To determine factors associated with mortality among confirmed Lassa fever cases.
We reviewed line lists and clinical records of laboratory-confirmed cases of Lassa fever during the 2016 outbreak in ...Nigeria to determine factors associated with mortality. We activated an incident command system to coordinate response.
We documented 47 cases, 28 of whom died (case fatality rate CFR = 59.6%; mean age 31.4 years; SD = ±18.4 years). The youngest and the oldest were the most likely to die, with 100% mortality in those aged 5 years or younger and those aged 55 years or older. Patients who commenced ribavirin were more likely to survive (odds ratio OR = 0.1; 95% confidence interval CI = 0.03, 0.50). Fatality rates went from 100% (wave 1) through 69% (wave 2) to 31% (wave 3; χ
for linear trend: P < .01). Patients admitted to a health care center before incident command system activation were more likely to die (OR = 4.4; 95% CI = 1.1, 17.6). The only pregnant patient in the study died postpartum.
Effective, coordinated response reduces mortality from public health events. Attention to vulnerable groups during disasters is essential. Public Health Implications. Activating an incident command system improves the outcome of disasters in resource-constrained settings.
Background Adverse reactions to antivenom considerably complicate the clinical management of snakebite envenomed patients because it necessitates a temporary suspension of life-saving antivenom, ...increases costs and can compromise patient outcomes. This study sought to explore the association between cattle-herding occupation and ethnic group and the occurrence of early adverse reactions to antivenom. Methods This cross-sectional study was conducted between the 25th April and 11th July 2011 at the Kaltungo General Hospital in north east Nigeria. The exposure variable of cattle-herding occupation showed a strong correlation with the ethnic group variable, thus these were combined into a new variable with three categories (Fulani and herder, either Fulani or herder, and neither Fulani nor herder). The outcome variable was the occurrence of early adverse reactions, defined as any new symptoms occurring within 6 hours of antivenom administration. Odds Ratios were estimated using multivariable logistic regression models controlling for potential confounders. Results Among 231 envenomed snakebite victims, the overall incidence of early adverse reactions was 11.9% (95% confidence intervals: 8.0-16.9%). Patients who were Fulani and herders had a higher incidence of early adverse reactions compared to patients who were neither Fulani nor herders (20% vs 5.7%). After adjusting for age and gender, victims who were Fulani and herders were 5.9 times more likely to have an early adverse reaction, compared to victims who were neither Fulani nor herders (95% CI: 1.88-18.59; p = 0.002). Interpretation To the best of our knowledge, this is the first study to provide evidence of higher odds of early adverse reactions among patients from a particular occupation and/or ethnic group. We recommend that snake envenomed patients of Fulani origin be especially closely monitored for adverse reactions, that hospitals receiving these patients be appropriately resourced to manage both envenoming and adverse reactions and that premedication with adrenaline should be considered. Our findings provide an argument for speculation on the influence of immunological or lifestyle-related differences on the occurrence of early adverse reactions to antivenom.
The highly glycosylated glycoprotein spike of Ebola virus (EBOV-GP1,2) is the primary target of the humoral host response. Recombinant EBOV-GP ectodomain (EBOV-GP1,2ecto) expressed in mammalian cells ...was used to immunize sheep and elicited a robust immune response and produced high titers of high avidity polyclonal antibodies. Investigation of the neutralizing activity of the ovine antisera in vitro revealed that it neutralized EBOV. A pool of intact ovine immunoglobulin G, herein termed EBOTAb, was prepared from the antisera and used for an in vivo guinea pig study. When EBOTAb was delivered 6 hours after challenge, all animals survived without experiencing fever or other clinical manifestations. In a second series of guinea pig studies, the administration of EBOTAb dosing was delayed for 48 or 72 hours after challenge, resulting in 100% and 75% survival, respectively. These studies illustrate the usefulness of EBOTAb in protecting against EBOV-induced disease.
In 2010, Médecins Sans Frontières (MSF) investigated reports of high mortality in young children in Zamfara State, Nigeria, leading to confirmation of villages with widespread acute severe lead ...poisoning. In a retrospective analysis, we aimed to determine venous blood lead level (VBLL) thresholds and risk factors for encephalopathy using MSF programmatic data from the first year of the outbreak response.
