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National public health institutes (NPHIs)-science-based governmental agencies typically part of, or closely aligned with, ministries of health-have played a critical part in many countries' responses to the COVID-19 pandemic. Through listening sessions with NPHI leadership, we captured the experiences of NPHIs in Africa. Our research was further supplemented by a review of the literature. To address issues related to COVID-19, NPHIs in Africa developed a variety of innovative approaches, such as working with the private sector to procure and manage vital supplies and address key information needs. Creative uses of technology, including virtual training and messaging from drones, contributed to sharing information and battling misinformation. Positive impacts of the pandemic response include increased laboratory capacity in many countries, modernized surveillance systems, and strengthened public-private partnerships; much of this enhanced capacity is expected to persist beyond the pandemic. However, several challenges remain, including the lack of staff trained in areas like bioinformatics (essential for genomic analysis) and the need for sustained relationships and data sharing between NPHIs and agencies not traditionally considered public health (eg, those related to border crossings), as well as the impact of the pandemic on prevention and control of non-COVID-19 conditions-both infectious and noncommunicable. Participants in the listening sessions also highlighted concerns about inequities in access to, and quality of, the public health services and clinical care with resultant disproportionate impact of the pandemic on certain populations. COVID-19 responses and challenges highlight the need for continued investment to strengthen NPHIs and public health infrastructure to address longstanding deficiencies and ensure preparedness for the next public health crisis.

Nigeria Centres for Disease Control and Prevention established an event-based surveillance (EBS) system in 2016 to supplement traditional surveillance structures. The EBS system is comprised of an internet-based data mining tool and a call center. To evaluate the EBS system for usefulness, simplicity, acceptability, timeliness, and data quality, we performed a descriptive analysis of signals received during September 2017-June 2018. We used questionnaires, semistructured interviews, and direct observation to collect information from EBS staff. Amongst 43,631 raw signals detected, 138 (0.3%) were escalated; 63 (46%) of those were verified as events, including 25 Lassa fever outbreaks and 13 cholera outbreaks. Interviewees provided multiple examples of earlier outbreak detections but suggested notifications and logging could be improved to ensure action. EBS proved effective in detecting outbreaks, but we noted clear opportunities for efficiency gains. We recommend improving signal logging, standardizing processes, and revising outputs to ensure appropriate public health action.

Globally, effective emergency response to disease outbreaks is usually affected by weak coordination. However, coordination using an incident management system (IMS) in line with a One Health approach involving human, environment, and animal health with collaborations between government and non-governmental agencies result in improved response outcome for zoonotic diseases such as Lassa fever (LF). We provide an overview of the 2019 LF outbreak response in Nigeria using the IMS and One Health approach. The response was coordinated via ten Emergency Operation Centre (EOC) response pillars. Cardinal response activities included activation of EOC, development of an incident action plan, deployment of One Health rapid response teams to support affected states, mid-outbreak review and after-action review meetings. Between 1st January and 29th December 2019, of the 5057 people tested for LF, 833 were confirmed positive from 23 States, across 86 Local Government Areas. Of the 833 confirmed cases, 650 (78%) were from hotspot States of Edo (36%), Ondo (26%) and Ebonyi (16%). Those in the age-group 21–40 years (47%) were mostly affected, with a male to female ratio of 1:1. Twenty healthcare workers were affected. Two LF naive states Kebbi and Zamfara, reported confirmed cases for the first time during this period. The outbreak peaked earlier in the year compared to previous years, and the emergency phase of the outbreak was declared over by epidemiological week 17 based on low national threshold composite indicators over a period of six consecutive weeks. Multisectoral and multidisciplinary strategic One Health EOC coordination at all levels facilitated the swift containment of Nigeria's large LF outbreak in 2019. It is therefore imperative to embrace One Health approach embedded within the EOC to holistically address the increasing LF incidence in Nigeria.

