Nigeria: Implications for Risk Communication
Action-Based Costing for National Action Plans for Health Security: Accelerating Progress Toward the International Health Regulations (2005)
Are Patients With Pulmonary Tuberculosis Who Are Identified Through Active Case Finding in the Community Different Than Those Identified in Healthcare Facilities?
Ebola Virus Disease - Gaps in Knowledge and Practice Among Healthcare Workers in Lagos, August 2014
What Are the Drivers of Recurrent Cholera Transmission in Nigeria? Evidence From a Scoping Review
Learning From the Epidemiological Response to the 2014/15 Ebola Virus Disease Outbreak
Building a Public Health Workforce in Nigeria Through Experiential Training
Lassa Fever: Epidemiology, Clinical Features, Diagnosis, Management and Prevention
Meningococcal Meningitis Outbreaks in the African Meningitis Belt After Meningococcal Serogroup A Conjugate Vaccine Introduction, 2011-2017
The Multi-Sectorial Emergency Response to a Cholera Outbreak in Internally Displaced Persons Camps in Borno State, Nigeria, 2017
Complete Genome Sequence of a Hepatitis E Virus Genotype 1e Strain From an Outbreak in Nigeria, 2017
Association of Blood Lead Level With Neurological Features in 972 Children Affected by an Acute Severe Lead Poisoning Outbreak in Zamfara State, Northern Nigeria
Caseload and Case Fatality of Lassa Fever in Nigeria, 2001-2018: A Specialist Center\'s Experience and Its Implications
Lessons Learnt From the Management of a Case of Lassa Fever and Follow-Up of Nosocomial Primary Contacts in Nigeria During Ebola Virus Disease Outbreak in West Africa
Improving Cross-Border Preparedness and Response: Lessons Learned From 3 Lassa Fever Outbreaks Across Benin, Nigeria, and Togo, 2017-2019
Accelerating Action in Global Health Security: Global Biosecurity Dialogue as a Model for Advancing the Global Health Security Agenda
A New Hepatitis E Virus Genotype 2 Strain Identified From an Outbreak in Nigeria, 2017
A New Twenty-First Century Science for Effective Epidemic Response
Epidemiology and Case-Control Study of Lassa Fever Outbreak in Nigeria From 2018 to 2019
The Reactive Vaccination Campaign Against Cholera Emergency in Camps for Internally Displaced Persons, Borno, Nigeria, 2017: A Two-Stage Cluster Survey
Sharing Experiences From the Field: Updates From the Nigeria Field Epidemiology and Laboratory Training Program
The Response to Re-Emergence of Yellow Fever in Nigeria, 2017
Lay Media Reporting of Monkeypox in Nigeria
Outbreak of Human Monkeypox in Nigeria in 2017-18: A Clinical and Epidemiological Report
Performance of the Public Health System During a Full-Scale Yellow Fever Simulation Exercise in Lagos State, Nigeria, in 2018: How Prepared Are We for the Next Outbreak?
1. Is Africa Prepared for Tackling the COVID-19 (SARS-CoV-2) Epidemic? Lessons from Past Outbreaks, Ongoing Pan-African Public Health Efforts, and Implications for the Future;
Notes from the Field: Responding to an Outbreak of Monkeypox Using the One Health Approach — Nigeria, 2017–2018
On September 22, 2017, a suspected human case of monkeypox was reported to the Nigeria Centre for Disease Control (NCDC) from Bayelsa State in southern Nigeria. Because monkeypox had not been reported in Nigeria since 1978 (1), the case raised national and international concern. A multisectoral, international outbreak investigation was undertaken to identify sources and risk factors, establish surveillance, and enhance preparedness. A suspected case was defined as the sudden onset of fever, followed by a vesiculopustular rash primarily on the face, palms, and soles. A confirmed case was any suspected case with laboratory confirmation (by serology, molecular detection of viral DNA, or virus isolation). A probable case was a suspected case epidemiologically linked to a confirmed case. As of February 25, 2018, a total of 228 suspected cases (including 89 confirmed and three probable cases) had been investigated in 24 of Nigeria’s 36 states and the Federal Capital Territory. Six deaths (6.7%) were recorded among the 89 confirmed cases. The outbreak has not been declared over, and NCDC continues to collect data to develop a baseline level for this disease, which had not been reported in 40 years and now might be endemic to Nigeria. Given the zoonotic nature of the disease, this outbreak has required a robust One Health outbreak collaboration among human, animal, and environmental health institutions.