We included children aged ≤5 years with VBLL ≥45 µg/dL before any chelation and recorded neurological status. Odds ratios (OR) for neurological features were estimated; the final model was adjusted for age and baseline VBLL, using random effects for village of residence. 972 children met inclusion criteria: 885 (91%) had no neurological features; 34 (4%) had severe features; 47 (5%) had reported recent seizures; and six (1%) had other neurological abnormalities. The geometric mean VBLLs for all groups with neurological features were >100 µg/dL vs 65.9 µg/dL for those without neurological features. The adjusted OR for neurological features increased with increasing VBLL: from 2.75, 95%CI 1.27-5.98 (80-99.9 µg/dL) to 22.95, 95%CI 10.54-49.96 (≥120 µg/dL). Neurological features were associated with younger age (OR 4.77 95% CI 2.50-9.11 for 1-<2 years and 2.69 95%CI 1.15-6.26 for 2-<3 years, both vs 3-5 years). Severe neurological features were seen at VBLL <105 µg/dL only in those with malaria.
Increasing VBLL (from ≥80 µg/dL) and age 1-<3 years were strongly associated with neurological features; in those tested for malaria, a positive test was also strongly associated. These factors will help clinicians managing children with lead poisoning in prioritising therapy and developing chelation protocols.
Snakebite is a significant cause of death and disability in subsistent farming populations of sub-Saharan Africa. Antivenom is the most effective treatment of envenoming and is manufactured from IgG ...of venom-immunised horses/sheep but, because of complex fiscal reasons, there is a paucity of antivenom in sub-Saharan Africa. To address the plight of thousands of snakebite victims in savannah Nigeria, the EchiTAb Study Group organised the production, testing and delivery of antivenoms designed to treat envenoming by the most medically-important snakes in the region. The Echis saw-scaled vipers have a wide African distribution and medical importance. In an effort to maximise the clinical utility of scarce antivenom resources in Africa, we aimed to ascertain, at the pre-clinical level, to what extent the E. ocellatus-specific EchiTAbG antivenom, which was designed specifically for Nigeria, neutralised the lethal activity of venom from two other African species, E. pyramidum leakeyi and E. coloratus.
Despite apparently quite distinctive venom protein profiles, we observed extensive cross-species similarity in the immuno-reactivity profiles of Echis species-specific antisera. Using WHO standard pre-clinical in vivo tests, we determined that the monospecific EchiTAbG antivenom was as effective at neutralising the venom-induced lethal effects of E. pyramidum leakeyi and E. coloratus as it was against E. ocellatus venom. Under the restricted conditions of this assay, the antivenom was ineffective against the lethal effects of venom from the non-African Echis species, E. carinatus sochureki.
Using WHO-recommended pre-clinical tests we have demonstrated that the new anti-E. ocellatus monospecific antivenom EchiTAbG, developed in response to the considerable snakebite-induced mortality and morbidity in Nigeria, neutralised the lethal effects of venoms from Echis species representing each taxonomic group of this genus in Africa. This suggests that this monospecific antivenom has potential to treat envenoming by most, perhaps all, African Echis species.
Objective
Healthcare workers (HCWs) play pivotal roles in outbreak responses. Ebola virus disease (EVD) outbreak spread to Lagos, Nigeria, in July 2014, infecting 11 HCWs (case fatality rate of 45%). ...This study was conducted during the outbreak to assess HCWs' EVD‐related knowledge and practices.
Methods
A health facility‐based cross‐sectional study was conducted among HCWs across Lagos State using stratified sampling technique. An interviewer‐administered questionnaire was administered to elicit respondents' socio‐demographic characteristics, knowledge and practices. A checklist assessing health facility's level of preparedness and HCWs' EVD‐related training was employed. HCWs' knowledge and practices were scored and classified as either good or poor. Multivariate analysis was performed with confidence interval set at 95%.
Results
A total of 112 health facilities with 637 HCWs were recruited. Mean age of respondents was 40.1 ± 10.9 years. Overall, 72.5% had good knowledge; doctors knew most. However, only 4.6% of HCWs reported good practices. 16.6% reported having been trained in identifying suspected EVD patient(s); 12.2% had a triaging area for febrile patients in their facilities. Higher proportions of HCWs with good knowledge and training reported good practices. HCWs with EVD‐related training were three times more likely to adopt good practices.
