Epidemiological description of and response to a large yellow fever outbreak in Edo state Nigeria, September 2018 - January 2019.

BACKGROUND: Edo State Surveillance Unit observed the emergence of a disease with "no clear-cut-diagnosis", which affected peri-urban Local Government Areas (LGAs) from September 6 to November 1, 2018. On notification, the Nigeria Centre for Disease Control deployed a Rapid Response Team (RRT) to support outbreak investigation and response activities in the State. This study describes the epidemiology of and response to a large yellow fever (YF) outbreak in Edo State. METHODS: A cross-sectional descriptive outbreak investigation of YF outbreak in Edo State. A suspected case of YF was defined as "Any person residing in Edo State with acute onset of fever and jaundice appearing within 14 days of onset of the first symptoms from September 2018 to January 2019". Our response involved active case search in health facilities and communities, retrospective review of patients' records, rapid risk assessment, entomological survey, rapid YF vaccination coverage assessment, blood sample collection, case management and risk communication. Descriptive data analysis using percentages, proportions, frequencies were made. RESULTS: A total of 209 suspected cases were line-listed. Sixty-seven (67) confirmed in 12 LGAs with 15 deaths [Case fatality rate (CFR 22.4%)]. Among confirmed cases, median age was 24.8, (range 64 (1-64) years; Fifty-one (76.1%) were males; and only 13 (19.4%) had a history of YF vaccination. Vaccination coverage survey involving 241 children revealed low YF vaccine uptake, with 44.6% providing routine immunisation cards for sighting. Risk of YF transmission was 71.4%. Presence of Aedes with high-larval indices (House Index ≥5% and/or Breteau Index ≥20) were established in all the seven locations visited. YF reactive mass vaccination campaign was implemented. CONCLUSION: Edo State is one of the states in Nigeria with the highest burden of yellow fever. More males were affected among the confirmed. Major symptoms include fever, jaundice, weakness, and bleeding. Majority of surveillance performance indicators were above target. There is a high risk of transmission of the disease in the state. Low yellow fever vaccination coverage, and presence of yellow fever vectors (Ae.aegypti, Ae.albopictus and Ae.simpsoni) are responsible for cases in affected communities. Enhanced surveillance, improved laboratory sample management, reactive vaccination campaign, improved yellow fever case management and increased risk communication/awareness are very important mitigation strategies to be sustained in Edo state to prevent further spread and mortality from yellow fever.

Transmission Based Precaution Practices among Nurses in Edo State, Nigeria during COVID-19 Pandemic.

The novel covid-19 pandemic is a highly infectious disease without known specific treatment and vaccine. Transmission based precautions are important in the fight against the virus. This study investigated the level of transmission-based precautions practiced, the predictors of correct practices, and the challenges experienced by nurses in public health facilities in Edo State during the outbreak of the Covid-19 pandemic. The study employed a descriptive cross-sectional survey to elicit responses from 367 front line nurses using a Google online questionnaire. Data analysis involved descriptive statistics and logistic regression analysis. The majority 314(85.6%) of the respondents maintained a good level of transmission-based precautions practice. Hand hygiene was performed by 327(89.1%) of the respondents. Academic qualification was a significant predictor of good practice in favour of respondents with a degree in nursing. Challenges identified were lack of financial motivation, fear of infecting family members and fear of contracting the virus (93.5%). It was concluded that nurses in Edo State Nigeria have good transmission- based practices in relation to covid-19 however efforts should be made to ensure 100% compliance and sustain practices.