ObjectivesThis study aimed to develop and validate a symptom prediction tool for COVID-19 test positivity in Nigeria.DesignPredictive modelling study.SettingAll Nigeria States and the Federal Capital Territory.ParticipantsA cohort of 43 221 individuals within the national COVID-19 surveillance dataset from 27 February to 27 August 2020. Complete dataset was randomly split into two equal halves: derivation and validation datasets. Using the derivation dataset (n=21 477), backward multivariable logistic regression approach was used to identify symptoms positively associated with COVID-19 positivity (by real-time PCR) in children (≤17 years), adults (18–64 years) and elderly (≥65 years) patients separately.Outcome measuresWeighted statistical and clinical scores based on beta regression coefficients and clinicians’ judgements, respectively. Using the validation dataset (n=21 744), area under the receiver operating characteristic curve (AUROC) values were used to assess the predictive capacity of individual symptoms, unweighted score and the two weighted scores.ResultsOverall, 27.6% of children (4415/15 988), 34.6% of adults (9154/26 441) and 40.0% of elderly (317/792) that had been tested were positive for COVID-19. Best individual symptom predictor of COVID-19 positivity was loss of smell in children (AUROC 0.56, 95% CI 0.55 to 0.56), either fever or cough in adults (AUROC 0.57, 95% CI 0.56 to 0.58) and difficulty in breathing in the elderly (AUROC 0.53, 95% CI 0.48 to 0.58) patients. In children, adults and the elderly patients, all scoring approaches showed similar predictive performance.ConclusionsThe predictive capacity of various symptom scores for COVID-19 positivity was poor overall. However, the findings could serve as an advocacy tool for more investments in resources for capacity strengthening of molecular testing for COVID-19 in Nigeria.

BackgroundWith reports of surges in COVID-19 case numbers across over 50 countries, country-level epidemiological analysis is required to inform context-appropriate response strategies for containment and mitigation of the outbreak. We aimed to compare the epidemiological features of the first and second waves of COVID-19 in Nigeria.MethodsWe conducted a retrospective analysis of the Surveillance Outbreak Response Management and Analysis System data of the first and second epidemiological waves, which were between 27 February and 24 October 2020, and 25 October 2020 to 3 April 2021, respectively. Descriptive statistical measures including frequencies and percentages, test positivity rate (TPR), cumulative incidence (CI) and case fatality rates (CFRs) were compared. A p value of ResultsThere were 802 143 tests recorded during the study period (362 550 and 439 593 in the first and second waves, respectively). Of these, 66 121 (18.2%) and 91 644 (20.8%) tested positive in the first and second waves, respectively. There was a 21.3% increase in the number of tests conducted in the second wave with TPR increasing by 14.3%. CI during the first and second waves were 30.3/100 000 and 42.0/100 000 respectively. During the second wave, confirmed COVID-19 cases increased among females and people 30 years old or younger and decreased among urban residents and individuals with travel history within 14 days of sample collection (p value ConclusionNigeria experienced a larger but less severe second wave of COVID-19. Continued implementation of public health and social measures is needed to mitigate the resurgence of another wave.

Lassa fever (LF) is endemic to Nigeria, where the disease causes substantial rates of illness and death. In this article, we report an analysis of the epidemiologic and clinical aspects of the LF outbreak that occurred in Nigeria during January 1-May 6, 2018. A total of 1,893 cases were reported; 423 were laboratory-confirmed cases, among which 106 deaths were recorded (case-fatality rate 25.1%). Among all confirmed cases, 37 occurred in healthcare workers. The secondary attack rate among 5,001 contacts was 0.56%. Most (80.6%) confirmed cases were reported from 3 states (Edo, Ondo, and Ebonyi). Fatal outcomes were significantly associated with being elderly; no administration of ribavirin; and the presence of a cough, hemorrhaging, and unconsciousness. The findings in this study should lead to further LF research and provide guidance to those preparing to respond to future outbreaks.