Conclusion
Lagos State HCWs had good knowledge of EVD without a corresponding level of good practices. Training was a predictor of good practices.
Objectif
Les agents de la santé (AS) jouent un rôle essentiel dans les réponses aux épidémies. L’épidémie de la maladie du virus Ebola (MVE) s'est propagée à Lagos, au Nigeria, en juillet 2014, infectant 11 AS (taux de létalité de 45%). Cette étude a été menée au cours de l’épidémie pour évaluer les connaissances et les pratiques des AS liées à la MVE.
Méthodes
Une étude transversale basée sur les établissements de santé a été menée chez les AS dans l'Etat de Lagos, en utilisant la technique d’échantillonnage stratifié. Un questionnaire administré par un intervieweur a été appliqué pour obtenir les caractéristiques sociodémographiques, les connaissances et les pratiques des répondants. Une liste d’évaluation de l’état d'apprêtement de l’établissement de santé et de la formation des AS liée à la MVE a été employée. Les connaissances et les pratiques des AS ont été inscrites sur une échelle et classées comme bonnes ou mauvaises. L'analyse multivariée a été effectuée avec un intervalle de confiance fixé à 95%.
Résultats
Un total de 112 établissements de santé avec 637 AS ont été recrutés. L’âge moyen des répondants était de 40,1 ± 10,9 ans. Dans l'ensemble, 72,5% avaient une bonne connaissance; les médecins en savaient plus. Toutefois, seuls 4,6% des AS faisaient état de bonnes pratiques. 16,6% ont déclaré avoir été formés à l'identification des patients suspectés de la MVE; 12,2% disposaient dans leurs établissements d'une zone de triage pour les patients fébriles. Des proportions plus élevées d’AS ayant de bonnes connaissances et formations, rapportaient de bonnes pratiques. Les AS avec une formation liée à la MVE étaient trois fois plus susceptibles d'adopter de bonnes pratiques.
Conclusion
Les AS de l'Etat de Lagos avaient de bonnes connaissances sur la MVE sans avoir un niveau correspondant de bonnes pratiques. La formation était un prédicteur de bonnes pratiques.
Objetivo
Los trabajadores sanitarios (TS) juegan un papel primordial en las respuestas a los brotes epidémicos. Los primeros brotes de enfermedad por el virus del Ébola (EVE) aparecieron en Lagos, Nigeria, en Julio del 2014, infectando 11 TS (tasa de letalidad del 45%). Este estudio se realizó durante el brote, para evaluar los conocimientos y prácticas de los TS sobre la EVE.
Métodos
Se realizó un estudio croseccional en centros sanitarios y entre los TS, a lo largo del estado de Lagos, utilizando una técnica de muestreo estratificada. Un entrevistador administró un cuestionario sobre las características demográficas, conocimientos y prácticas del entrevistado. Mediante una lista de verificación se evaluó en nivel de preparación del centro de atención sanitaria y el entrenamiento recibido por los TS sobre la EVE. Los conocimientos y prácticas de los TS se puntuaron y clasificaron como “buenos” o “pobres”. Se realizó un análisis multivariado con intervalos de confianza del 95%.
Resultados
Se reclutaron 112 centros sanitarios con 637 TS. La edad media de quienes respondieron era de 40.1±10.9 años. En total, un 72.5% tenía un buen nivel de conocimientos; los médicos eran quienes más sabían. Sin embargo, solo un 4.6% de los TS reportaron buenas prácticas. Un 16.6% reportó haber sido entrenado en la identificación de pacientes con sospecha de EVE; un 12.2% tenía, en sus centros, un área de triaje para pacientes febriles. Una mayor proporción de TS con un buen nivel de conocimientos y entrenamiento reportó buenas prácticas. Los TS con entrenamiento sobre la EVE tenían tres veces más probabilidad de adoptar unas buenas prácticas.
Conclusión
Los trabajadores sanitarios del Estado de Lagos tenían un buen nivel de conocimientos sobre la EVE, sin un nivel correspondiente de buenas prácticas. El entrenamiento era un vaticinador de buenas prácticas.