The Nigeria Centre for Disease Control
Summary box
Tackling Viral Haemorrhagic Fever in Africa
Genomic Characterisation of Human Monkeypox Virus in Nigeria
A Cluster of Nosocomial Lassa Fever Cases in a Tertiary Health Facility in Nigeria: Description and Lessons Learned, 2018
Background
Methods
Results
Conclusion
The 2017 Human Monkeypox Outbreak in Nigeria - Report of Outbreak Experience and Response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
Top Articles
Latest Posts
Recommended Articles
- 35 Facts About South American Combs
- It’s Time to Level Up Your Manicures With These Nail Drills
- 30 Memorable Embrace the Radiant Experience Slogan & Tagline Ideas
- Laika: Aged Through Blood
- Stranger Things/Season 1 - Wikiquote
- Doom 3: BFG Edition Review
- Wartales - Full Maps & Locations Guide
- Filtering PowerApps Gallery By Dropdown & Multiple Dropdowns – Softree Technology
- Terms & Conditions - Ear Care Solutions
- Como encontrar adesivos para a região dos olhos: um guia de compras para 2025
- Het kentekenbewijs - hoe & wat?
- R&G Dugout: Show Me the Money—Fund Formation & Management | Insights | Ropes & Gray LLP
- The Ultimate Guide to Choosing the Best Cuticle Pusher in 2025 - Beutella
- Natascha Kampusch wurde vor 10 Jahren entführt
- The Surprising Origins of the ‘Guess Who?’ Game
- How To Make Traditional Yerba Mate - Sally Tea Cups
- Saegusa Mayumi/Relationships
- Great Republic Day Sale: Stock Up and Save on Makeup Removing Wipes
- Soy and Dairy Protein Ingredients Market Size, Share, and Outlook, 2025 Report- By Dairy Protein (Milk Protein Concentrates, Whey Protein Concentrates, Whey Protein Isolates, Whey Protein Hydrolysates, Casein), By Soy Protein (Soy Protein Concentrates, So
- Neuromodulation in Addiction Treatment
- 13 Skincare Products That Will Help You Survive Winter, According to Our Editors
- Angel Wings Temporary Tattoo. Lasts 1-2 Weeks.
- Program: Nursing: Clinical Nursing Concentration (5311), B.S.N. - University of Tennessee at Martin
- The 8 best toiletry bottles for travel, according to frequent flyers | CNN Underscored
- Crítica de 'Hombre Lobo': "Una película de terror buenísima, tan epidérmica como 'La mosca' de David Cronenberg"
- How to Use Builder Gel - HogoNext
- Oxygen Facial at Home: Best Products and Devices
- Para salvar o pai, Eva é baleada
- Terms & Conditions - Ear Care Solutions
- 1942: Ostfront - Filmkritik & Bewertung | Filmtoast.de - Filmkritik & Bewertung
- What to Use to Exfoliate Body: Tools and Techniques Explained?
- 10: Faith For the Unfaithful
- Tinder Apk 14.22.1 Latest Version Download - Tinder
- How to Choose & Use a Comedone/Blackhead Extractor
- Ayudas DANA: "A los ciudadanos nos da igual las riñas políticas por el bocadillo de los votos. Hay un problema, si el Gobierno tiene medios para solucionarlo, que lo haga" - Agroinformacion
- Cottage Style House Plan - 3 Beds 2.5 Baths 2093 Sq/Ft Plan #120-285
- Das erste Mal? - Wax Inn
- Against the Blade of Honour
- New Irish Songs To Hear This Week | Hotpress
- Política de privacidad – Nil Moliner
- Chodakiewicz Marek Jan - Po Zagładzie. Stosunki Polsko - Żydowskie 1944 - 1947 - PDFCOFFEE.COM
- Osobní údaje - V – CON, s.r.o.
