Lassa fever outbreak and challenges of effective infection control in an isolation ward, Edo State, 2016

Abstract

Introduction : lassa fever (LF) is an epidemic-prone viral haemorrhagic disease caused by the Lassa virus. However, prompt patients’ isolation, good infection control practices and contact tracing are important in outbreak control. On January 8, 2016, the Nigeria Federal Ministry of Health was alerted of an ongoing outbreak of Lassa fever across states including Edo State. We investigated to establish the existence of the outbreak, contact tracing, monitoring, described the outbreak and assessed infection control measures in Edo State. Methods : we did a descriptive study of confirmed LF cases of Edo State from 23rd December 2015 to February 2016. Active contact tracing and laboratory surveillance were used to detect suspected and confirmed Lassa fever cases. Infection prevention and control checklist was used to assess infection control of the Lassa fever institute isolation ward. Patients’ bio-data were collected from structured questionnaires applied on patient’s relatives, Lassa fever laboratory register and survey forms. Data was analyzed with Epi Info 7 and the outbreak described by person, place and time. Univariate analysis was expressed as frequency distribution, percentages, median, interquartile range, and rate. Results : a total of 359 suspected cases were screened of which 29 (8%) tested positive for Lassa virus. Case fatality rate was 9 (31%). The median age of cases was 30 years (IQR = 25 - 47), 17 (58.6%) were males, and 13 (44.8%) were students. Ten LGAs were affected including Etsako West LGA 12(41%) of cases. During the outbreak period, 179 contacts were monitored. Clinical presentations included redness of the eyes (79%), haematuria (69%), and facial oedema (52%). Infection control assessment of 15 items revealed 7 (46.7%) not available in the isolation ward. Conclusion : good infection prevention and control at the isolation ward challenged by an initial unavailability of some infection control items. Active contact tracing, prompt patients’ isolation, and surveillance helped in control and detection of the outbreak. Continuous community awareness, good infection control practices, and active surveillance may prevent and detect early outbreaks.