Highlights • Outbreak, mostly a severe febrile gastroenteritis syndrome (85% fever, 70% fatigue, 65% diarrhea, 50% vomiting) in keeping with the West Africa EVD pattern. • Began in Africa's most ...populous city, spread to a 2nd large city but only 20 cases, mostly females and health workers, low CFR of 40%. No case-management worker infected. • Higher mortality in males, older age-group (>40 years), patients with diarrhea, vomiting, bleeding or late presentation to treatment center. • Early case-identification (survivors 3 ± 2 days, non-survivors 5 ± 2) due to effective contact tracing by epidemiologists/trainee-epidemiologists and prompt suspect-case evaluation/isolation achieving containment within 2-months.
The first ever outbreak of Ebola virus disease (EVD) in Nigeria was declared in July, 2014. Level of public knowledge, perception and adequacy of information on EVD were unknown. We assessed the ...public preparedness level to adopt disease preventive behavior which is premised on appropriate knowledge, perception and adequate information.
We enrolled 5,322 respondents in a community-based cross-sectional study. We used interviewer-administered questionnaire to collect data on socio-demographic characteristics, EVD-related knowledge, perception and source of information. We performed univariate and bivariate data analysis using Epi-Info software setting p-value of 0.05 as cut-off for statistical significance.
Mean age of respondents was 34 years (± 11.4 years), 52.3% were males. Forty one percent possessed satisfactory general knowledge; 44% and 43.1% possessed satisfactory knowledge on mode of spread and preventive measures, respectively. Residing in EVD cases districts, male respondents and possessing at least secondary education were positively associated with satisfactory general knowledge (p-value: 0.01, 0.001 and 0.000004, respectively). Seventy one percent perceived EVD as a public health problem while 61% believed they cannot contract the disease. Sixty two percent and 64% of respondents will not shake hands and hug a successfully treated EVD patient respectively. Only 2.2% of respondents practice good hand-washing practice. Television (68.8%) and radio (55.0%) are the most common sources of information on EVD.
Gaps in EVD-related knowledge and perception exist. Targeted public health messages to raise knowledge level, correct misconception and discourage stigmatization should be widely disseminated, with television and radio as media of choice.
Global concerns about an impending influenza pandemic escalated when highly pathogenic influenza A subtype H5N1 appeared in Nigeria in January 2006. The potential devastation from emergence of a ...pandemic strain in Africa has led to a sudden shift of public health focus to pandemic preparedness. Preparedness and control activities must work within the already strained capacity of health infrastructure in Africa to respond to immense existing public health problems. Massive attention and resources directed toward influenza could distort priorities and damage critical public health programs. Responses to concerns about pandemic influenza should strengthen human and veterinary surveillance and laboratory capacity to help address a variety of health threats. Experiences in Asia should provide bases for reassessing strategies for Africa and elsewhere. Fowl depopulation strategies will need to be adapted for Africa. Additionally, the role of avian vaccines should be comprehensively evaluated and clearly defined.
On 26th March 2014, a newspaper published an article on the death of a 15 year old female student who attended a private university in Nasarawa state from suspected VHF; presumably Ebola. We ...investigated to know the cause of death, identified the agent and the source and proposed recommendations. We defined a suspected a case of Viral Haemorrhagic Fever (VHF) as any person with onset of fever and no response to usual causes of fever and at least one of the following signs: bloody diarrhoea, bleeding from gums, bleeding into skin (purpura), bleeding into eyes and urine within and around Abuja from 9th February 2014 to 2nd April 2014. We reviewed the hospital records of the index case and re-tested stored blood samples. We searched actively for contacts with the index case in hospitals where she was treated before her demise. Hospital staff were line listed at the various hospitals. We confirmed one death (index case) a 15 year old female who died on 15th March 2014. Serum sample tested positive for Dengue virus serotypes 1,2,3 and 4 using ELISA and PCR. We implemented VHF detection, management and reporting for health professionals in the country. We recommended sero-surveillance and entomological surveys be done to determine the prevalence of Dengue virus and its vector in Abuja and Nasarawa state. Dengue and other VHFs are emerging diseases that can easily be missed or misdiagnosed in early stages. Equipping laboratories and improving surveillance can help in early detection, management and epidemic aversion.
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