Background Large outbreaks of Lassa fever (LF) occur annually in Nigeria. The case fatality rate among hospitalised cases is ~ 20%. The antiviral drug ribavirin along with supportive care and rehydration are the recommended treatments but must be administered early (within 6 days of symptom onset) for optimal results. We aimed to identify factors associated with late presentation of LF cases to a healthcare facility to inform interventions. Methods We undertook a retrospective cohort study of all laboratory confirmed LF cases reported in Nigeria from December 2018 to April 2019. We performed descriptive epidemiology and a univariate Cox proportional-hazards regression analysis to investigate the effect of clinical (symptom severity), epidemiological (age, sex, education, occupation, residential State) and exposure (travel, attendance at funeral, exposure to rodents or confirmed case) factors on time to presentation. Results Of 389 cases, median presentation time was 6 days (IQR 4–10 days), with 53% attending within 6 days. There were no differences in presentation times by sex but differences were noted by age-group; 60+ year-olds had the longest delays while 13–17 year-olds had the shortest. By sex and age, there were differences seen among the younger ages, with 0–4-year-old females presenting earlier than males (4 days and 73% vs. 10 days and 30%). For 5–12 and 13–17 year-olds, males presented sooner than females (males: 5 days, 65% and 3 days, 85% vs. females: 6 days, 50% and 5 days, 61%, respectively). Presentation times differed across occupations 4.5–9 days and 20–60%, transporters (people who drive informal public transport vehicles) had the longest delays. Other data were limited (41–95% missing). However, the Cox regression showed no factors were statistically associated with longer presentation time. Conclusions Whilst we observed important differences in presentation delays across factors, our sample size was insufficient to show any statistically significant differences that might exist. However, almost half of cases presented after 6 days of onset, highlighting the need for more accurate and complete surveillance data to determine if there is a systemic or specific cause for delays, so to inform, monitor and evaluate public health strategies and improve outcomes.

Background: COVID-19 mortality rate has not been formally assessed in Nigeria. We therefore aimed to address this gap and identify associated mortality risk factors during the first and second waves in Nigeria. Methods: We conducted a retrospective cohort study using the national surveillance database between February 27, 2020, and April 3, 2021. The outcome was deaths amongst persons with a laboratory diagnosis of COVID-19. Incidence rates of COVID-19 death per 100,000 person-days were estimated. Adjusted negative binomial regression was used to identify factors associated with COVID-19 death, and presented as adjusted Incidence Rate Ratios (aIRR) with 95% confidence intervals (CI). Results: The first wave included 65,790 COVID-19 patients, of whom 994 (1∙51%) died; the second wave included 91,089 patients, of whom 513 (0∙56%) died. The incidence rate of deaths related to COVID-19 was higher in the first wave [54∙25 (95% CI: 50∙98-57∙73)] than in the second wave [19∙19 (17∙60-20∙93)]. Factors independently associated with increased risk of death in both waves were: age ≥45 years, male gender [first wave aIRR 1∙65 (1∙35-2∙02) and second wave 1∙52 (1∙11-2∙06)], being symptomatic [aIRR 3∙17 (2∙59-3∙89) and 3∙04 (2∙20-4∙21)], and being hospitalised [aIRR 4∙19 (3∙26-5∙39) and 7∙84 (4∙90-12∙54)]. Interpretation: The incidence rate of COVID-19 death in Nigeria was higher in the first wave, suggesting improved public health response and care during the second wave. Regional mortality differences suggest that policy makers focus on regional equity in access to testing and quality of care to mitigate the impact of another COVID-19 wave in Nigeria. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: Ethical approval for the study was given by the Nigeria National Health Research Ethics Committee (NHREC/01/01/2007-22/06/2020).

