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1.
BMJ Glob Health ; 7(Suppl 7)2022 09.
Article in English | MEDLINE | ID: covidwho-2038290

ABSTRACT

Response to public health emergencies requires continued adaptation and innovation. The Nigeria Centre for Disease Control (NCDC) is the country's public health institute with the mandate to protect the health of Nigerians. Achieving such mandate in resource-limited settings with divergent demographic characteristics of the citizens, necessitates the readiness to learn from experience and to develop policies and activities in line with lessons learnt and best practices. This practice paper describes the initiatives of the NCDC towards adapting its public health response activities by establishing learning systems across its structure. The paper informs on some of the steps taken by the Centre regarding learning from the Lassa fever outbreak and the COVID-19 pandemic in Nigeria. It concludes that commitment and investments are key requirements for learning and adapting public health responses to achieve success with combating infectious diseases.


Subject(s)
COVID-19 , Lassa Fever , Humans , Lassa Fever/epidemiology , Lassa Fever/prevention & control , Nigeria/epidemiology , Pandemics/prevention & control , Public Health
2.
Int J Infect Dis ; 122: 767-774, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2036065

ABSTRACT

OBJECTIVES: Liberia is endemic to Lassa fever (LF) and has the largest reported per capita incidence of LF patients in the West African region. Cases of the disease increased unprecedentedly in 2019 and 2020, characterized by a geographical drift in epidemiology and seasonal variation of occurrence. This study aims to describe the epidemiological and clinical characteristics of LF in Liberia from 2019 to 2020. METHODS: A retrospective study was conducted on cases of LF confirmed at the National Public Health Reference Laboratory from January 2019 to December 2020. Medical records were reviewed, and epidemiological and clinical data were collected in an organized manner. Descriptive and inferential statistics were carried out using Epi Info (version 7.2.5.0). RESULTS: A total of 382 suspected LF cases were reported, of which 103 were laboratory-confirmed, yielding a case positivity rate of 27% (103/382). The median age of the LF cases was 20 (IQR: 9-30). Children younger than 18 years accounted for 40.8% (42/103) of the cases and healthcare workers' cases constituted 7.7% of the cases. Bong, Nimba, and Grand Bass accounted for 87.4% of the cases with cases in new counties like Lofa, Margibi, and Grand Kru. Hemorrhage (aOR:10.2; 95% CI: 3.11-33.81), patients who did not receive ribavirin (aOR: 4.4; 95% CI: 1.12-17.57, P = 0.034), and patients aged 40 years or older (aOR: 6.2; 95% CI: 1.19-32.53, P = 0.049) were associated with LF mortality. CONCLUSION: The LF cases in 2019 and 2020 had a high case fatality rate and spread to new counties that had not previously reported LF. The disease occurred during most of the rainy season instead of the usual dry season. There is an urgent need to lower morbidity and mortality, improve early presentation to the hospital, and early initiation of appropriate medical care.


Subject(s)
Lassa Fever , Child , Humans , Lassa Fever/epidemiology , Lassa virus , Liberia/epidemiology , Public Health , Retrospective Studies , Ribavirin
3.
PLoS Negl Trop Dis ; 16(5): e0010423, 2022 05.
Article in English | MEDLINE | ID: covidwho-1854983

ABSTRACT

BACKGROUND: Lassa fever (LF) often presents clinically as undifferentiated febrile illness. Lassa Fever cases in Sierra Leone have been falling since the 2014-2016 Ebola epidemic. Data from other LF endemic countries suggest that this is not a true reflection of local epidemiological decline, but rather a function of either health seeking behaviour or the health/referral system. In Sierra Leone, many other diseases present with a similar early clinical picture, including COVID-19 and Marburg Disease (which has recently emerged in neighbouring Guinea). This empirical study explores the implementation of health system processes associated with International Health Regulations (IHR) requirements for early detection and timely and effective responses to the spread of febrile disease, through the case study of LF in Sierra Leone. METHODOLOGY/PRINCIPAL FINDINGS: This study used a qualitative approach to analyse local policy and guidance documents, key informant interviews with policy and practice actors, and focus group discussions and in-depth interviews with health care workers (HCWs) and community health workers (CHWs) in Kenema District to examine the ways in which undifferentiated fever surveillance and response policies and processes were implemented in the post-Ebola period. Multiple challenges were identified, including: issues with the LF case definition, approaches to differential diagnosis, specimen transport and the provision of results, and ownership of laboratory data. These issues lead to delays in diagnosis, and potentially worse outcomes for individual patients, as well as affecting the system's ability to respond to outbreak-prone disease. CONCLUSIONS/SIGNIFICANCE: Identification of ways to improve the system requires balancing vertical disease surveillance programmes against other population health needs. Therefore, health system challenges to early identification of LF specifically have implications for the effectiveness of the wider Integrated Disease Surveillance and Response (IDSR) system in Sierra Leone more generally. Sentinel surveillance or improved surveillance at maternity facilities would help improve viral haemorrhagic fever (VHF) surveillance, as well as knowledge of LF epidemiology. Strengthening surveillance for vertical disease programmes, if correctly targeted, could have downstream benefits for COVID-19 surveillance and response as well as the wider health system-and therefore patient outcomes more generally.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Lassa Fever , COVID-19/diagnosis , COVID-19/epidemiology , Disease Outbreaks , Female , Hemorrhagic Fever, Ebola/epidemiology , Humans , Lassa Fever/diagnosis , Lassa Fever/epidemiology , Pregnancy , Sierra Leone/epidemiology
4.
PLoS Negl Trop Dis ; 16(3): e0010259, 2022 03.
Article in English | MEDLINE | ID: covidwho-1833509

