Posted on 11TH SEP 2017
tagged Lassa Fever, West Africa; Nigeria

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 1 Sep 2017
Source: Nigeria Centre for Disease Control, Weekly Epidemiological Report 7(33) [edited]

Recommendations from the National Lassa Fever After-Action Review Meeting
The primary goal of the Lassa Fever After-Action Review Meeting of the 2016/2017 Lassa fever outbreak was to review the Lassa fever outbreak in Nigeria as well as strengthen preparedness and response measures. A major output of this meeting was the development of a communique with proceedings and recommendations from the meeting. As a sequel to last week's issue editorial, this week focuses on specific recommendations from the meeting with the goal to implement these for an improved response to Lassa fever in Nigeria.

The meeting had in attendance state epidemiologists of 18 states that have been affected by the current outbreak, case management physicians from these states, representatives from NCDC collaborating laboratories across the country, members of the Lassa Fever Steering Committee chaired by Prof. Oyewale Tomori, and representatives from the Federal Ministries of Agriculture, Environment, the World Health Organization, UNICEF, US Centers for Disease Control, African Field Epidemiology Network, University of Maryland Baltimore (Nigeria office) and Medecins Sans Frontiers.

Given the range of attendees cutting across policy makers, surveillance officers, case management physicians, response teams and related, extensive discussions were held and first-hand experience shared to develop the recommendations below.

One key consensus was on coordination. The coordination of Lassa fever preparedness and response activities is essential for the prevention of a large outbreak. A key activity that we have continuously advocated for is the constitution of Rapid Response Teams (RRTs) at state and Local Government Area (LGA) levels with individuals with the relevant expertise. This should also be supported by the establishment of a multi-hazard Emergency Operations Centre (EOC) and Incident Management System (IMS) for the coordination of outbreak response.

In the past, outbreaks have spread across communities with late or incomplete reporting by Disease Surveillance and Notification Officers (DSNOs) and State Epidemiologists. It is very important that surveillance officers at all levels provide complete and timely information on all cases as requested in the case-based viral haemorrhagic fever management system forms. States are also encouraged to designate and train surveillance focal persons in all health facilities and involve communities in disease surveillance. Surveillance activities have been stalled by the lack of sufficient funding. State governments are encouraged to create budgetary allocations and timely release of funds for surveillance activities and training.

The Nigeria Centre for Disease Control has developed guidelines for response to Lassa fever and related guidelines for Viral Hemorrhagic Fevers [VHFs]. These should be used as a guide to ensure a harmonized approach to prevention, detection and response across the country. In addition, it is important for each state to designate a treatment centre state with a constituted case management team/IPC team for Lassa fever and other VHFs. There should be dedicated funds at facility, LGA, state, and national levels for management of cases.

In the last few years, the NCDC collaborating laboratories in Lagos and Irrua have served as the main diagnostic facilities for Lassa fever and other VHFs. With the recent operationalization of the NCDC National Reference Laboratory in Gaduwa, Abuja, the Northern region will also have a hub for Lassa fever diagnosis. There are ongoing discussions to develop a national VHF sample transportation logistical framework, protocol and policy for sample management. This will be in addition to the establishment of VHF diagnostic laboratories in each geopolitical zone in Nigeria within the next 12 months. Each state should provide standardised sample collection and transportation kits in order to reduce the hazards inherent in current methods of shipping samples.

Risk Communication and Social Mobilization have remained often ignored and underserved areas. It is important for states and federal levels to organise periodic media workshops and engagement to increase sensitisation and awareness of VHFs among the general public. An all-hazard risk communications plan currently being developed by the NCDC can be adapted by states.

Finally, the NCDC will work to facilitate One Health collaborative research to establish the drivers of Lassa fever, including areas of case management, drug manufacture, Rapid Diagnostic Test (RDT) kits and vaccine development.