The International Health Regulation (IHR) monitoring and evaluation framework includes voluntary instruments such as after-action reviews (AAR) as part of a five-year global strategic plan to improve public health preparedness and response. The Nigeria Centre for Disease Control conducted three AARs post-response to multi-city outbreaks of Monkeypox, Cerebrospinal Meningitis and Lassa Fever in 2018. All outbreaks were in urban local government areas (LGA)/cities across more than 20 states lending credence to the rise of city-states as a locus of risk for infectious disease re-emergence. Aspects of modern life in urban LGAs such as encroachment of humans into new environments and destruction of forests for agriculture puts residents in close contact with wildlife and at risk for infectious disease outbreaks. This chapter discusses the usefulness of AARs as a tool for evaluating responses to urban disease outbreaks and assess preparations for future ones using an approach that combines self-evaluation and peer review complying with the recommendations of the IHR for mandatory State Parties self-assessment annual reporting. This experience helped Nigeria identify how best practices can be maintained, improved, institutionalized and shared with relevant stakeholders. The AARs also determined how actions were implemented as opposed to how they were planned, identified processes that worked and those that didn’t, determined root causes for success and failure, and finally, provided SMART corrective recommendations to improve future performance actions and to strengthen cities pandemic readiness.

ObjectiveDespite the increasing disease burden, there is a dearth of context-specific evidence on the risk factors for COVID-19 positivity and subsequent death in Nigeria. Thus, the study objective was to identify context-specific factors associated with testing positive for COVID-19 and fatality in Nigeria.DesignRetrospective cohort study.SettingCOVID-19 surveillance and laboratory centres in 36 states and the Federal Capital Territory reporting data to the Nigeria Centre for Disease Control.ParticipantsIndividuals who were investigated for SARS-CoV-2 using real-time PCR testing during the study period 27 February–8 June 2020.MethodsCOVID-19 positivity and subsequent mortality. Multivariable logistic regression analyses were performed to identify factors independently associated with both outcome variables, and findings are presented as adjusted ORs (aORs) and 95% CIs.ResultsA total of 36 496 patients were tested for COVID-19, with 10 517 confirmed cases. Of 3215 confirmed cases with available clinical outcomes, 295 died. Factors independently associated with COVID-19 positivity were older age (p value for trendConclusionThe significant risk factors associated with COVID-19 positivity and subsequent mortality in the Nigerian population are similar to those reported in studies from other countries and should guide clinical decisions for COVID-19 testing and specialist care referrals.

Lassa fever (LF) is an acute rodent-borne viral haemorrhagic fever that is a longstanding public health concern in West Africa and increasingly a global health priority. Recent molecular studies1,2 have confirmed the fundamental role of the rodent host (Mastomys natalensis) in driving human infections, but LF control and prevention efforts remain hampered by a limited baseline understanding of the disease’s true incidence, geographical distribution and underlying drivers3. Here, through analysing 8 years of weekly case reports (2012-2019) from 774 local government authorities (LGAs) across Nigeria, we identify the socioecological correlates of LF incidence that together drive predictable, seasonal surges in cases. At the LGA-level, the spatial endemic area of LF is dictated by a combination of rainfall, poverty, agriculture, urbanisation and housing effects, although LF’s patchy distribution is also strongly impacted by reporting effort, suggesting that many infections are still going undetected. We show that spatial patterns of LF incidence within the endemic area, are principally dictated by housing quality, with poor-quality housing areas seeing more cases than expected. When examining the seasonal and inter-annual variation in incidence within known LF hotspots, climate dynamics and reporting effort together explain observed trends effectively (with 98% of observations falling within the 95% predictive interval), including the sharp uptick in 2018-19. Our models show the potential for forecasting LF incidence surges 1-2 months in advance, and provide a framework for developing an early-warning system for public health planning.