ABSTRACT

BACKGROUND: The year 2020 Lassa fever (LF) outbreak had the greatest disease burden and this can place an enormous strain on the already overstretched healthcare system and can potentially increase morbidity and mortality due to infectious diseases. Therefore, having a knowledgeable healthcare workforce with appropriate skills and competencies to prevent and manage outbreaks of a neglected infectious disease such as LF in Nigeria will potentially enhance public health. Thus, this survey assessed the level of knowledge of LF and its prevention and control (PC) measures amongst the healthcare workers (HCWs) during a LF outbreak in Katsina state, Nigeria. METHODOLOGY/PRINCIPAL FINDINGS: During this cross-sectional survey, HCWs complete a validated 29-item questionnaire comprising 18 items on the knowledge of LF and its PC measures and an item on global self-evaluation of their LF knowledge. Psychometric properties of the questionnaire were evaluated. Chi-square and binary logistic regression analyses were conducted. Out of 435 HCWs invited, a total of 400 participated in the study (92% response rate). The majority of participants (51.8%) demonstrated inadequate LF knowledge, with 62.9% of those scoring low having a high self-perception of their LF knowledge with the global scale. This LF knowledge over-estimation was predicted by LF training status (odds ratio (OR) 2.53; 95% CI: 1.49-4.30; p = 0.001). The level of LF knowledge and its PC measures among the study participants was low (11.60±8.14, 64.4%) and predicted by participants' LF training status (OR 2.06; 95% CI: 1.19-3.57; p = 0.009), place of work (OR 1.82; 95% CI: 1.07-3.08; p = 0.03) and their designations (OR 2.40; 95% CI: 1.10-5.22; p = 0.03). CONCLUSION: The level of knowledge of LF and its PC measures among the HCWs surveyed was suboptimal and participants' LF training status, place of work and occupational category were the significant predictors. In addition, LF knowledge overestimation on a global scale was observed among a majority of HCWs and this was also predicted by LF training status. Therefore, there is a critical need for health authorities in Nigeria to prioritize continuous on-the-job training of HCWs on priority neglected tropical diseases such as Lassa fever.


Subject(s)
Lassa Fever , Cross-Sectional Studies , Disease Outbreaks/prevention & control , Health Knowledge, Attitudes, Practice , Health Personnel , Humans , Lassa Fever/epidemiology , Lassa Fever/prevention & control , Nigeria/epidemiology , Surveys and Questionnaires
5.
Int J Infect Dis ; 117: 45-47, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1654578

ABSTRACT

As the COVID-19 pandemic poses serious threats to global public health, Nigeria faces a potential public health crisis owing to COVID-19 and other infectious diseases, such as Lassa fever (LF) and malaria. In this study, we discuss the possible determinants behind the decreased number of LF cases in Nigeria, which was likely due to the synergistic impact of the COVID-19 pandemic. During the COVID-19 pandemic, the epidemic curve of LF seems to have deviated from the general seasonal scale seen in past years, which could be due to underreporting of cases. In addition, partial compliance with nonpharmaceutical interventions, limited resources, or human behavior could be contributing factors. Thus, we suggest that better differentiation in terms of human and resource allocation between COVID-19 and LF could help curtail the transmission effectively.