1. Lassa fever
Please note that the data reflect the routine reports, i.e. all suspected cases including the laboratory positive and negative cases
1.1. 39 suspected cases of Lassa fever with 6 laboratory confirmed were reported from 11 LGAs (8 states; Anambra - 1, Edo - 3, Kwara - 24, Ogun - 5, Ondo - 2, Nasarawa - 1, Plateau - 1 & Taraba - 2) in week 33, 2017 compared with 3 suspected cases with one laboratory confirmed and 2 deaths (CFR, 66.7 percent) reported from 3 LGAs (3 states) at the same period in 2016.
1.2. Laboratory results of the 39 suspected cases were 6 positives for Lassa fever (Edo - 3, Ogun - 2 & Ondo -1) while 4 were negative for Lassa fever and other VHFs (Ogun - 3 & Ondo - 1) while 28 pending (Kwara - 24, Nasarawa - 1, Plateau - 1 & Taraba - 2).
1.3. Between weeks 1 and 33 (2017), 432 suspected Lassa fever cases with 104 laboratory confirmed cases and 58 deaths (CFR, 13.43 percent) from 78 LGAs (26 states) were reported compared with 790 suspected cases with 76 laboratory confirmed cases and 92 deaths (CFR, 11.65 percent) from 130 LGAs (28 states) during the same period in 2016 (Figure 1).
1.4. Between weeks 1 and 52 2016, 921 suspected Lassa fever cases with 109 laboratory confirmed cases and 119 deaths (CFR, 12.92 percent) from 144 LGAs (28 states and FCT) were reported compared with 430 suspected cases with 25 laboratory confirmed cases and 40 deaths (CFR, 9.30 percent) from 37 LGAs (14 states and FCT) during the same period in 2015 (Figure 2).
1.5. Investigation and active case search ongoing in affected states with coordination of response activities by the NCDC with support from partners.
1.5.1. National Lassa Fever Working Group meeting and weekly National Surveillance and Outbreak Response meeting on-going at NCDC to keep abreast of the current Lassa fever situation in the country.
1.5.2. Response materials for VHFs prepositioned across the country by NCDC at the beginning of the dry season.
1.5.3. New VHF guidelines have been developed by the NCDC (National Viral Haemorrhagic Fevers Preparedness guidelines, Infection Prevention and Control of VHF and Standard Operating Procedures for Lassa fever management) and are available on the NCDC website.
1.5.4. Ongoing reclassification of reported Lassa fever cases
1.5.5. Ongoing review of the variables for case-based surveillance for VHF
1.5.6. VHF case-based forms completed by affected states are being entered into the new VHF management system. This system allows for the creation of a VHF database for the country.
1.5.7. NCDC team sent to Edo State to support Lassa fever data harmonization & updating of VHF case-based management database
1.5.8. Confirmed cases are being treated at identified treatment/isolation centres across the states with ribavirin and necessary supportive management also instituted
1.5.9. Onsite support was earlier provided to Ogun, Nasarawa, Taraba, Ondo and Borno States by the NCDC and partners
1.5.10. Offsite support provided by NCDC/partners in all affected states
1.5.11. NCDC and partners are providing onsite support in Ondo and Plateau state
1.5.12. States are enjoined to intensify surveillance and promote infection, prevention and control (IPC) measures in health facilities.

Figure 1: Map of Nigeria showing areas affected by Lassa fever, week 1- 33, 2016 & 2017
Figure 2: Map of Nigeria showing areas affected by Lassa fever, week 1 - 53, 2015 and week 1 - 52, 2016