Emerging and re-emerging infectious diseases are becoming more frequent and developing countries are especially at increased risk. A recurring infectious disease outbreak in Nigeria has been that of Lassa fever (LF), a disease that is endemic in Nigeria and other West African countries. Nigeria, between 1stJanuary and 27thOctober 2019, reported 743 confirmed cases of LF and 157 deaths in confirmed cases. Lassa fever outbreaks continue to be recurrent after fifty years of its identification. The true burden of the disease in Nigeria is unknown while gaps in knowledge about the infection still persist. Based on the Nigeria national Lassa fever research agenda and the World Health Organisation's roadmap initiative for accelerating research and product development which enables effective and timely emergency response to LF disease epidemics among other infectious diseases; a research pillar was added to the seven existing LF emergency operations centre response pillars in 2019. We describe lessons learnt from the integration of a research pillar into the LF national emergency response.

The objective of this study was to describe the epidemiology of COVID-19 in Nigeria with a view of generating evidence to enhance planning and response strategies. A national surveillance dataset between 27 February and 6 June 2020 was retrospectively analysed, with confirmatory testing for COVID-19 done by real-time polymerase chain reaction (RT-PCR). The primary outcomes were cumulative incidence (CI) and case fatality (CF). A total of 40 926 persons (67% of total 60 839) had complete records of RT-PCR test across 35 states and the Federal Capital Territory, 12 289 (30.0%) of whom were confirmed COVID-19 cases. Of those confirmed cases, 3467 (28.2%) had complete records of clinical outcome (alive or dead), 342 (9.9%) of which died. The overall CI and CF were 5.6 per 100 000 population and 2.8%, respectively. The highest proportion of COVID-19 cases and deaths were recorded in persons aged 31–40 years (25.5%) and 61–70 years (26.6%), respectively; and males accounted for a higher proportion of confirmed cases (65.8%) and deaths (79.0%). Sixty-six per cent of confirmed COVID-19 cases were asymptomatic at diagnosis. In conclusion, this paper has provided an insight into the early epidemiology of COVID-19 in Nigeria, which could be useful for contextualising public health planning.

Background Electronic reporting of integrated disease surveillance and response (eIDSR) was implemented in Adamawa and Yobe states, Northeastern Nigeria, as an innovative strategy to improve disease reporting. Its objectives were to improve the timeliness and completeness of IDSR reporting by health facilities, prompt identification of public health events, timely information sharing, and public health action. We evaluated the project to determine whether it met its set objectives. Method We conducted a cross-sectional study to assess and document the lessons learned from the project. We reviewed the performance of the local government areas (LGAs) on timeliness and completeness of reporting, rumors identification, and reporting on the eIDSR and the traditional paper-based system using a checklist. Respondents were interviewed online on the relevance, efficiency, sustainability, project progress and effectiveness, the effectiveness of management, and potential impact and scalability of the strategy using structured questionnaires. Data were cleaned, analyzed, and presented as proportions using an MS Excel spreadsheet. Responses were also presented as direct quotes. Results The number of health facilities reporting IDSR increased from 103 to 228 (117%) before and after implementation of the eIDSR respectively. The timeliness of reporting was 43% in the LGA compared to 73% in health facilities implementing eIDSR. The completeness of IDSR reports in the last 6 months before the evaluation was ≥85%. Of the 201 rumors identified and verified, 161 (80%) were from the eIDSR pilot sites. The majority of the stakeholders interviewed believed that eIDSR met its predetermined objectives for public health surveillance. The benefits of eIDSR included timely reporting and response to alerts and disease outbreaks, improved timeliness, and completeness of reporting, and supportive supervision to the operational levels. The strategy helped stakeholders to appreciate their roles in public health surveillance. Conclusion The eIDSR has increased the number of health facilities reporting IDSR, enabled early identification, reporting, and verification of alerts, improved timeliness and completeness of reports, and supportive supervision of staff at the operational levels. It was well accepted by the stakeholder as a system that made reporting easy with the potential to improve the public health surveillance system in Nigeria.