- Justia Blawg Search - Law Blogs, Lawyer Blogs, Legal Blogs Directory & Search Engine
- World of KJ - View topic
- Pre-K Learning with Ms. Liz: Read Aloud Rhyming Stories and Same Sound Songs
- Dry Canyon | Spyro The Dragon Walkthrough - Spyro Reignited Trilogy Guide
- Private Location | F-Droid - Free and Open Source Android App Repository
- I Found The One Depuffing Tool I'll Actually Use Every Day
- Nikah Playlist 2023 Updated : Abu Fareedah : Free Download, Borrow, and Streaming : Internet Archive
- Walkthroughs - Tales of the Unknown volume 1: The Bard's Tale -- Bard's Tale Online
- Rasulullah SAW Bersabda 'Ipar Adalah Maut!' Ini Penjelasan Tentangnya - Kashoorga
- The best hair styler 2025: effective tools to shape, smooth and sculpt
- Issue 87 Pershore October 2023 - Flip eBook Pages 1-32
- 18-Oz Dove Men+Care Body & Face Wash (Various) 2 for $2 at Walgreens + Free Store Pickup on Orders $10+
- Catching Feelings: Meet Alexis, JT Realmuto's wife
- A&V Baumanagement GmbH Berlin HRB 241595 B
- Steps for Trimming Eyebrows at Home | Venus UK
- The best streaming services right now
- 20 Essential Equipment Every Makeup Artist (MUA) Should Have -
- +++ 11:01 "Selenskyjs Beliebtheitswerte sind dramatisch gesunken" +++
- The most innovative personal care products of 2022
- Trendy Hair Pin/Brooch Sweet Puppy Shape Hair Clips Non Slip for Women Girls • EUR 4,30
- Chrome Dino - Spiel T-Rex im Google Chrome-Browser ausführen
- 20 Pros and Cons of Gatekeeper in Healthcare | Ablison
- Will a £395 hairbrush made from boar bristles transform your hair?
- Glam Winter Outfit: This Pretty Puffer + Rhinestone Jeans
- 5 Ways We Expect Captain America: Brave New World to Change the MCU Forever
- The Cosmic We with Barbara Holmes and Donny Bryant | Listen to Podcasts On Demand Free | TuneIn
- The EqualSplit Pill Cutter Saved Me from an Angry Spiral of Doing It Myself
- KTT Mallo Tactile Switch vs HMX Poro Linear Switch · Milktooth
- Buy Sea Fresh Antiplaque & Strengthening Toothpaste 3 Oz By Jason Natural Products | Herbspro.com
- With ‘Twisters,’ 4DX Finally Swept America. Where Does Hollywood Go From Here?
- Lies of P: Mad Donkey boss fight tips and shortcut
- A Dietitian’s Guide to Walmart Diabetes Supplies, Skincare, and Clothes | Milk & Honey Nutrition
- Patent Extraction Process Of Polyhydroxyalkanoates (pha) From Pha-rich Mixed Culture Waste Activated Sludge (was) In A Continuous Mode Reactor System Using Low Cost Acid Recovery Method Filed 2024
- O tala sili ona lelei o taimi uma
- True Story (Film, 2015) - MovieMeter.nl
- Choosing the Best Hypoallergenic Eyelash Extension Glue: Top Recommendations
- Orgasmic Birth: Conscious Conception, Pregnancy, and Ecstatic Birthing
- Resident Evil: Afterlife - 4K Blu-ray Review
- Are Hair Relaxers Safe?
- What is Collagen Protein and What Are the Benefits?
- What is the Four-Eyes Principle? - Smartpedia -t2informatik
- Lycopin - Inhaltsstoff.info
- Study Group: Episode 1 (First Impressions)
- 11 Best Joan Fontaine Movies: The Refined Elegance of a British-American Actress
- 25 Easy Claw Clip Hairstyles To Upgrade Your Casual Looks - The List
- Kingdom Come: Deliverance 2 Roadmap Confirms Three Expansions and Loads of Updates in 2025
- The Haunted Carousel
- 7 of the best reusable water bottles for Earth Day
- What You Need To Know Baout B
- Die besten Streaming-Sticks und Streaming-Boxen 2024
- UVNAILZ | Gel-Nagelaufkleber – perfekte Nägel in 60 Sekunden
- “Emotional Ping-Pong”: David Osit’s ‘Predators’ Moves Beyond True Crime Binaries
- Was ist der Unterschied zwischen Top Coat und Base Coat?
- Subscription Gifts for Men
- ARTIST COLOR SHADOW - METALLIC EYESHADOW REFILL
- I Tested the Best Functional Socks for Neuropathy - Here's What You Need to Know!
- Kann ich nach einer Nasenkorrektur ins Solarium gehen?
- Long Life and Funerals in Iowa: What You Need to Know
Article information
Author: Frankie Dare
Last Updated:
Views: 6273
Rating: 4.2 / 5 (73 voted)
Reviews: 88% of readers found this page helpful
Author information
Name: Frankie Dare
Birthday: 2000-01-27
Address: Suite 313 45115 Caridad Freeway, Port Barabaraville, MS 66713
Phone: +3769542039359
Job: Sales Manager
Hobby: Baton twirling, Stand-up comedy, Leather crafting, Rugby, tabletop games, Jigsaw puzzles, Air sports
Introduction: My name is Frankie Dare, I am a funny, beautiful, proud, fair, pleasant, cheerful, enthusiastic person who loves writing and wants to share my knowledge and understanding with you.