Table of cases by state, cumulative data weeks 1-33 (14-20 Aug 2017) as of 25 Aug 2017)
State: Cases / Laboratory confirmed / Deaths
Adamawa: 6 / 0 / 2
Akwa Ibom 2 / 1 / 0
Bauchi: 11 / 4 / 4
Benue: 1 / 0 / 0
Cross River: 7 / 0 / 1
Ebonyi: 4 / 1 / 1
Edo: 154 / 36 / 9
Enugu: 1 / 1 / 1
FCT: 2 / 0 / 0
Gombe: 17 / 0 / 1
Jigawa: 1 / 0 / 0
Kadun: 1 / 0 / 0
Kano: 23 / 2 / 10
Katsina: 4 / 0 / 0
Kebbi: 1 / 0 / 1
Kogi: 3 / 1 / 1
Kwara: 29 / 1 / 0
Lagos 1 / 1/ 0
Nasarawa: 30 / 6 / 2
Ogun: 19 / 4 / 0
Ondo: 31 / 21 / 7
Oyo: 1 / 0 / 0
Plateau: 31 / 9 / 7
Rivers: 6 / 1 / 0
Taraba: 40 / 12 / 9
Yobe: 6 / 3 / 2
Total: 432 / 104 / 58

Communicated by:
Olutayo Olajide Babalobi
Lecturer and Consultant Epizootiologist
(One Health, Participatory Epizootiology and Veterinary ICT Research Group)
Department of Veterinary Public Health and Preventive Medicine
Faculty of Veterinary Medicine
University of Ibadan
Ibadan, Nigeria

[Overall, case numbers have increased by 29 confirmed, 7 laboratory confirmed, and no additional deaths in the past week.

The after action review identified the need for an integrated approach to prevention, detection and response across the country. Implementing the recommendations coming from the review meeting will require significant funding and continual training of medical personnel.

Once again, ProMED-mail thanks Dr Olutayo Olajide Babalobi for sending in the epidemiological report above.

As noted in earlier comments, Lassa fever remains a problem in Nigeria because the virus is endemic there. Virus transmission to humans occurs when people are in contact with the reservoir rodent host, the multimammate mouse (in the genus _Mastomys_) or their excreta. Transmission also occurs in health facilities when personal protective equipment is not employed and barrier-nursing practices are not adequate to protect staff from blood and secretions of infected patients.

Images of mastomys mice, the rodent reservoir of Lassa fever virus, can be seen at

Maps of Nigeria can be accessed at and - Mod.TY]

See Also

Lassa fever - West Africa (33): Nigeria 20170904.5293066
Lassa fever - West Africa (32): Nigeria 20170819.5262007
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Lassa fever - West Africa (28): Nigeria 20170727.5208474
Lassa fever - West Africa (27): Nigeria 20170714.5173313
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Lassa fever - West Africa (25): Nigeria 20170629.5140763
Lassa fever - West Africa (24): Nigeria 20170626.5130588
Lassa fever - West Africa (23): Nigeria (ON) 20170622.5124247
Lassa fever - West Africa (22): Nigeria (AN) 20170620.5118831
Lassa fever - West Africa (21): Nigeria 20170617.5112720
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Lassa fever - West Africa (18): Nigeria 20170530.5070103
Lassa fever - West Africa (17): Nigeria 20170513.5033800
Lassa fever - West Africa (16): Nigeria (BA) 20170412.4967018
Lassa fever - West Africa (15): Nigeria (KO) 20170404.4947996
Lassa fever - West Africa (14): Nigeria 20170402.4943005
Lassa fever - West Africa (13): update 20170328.4931422
Lassa fever - West Africa (12): Nigeria 20170327.4929174
Lassa fever - West Africa (11): Nigeria 20170319.4911462
Lassa fever - West Africa (09): Nigeria (BO) 20170302.4875164
Lassa fever - West Africa (07): Nigeria (BA) 20170225.4864837
Lassa fever - West Africa (06): Nigeria 20170225.4862689
Lassa fever - West Africa (05): Nigeria (NA) 20170215.4842179
Lassa fever - West Africa (03): Nigeria (RI) 20170122.4782917
Lassa fever - West Africa (02): Nigeria (NA) 20170118.4773375
Lassa fever - West Africa (01): Nigeria (OG) 20170101.4735363