Background: Outbreaks of Lassa fever (LF) in Nigeria have become more frequent, with increasing more healthcare worker infections. Prevention of infection is dependent on strict compliance to infection prevention and control (IPC) practices in treatment centres where patients are managed. Objective: To evaluate IPC practices during an ongoing LF outbreak in the two major tertiary hospitals serving as the referral LF treatment centres in the north-central region of Nigeria. Methods: This cross-sectional survey was carried out by the IPC subteam of the National Rapid Response Team of the Nigeria Centre for Disease Control (NCDC) deployed to Plateau State, north-central Nigeria during the 2019 LF outbreak. Information on IPC in these facilities was collected using the NCDC viral haemorrhagic fevers (VHFs) isolation and treatment facility IPC survey tool. Results: Both treatment centres had national VHF IPC isolation guidelines and few health workers had received IPC training. In both centres, there were no clearly demarcated entry points for staff going into clinical areas after putting on personal protective equipment, and there were also no standard operating procedures in place for reporting occupational exposure of staff to infected blood or body fluids in both centres. Discussion: The LF treatment centers located in Plateau State during the 2019 LF outbreak were not fully implementing the national VHF IPC guidelines. Periodic assessments of IPC are recommended for proper management of cases and effective control of LF in the State.

'Introduction:' Lassa fever (LF) is a communicable viral haemorrhagic disease. Person-to-person spread occurs by inhalation or direct contact with the bodily fluids of an infected patient. Infection Prevention and Control (IPC) is essential in healthcare facilities for the wellbeing and safety of patients, staff and visitors. Federal Teaching Hospital, Abakaliki is the designated treatment center for LF in Ebonyi State. We assessed IPC practices in this facility during the 2018 outbreak of LF involving healthcare workers. 'Methods:' We conducted a cross-sectional study on 135 healthcare workers selected by systematic sampling. Information on their knowledge and practice of IPC was collected using a pre-tested, semi-structured questionnaire. We classified knowledge into “good”, “fair” and “poor” based on the total correct response. Those that scored ≥75% of the maximum score were classified as good, 50-74% as fair and 15years in the facility (OR: 1.16 95%CI: 0.39 - 3.44) were associated with good knowledge of IPC precautionary measures. However, these associations were not statistically significant. 'Conclusions:' The majority of the staff had good knowledge of IPC. However, knowledge of LF epidemiology was greater among those whose roles were related to management of LF cases. We recommended more awareness on LF, IPC practices and improved supply of IPC commodities.

We reviewed data pertaining to the massive wave of Lassa fever cases that occurred in Nigeria in 2018. No new virus strains were detected, but in 2018, the outbreak response was intensified, additional diagnostic support was available, and surveillance sensitivity increased. These factors probably contributed to the high case count.

Lassa fever cases have increased in Nigeria since 2016 with the highest number, 633 cases, reported in 2018. From 1 January to 28 April 2019, 554 laboratory-confirmed cases including 124 deaths were reported in 21 states in Nigeria. A public health emergency was declared on 22 January by the Nigeria Centre for Disease Control. We describe the various outbreak responses that have been implemented, including establishment of emergency thresholds and guidelines for case management.

Background: Lassa fever is an acute viral haemorrhagic disease endemic in Nigeria. The 2018 Lassa fever outbreak in Nigeria was unprecedented, with 8% of all cases occurring among healthcare workers (HCWs). A disproportionately high number of these infections occurred in HCWs working in a tertiary health facility in Nigeria. This paper describes the cluster of Lassa fever infections among HCWs in a treatment centre and the lessons learnt. Methods: We analysed clinical, epidemiological and laboratory data from surveillance and laboratory records kept during the 2018 outbreak. Interviews were conducted with surviving HCWs using a questionnaire developed specifically for the investigation of Lassa fever infections in HCWs. Descriptive analysis of the data was performed in Microsoft excel. Results: The index case was a 15-year-old male who presented at the health facility with fever and uncontrolled nasopharyngeal bleeding, following a recent uvulectomy by a traditional healer. Overall, 16 HCWs were affected (15 confirmed and 1 probable) with five deaths (CFR-31.6%). Of the 15 confirmed cases, five (33.3%) were asymptomatic. Nine HCWs were direct contacts of the index case; the remaining six HCWs had no direct contact with the index case. HCW interviews identified a low index of suspicion for Lassa fever leading to inadequate infection prevention and control (IPC) practices as possible contributing factors to nosocomial transmission. Conclusion: Maintaining a high index of suspicion for Lassa fever in all patients, especially in endemic areas, is essential in adhering to adequate IPC practices in health facilities in order to prevent nosocomial transmission of Lassa fever among HCWs. There is a need to continually train and sensitise HCWs on strict adherence to IPC measures while providing care, irrespective of a patient’s provisional diagnosis. Keywords: Lassa fever, Healthcare workers, Nosocomial infection