Subject(s)
COVID-19 , Lassa Fever , COVID-19/epidemiology , Disease Outbreaks , Humans , Lassa Fever/epidemiology , Lassa Fever/prevention & control , Lassa virus , Nigeria/epidemiology , Pandemics/prevention & control
6.
J Med Virol ; 93(12): 6433-6436, 2021 12.
Article in English | MEDLINE | ID: covidwho-1557694

ABSTRACT

Lassa fever, caused by the Lassa virus of the Arenaviruses family, is a re-emerging public health concern that has led to 300,000 infections and 5000 deaths annually in Africa. Highly prevalent in Sierra Leone, Liberia, Guinea, Nigeria, Côte d'lvoire, Ghana, Togo, and Benin, patients infected with the virus can manifest with cough, sore throat, headache, nausea, and vomiting among other symptoms. Coexisting with the coronavirus disease 2019 (COVID-19) pandemic and its impacts, cases of Lassa fever in the African population have been reported to decrease due to hesitancy in visiting clinics that leads to unreported cases-all contributing to a silent outbreak in West Africa. Thus, to overcome current burdens, gaps, and challenges caused by Lassa fever amidst COVID-19 in Africa, various recommendations for efficient control of transmission, measures for disease containment, and strategies to correct misperceptions were made.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Lassa Fever/epidemiology , Lassa Fever/prevention & control , Patient Acceptance of Health Care/statistics & numerical data , Africa, Western/epidemiology , COVID-19/diagnosis , Disease Outbreaks/statistics & numerical data , Humans , Lassa Fever/diagnosis , Lassa virus , Molecular Diagnostic Techniques , Public Health , SARS-CoV-2 , Viral Vaccines
7.
Viruses ; 13(8)2021 08 13.
Article in English | MEDLINE | ID: covidwho-1376992

ABSTRACT

While investigating a signal of adaptive evolution in humans at the gene LARGE, we encountered an intriguing finding by Dr. Stefan Kunz that the gene plays a critical role in Lassa virus binding and entry. This led us to pursue field work to test our hypothesis that natural selection acting on LARGE-detected in the Yoruba population of Nigeria-conferred resistance to Lassa Fever in some West African populations. As we delved further, we conjectured that the "emerging" nature of recently discovered diseases like Lassa fever is related to a newfound capacity for detection, rather than a novel viral presence, and that humans have in fact been exposed to the viruses that cause such diseases for much longer than previously suspected. Dr. Stefan Kunz's critical efforts not only laid the groundwork for this discovery, but also inspired and catalyzed a series of events that birthed Sentinel, an ambitious and large-scale pandemic prevention effort in West Africa. Sentinel aims to detect and characterize deadly pathogens before they spread across the globe, through implementation of its three fundamental pillars: Detect, Connect, and Empower. More specifically, Sentinel is designed to detect known and novel infections rapidly, connect and share information in real time to identify emerging threats, and empower the public health community to improve pandemic preparedness and response anywhere in the world. We are proud to dedicate this work to Stefan Kunz, and eagerly invite new collaborators, experts, and others to join us in our efforts.


Subject(s)
Disaster Planning , Lassa Fever/epidemiology , Lassa virus/physiology , Africa, Western/epidemiology , Disaster Planning/methods , Humans , Lassa Fever/genetics , Lassa Fever/prevention & control , Lassa Fever/virology , Lassa virus/genetics , N-Acetylglucosaminyltransferases/genetics , N-Acetylglucosaminyltransferases/immunology , Nigeria/epidemiology , Pandemics , Polymorphism, Genetic , Receptors, Virus/genetics , Receptors, Virus/immunology
10.
J Clin Virol ; 128: 104434, 2020 07.
Article in English | MEDLINE | ID: covidwho-245416

ABSTRACT

With the COVID-19 officially declared a pandemic, Nigeria alongside other countries is directing all its resources and manpower to contain this pandemic. However, the existence of Lassa fever (LF), a more severe, zoonotic, endemic and viral haemorrhagic fever caused by Lassa virus with higher case fatality ratio (CFR) rages on across Nigeria while receiving little or no public health attention. The simultaneously increasing cases of COVID-19 and LF across Nigeria would be catastrophic unless infection prevention and control measures toward both LF and COVID-19 outbreaks are considered alongside.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/epidemiology , Disease Outbreaks , Hemorrhagic Fevers, Viral/epidemiology , Lassa Fever/epidemiology , Lassa virus/physiology , Pandemics , Pneumonia, Viral/epidemiology , COVID-19 , Coronavirus Infections/virology , Hemorrhagic Fevers, Viral/virology , Humans , Lassa Fever/virology , Nigeria/epidemiology , Pneumonia, Viral/virology , Public Health , SARS-CoV-2
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