Lassa fever outbreak investigation in a tertiary health institution in Abeokuta, Ogun State, January, 2017

Abstract

Introduction : Lassa fever (LF) is a highly infectious haemorrhagic disease associated with high morbidity and mortality. Health facility spread of infection is common especially in settings with poor infection prevention and control practices. In December 2016, a LF outbreak was reported in a tertiary health facility in Ogun State which involved the death of a health worker. A team of Epidemiologists was deployed to investigate the outbreak and institute appropriate control measures. Methods : we defined suspected, probable and confirmed cases using the national guidelines for integrated disease surveillance and response (IDSR). We conducted active case search and environmental assessment in 10 health facilities. Contact tracing was implemented, hospital and mortuary records were reviewed and line-list developed. We assessed Infection Prevention and Control (IPC) practices using a standard IPC checklist. Data were analyzed using Epi info version 7.2. Nineteen blood samples were collected from 14 cases and 5 high-risk contacts for virology. Results : all tested negative for Lassa fever virus except the first index case. We traced 3 probable cases and were able to link the confirmed case to hospital exposure. Case Fatality Rate was 100% among confirmed cases. Of the 345 contacts line-listed, 314 (89.5%) were health workers, out of which, 296 (94.5%) reported regular hand washing, 47(15%) and 100 b (32%) reported uninterrupted water supply and availability of soap respectively. IPC practices, especially waste management in the hospital was poor. Conclusion : investigation revealed a confirmed Lassa fever outbreak with a 100% Case Fatality Rate. Source of infection strongly indicative of being hospital acquired. Infection Prevention and Control practices were sub-optimal. We supported contact tracing to prevent further spread, conducted trainings and sensitization to improve infection control and instituted control measures.