First Cases of Sars-cov-2 Reinfection Coinciding with the Covid-19 Second Wave, Benin City, Nigeria.

BACKGROUND: Reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has important public health implications pertaining to herd immunity and durability of protection from vaccines. A small but growing number of cases have been reported globally but none from Africa. This is due, in part, to adherence to definitions based on genetic sequencing, the capabilities of which are in short supply on the continent. METHODS: Based on epidemiological and clinical parameters, we report the first two cases of SARS-CoV-2 reinfection from a Nigerian tertiary hospital managing coronavirus disease 2019 (COVID-19) patients. RESULT: Two cases of SARS-CoV-2 reinfection were seen in December, 2020 and January, 2021. Both were males associated with a healthcare setting and aged 37 and 38 years respectively. The number of days between the first infection and the second ranged from 160-196 days. Symptoms ranged from mild to moderate and they recovered without sequelae. CONCLUSION: Public health action, including risk communication and reinfection surveillance backed by genomic sequencing, is advocated.

CONTEXTE: La réinfection par le coronavirus 2 du syndrome respiratoire aigu sévère (SRAS-CoV-2) a des implications importantes pour la santé publique en ce qui concerne l'immunité du troupeau et la durabilité de la protection contre les vaccins. Un nombre petit mais croissant de cas a été signalé dans le monde, mais aucun en Afrique. Cela est dû, en partie, au respect des définitions basées sur le séquençage génétique, dont les capacités sont rares sur le continent. MÉTHODES: Sur la base de paramètres épidémiologiques et cliniques, nous rapportons les deux premiers cas de réinfection par le SRAS-CoV-2 d'un hôpital tertiaire nigérian prenant en charge des patients atteints de la maladie à coronavirus 2019 (COVID-19). RÉSULTAT: Deux cas de réinfection par le SRAS-CoV-2 ont été observés en décembre 2020 et janvier 2021. Tous deux étaient des hommes associés à un établissement de soins de santé et âgés respectivement de 37 et 38 ans. Le nombre de jours entre la première infection et la seconde variait de 160 à 196 jours. Les symptômes variaient de légers à modérés et ils se sont rétablis sans séquelles. CONCLUSION: Une action de santé publique, y compris la communication des risques et la surveillance des réinfections appuyées par le séquençage génomique, est préconisée. MOTS CLÉS: COVID-19; SRAS-CoV-2; Réinfection; Nigeria; Pandémie.

Facility-Based Surveillance Activities for COVID-19 Infection and Outcomes among Healthcare Workers in a Nigerian Tertiary Hospital

WATERLIT Abstract: COVID-19 in healthcare workers (HCWs) can result in nosocomial transmission, depletion in available workforce, and enhanced community transmission. This article describes surveillance for COVID-19 in HCWs at a tertiary healthcare facility, and documents the outcomes. A descriptive cross-sectional study of all HCWs identified from surveillance for COVID-19 from March 31 to August 31, 2020 was conducted. Healthcare workers were categorized as high risk and low risk using an adapted WHO Risk Assessment tool. Nasopharyngeal and oropharyngeal swab specimens obtained from high-risk subjects were tested by a reverse transcriptase PCR method. Data were analyzed with IBM SPSS version 25.0 software (IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY), and results were presented as frequencies and percentages. The level of significance was set at P < 0.05. During 5 months of surveillance, 1,466 HCWs with a mean age of 38.1 ± 9.7 years were identified as contacts. On risk assessment, 328 (22.4%) were adjudged high risk. High risk was associated with increasing age (P < 0.001), male gender (P = 0.001), and nonclinical staff (P = 0.002). Following testing, 78 (5.3%) in the high-risk category were confirmed to have COVID-19. There was no record of COVID-19 in HCWs adjudged low risk. Forty-four (56.4%) cases were epidemiologically linked to the community, 20 (25.7%) to patients, and 14 (17.9%) to another HCW. Surveillance and risk assessment are crucial to COVID-19 response in healthcare facilities and revealed HCW infections with predominantly nonoccupational epidemiological links in this study

Arterial Oxygen Saturation and other Clinical Predictors of Survival in Patients with Covid-19: A Review of Cases in a Tertiary Care Hospital in Nigeria.

BACKGROUND: We assessed clinical parameters in patients confirmed to have COVID-19 in relation to arterial hypoxaemia and survival. METHODOLOGY: This was a retrospective chart review of patients who were confirmed positive for SARS-CoV-2 virus by Real Time-Polymerase Chain Reaction (RT-PCR) testing. Data extracted from patients' case files included patient demographics, presenting symptoms, provisional diagnoses, and outcomes of hospitalisation. Descriptive variables were summarized; proportions were compared using Chi-square tests, and independent predictors of mortality were assessed using multivariate regression analysis. A p-value of < 0.05 was considered as statistically significant. RESULTS: There were a total of 61 patients with positive RT-PCR testing: mean age ± SD (minimum - maximum) was 53.0 ± 18.5 (5 months - 90) years. Persons aged 60 years and above were the largest group (n=24, 39.3%). More than half were male (n=35, 57.4%); about 43% had one morbidity; 41.0% had at least two co-morbidities. The mean (SD) arterial oxygen saturation (SpO2) was 86.9% ± 16.7. Patients who were clinically dyspnoeic at presentation, and who had co-morbidities were significantly more hypoxaemic (p = 0.026 and 0.04, respectively). Significantly more patients who had normal oxygen saturation at presentation survived (p = 0.006). None of these variables was an independent predictor of mortality, however. CONCLUSION: Arterial hypoxaemia was significantly associated with dyspnoea and underlying disease, and normal oxygen saturation at presentation was significantly associated with survival. Hospital managers and clinicians may thus prioritize routine pulse oximetry, supplemental oxygen therapy and management of co-morbidities in the COVID-19 fight.

An Analysis of COVID-19 Patients Receiving Care in a Tertiary Facility in Southern Nigeria.

BACKGROUND: Information pertaining to the clinical characteristics of COVID-19 in sub-Saharan Africa remains sparse. In Nigeria, it is limited to few isolated reports and case series confined to the early phase of the outbreak. The objective of this study is to describe the presenting characteristics, co-morbidities and outcomes of Nigerian patients managed over a 3-month period in a tertiary hospital. METHODS: This was a descriptive cross-sectional study involving the total population of patients with laboratory confirmed diagnosis of COVID-19 in the University of Benin Teaching Hospital, Edo State, Nigeria from March 31 to June 30, 2020. Data was collected using a review of patients' records. Analysis was by IBM SPSS version 25.0. The level of significance was set at p < 0.05. RESULTS: A total of 173 patients with mean age (SD) 50.7± 20.1 years were managed. One hundred and five (60.7%) were males and the commonest age group was 20-39 years (34.7%). The commonest presenting symptoms were fever, cough and malaise found in 103 (71.5%), 101 (70.1%) and 63 (43.8%) patients respectively. Twenty-five (14.5%) patients had severe disease; 60 (34.7%) had underlying medical conditions mostly hypertension and diabetes mellitus. Outcome analyses showed 117 (67.6%) discharges, 45 (26.0%) deaths, 10 (5.8%) discharges against medical advice, and 1 (0.6%) transfer to another facility. Male sex (p=0.044), increasing age (p<0.001), presence of symptoms (p=0.010), presence of co-morbidities (p=0.010) and non-healthcare worker status (p< 0.001) were significantly associated with mortality. CONCLUSION: The first epidemiological and clinical summary of COVID-19 cases in Edo state, Nigeria over a three-month period is presented showing globally recognized patterns of male predilection and higher mortality with increasing age and co-morbidity.