Introduction : lassa fever remains an important cause of morbidity and mortality in West Africa. In Nigeria, Lassa fever (LF) is endemic with an annual cycle of incident cases across the country. Despite seasonal epidemic preparedness and response efforts, there is still evidence of low clinical index of suspicion, poor sample management and delay in treatment resulting in nosocomial transmission, long turnaround time (TAT) for laboratory diagnosis and high case-fatality-rates (CFR). Methods : a structured questionnaire on sample and case management preparedness was developed by the multi-sectoral National Lassa Fever Working Group. The questionnaires were administered via telephone calls to all the 37 State epidemiologists. Variables of interest were summarized in frequencies, means and proportions using Epi-info Version 7. Results : most the states, 36 (97%) collect Lassa fever samples within 24 hours with 31 (83.7%) transporting samples immediately using personal delivery as mode of transportation. Majority (78%), of states routinely use standard triple packaging and 24 (64%) preserve samples in cold box prior to transportation. Two laboratories are designated for testing of viral hemorrhagic fevers in Nigeria (University of Lagos Teaching Hospital (LUTH) and Irrua Specialist Teaching Hospital (ISTH). The median laboratory TAT for LUTH is 48 hours (range 24 - 120) while for ISTH is 48 hours (range 24 - 48). Only sixteen states (43%) have designated Viral Hemorrhagic Fever (VHF) treatment centres with isolation units. Twenty-six states (70%) have trained personnel and a similar proportion (69%) commence presumptive treatment before receipt of laboratory result. Only 3(8%) States have ribavirin stock-out while 2(5%) States have short dated Ribavirin stock. Conclusion : there are nationwide gaps in sample and case management preparedness for Lassa fever outbreaks in Nigeria. Therefore the need for the establishment of designated functional VHF treatment centers in all states, active management of Ribavirin stocks and improvement in laboratory turn-around time.

Introduction : lassa fever (LF), an acute viral hemorrhagic fever is endemic in Nigeria with annual recurrent outbreaks in different States and varying levels of mortality and morbidity. In order to prevent such episodes with better preparation for early detection and rapid control of the disease, the Nigeria Center for Disease Control (NCDC) evaluated Nigerian States’ level of preparedness with a view to defining areas with high disease burden and risk of outbreak. The aim of the study is to assess the level of preparedness for co-ordination of LF outbreak response activities across the states for informed decision and effective LF outbreak response, planning and implementing of high impact interventions. Methods : a self-administered LF preparedness questionnaire was filled by 37 State Epidemiologists including the Federal Capital Territory to assess national preparedness. Data was entered, cleaned and analyzed using Epi-Info 7.2. States were stratified into Very High Risk (VHR), High Risk (HR) and Low Risk (LR) based on having ≥10, 1 - 9 or zero confirmed cases respectively in 2016 and 2017. State-specific level of preparedness, based on a three-staged scoring system was categorized into: Inadequate, 0 - 49%; fairly adequate, 50 - 74%; and adequate ≥75% preparedness. Variables of interest were summarized in frequencies and proportions. Results : six (16.0%) states were classified as VHR, 18 (49.0%) were HR, while 13 (35.0%). Twenty-six states (70.3%) had an Emergency Operations Centre (EOC) while 24 (64.9%) can activate their EOCs within 48 hours. Thirty-two (86.5%) have Emergency Preparedness and Response (EPR) Committees. A maximum of 3 (50%) of VHR states had functional EOCs, ability to activate EOCs within 48 hours and EPR Committees, when compared with 13 - 15 HR and 9-12 LR states, respectively. On the state-specific level of preparedness for co-ordination, 16 states (43.2%) were inadequate, 9 (24.4%) fairly inadequate, and 12 (32.4%) adequate. Conclusion : preparedness for co-ordination of Lassa fever outbreak responses should be improved in all the states, especially the VHR and HR states, to reduce morbidity, mortality, economic cost and psychosocial effect associated with LF outbreaks in Nigeria.

Introduction : lassa fever is an endemic Viral Hemorrhagic Fever (VHF) in Nigeria. Improvements in case detection and treatment outcome could be achieved by understanding the transmission dynamics better and applying the lessons from previous outbreaks considering the resource constrained setting. This study assessed age-sex disparities in treatment outcome using data from 2016/2017 lassa fever outbreak surveillance in Nigeria. Methods : lassa fever surveillance and outcome data from December 2016 to May 2017 from 14 States was extracted from the VHF platform. Univariate and bivariate analysis were carried out using Epi info 7 for socio-demographics and treatment outcome. Possible association between treatment outcome and selected variables (age, sex) were analyzed using Chi square at 0.05 level of significance. Results : there were 168 confirmed cases of Lassa fever during the study period, data was complete for 139 (82.7%). More men were affected (56%), as 61 of the 139 patients (46%) were female. The median age for all the patients treated was 32 years (IQR 25 - 44). Symptoms at presentation prior to treatment included fever (67%), nausea and vomiting (34.5%), diarrhea (14.4%), and intense fatigue (39%) while only 10.8% experienced unexplained bleeding. A total of 75 (54%) patients were treated and discharged alive, while 64 (46%) died. No significant association was found between gender and treatment outcome (p value = 0.976). Although survival was higher among patients aged 15 to 24 years (72%) and lowest among patients who were 45 years and above (35%), age of the patient was not significantly associated with the adverse treatment outcome (p-value = 0.06). Conclusion : for the 2016/2017 lassa fever outbreak in Nigeria, age and sex did not influence the treatment outcome of the recorded cases. There is a need for further analysis and more large scale studies on Lassa fever treatment outcomes.

Introduction : outbreaks of Lassa fever (LF) occur annually in many states such as Ondo in Nigeria. Early treatment with the drug of choice, Ribavirin, accessible treatment centers as well as implementation of prompt and appropriate outbreak control measures should significantly reduce morbidity and mortality. These had however, not been the case in Ondo State before a federal team from the Nigeria Centre for Disease Control (NCDC) and Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), was deployed to support investigation and control of the outbreak. Methods : outbreak protocol was used which included definitions for suspected and confirmed cases. Updating line lists, active case search, contact tracing and listing was carried out daily. A structured questionnaire was used to assess Infection Prevention and Control (IPC) practices and knowledge of Lassa fever in communities and health facilities. Advocacy at State and LGA levels was done to establish treatment centres and raise capacity for outbreak control. Laboratory confirmation was done at Irrua Specialist Teaching Hospital (ISTH), Edo state. Results : twelve of the 27 suspected cases were confirmed with six deaths; four among confirmed and two suspected. Case fatality rate was 22.2% for all cases but declined for confirmed cases from 75% before our intervention to 33.3% after. With our technical support, interventions included establishment of a treatment centre in Federal Medical Centre (FMC), Owo, Ondo State and reduction in number of referrals to ISTH, Edo State (from 100% to 12.5%). Treatment with Ribavirin now commenced immediately samples were collected rather than after receipt of results. Conclusion : provision of technical support by the federal government and partners improved outbreak response in Ondo State. Prompt and adequate investigation and implementation of control measures also reduced morbidity and mortality. These should be sustained and strengthened.