Containment Of Outbreak Research Articles

Education and Consistent Infection Prevention Practices Prevail: An Outbreak of CRE in a Long Term Acute Care Hospital

Carbapenem-resistant Enterobacteriaceae (CRE) infections are difficult to treat and pose a significant threat to public health. In July 2018, an infection preventionist (IP) notified Los Angeles County Department of Public Health (LACDPH) of eight cases of healthcare-onset carbapenem-resistant Klebsiella pneumoniae (CRKP) among residents of a 54-bed long term acute care facility (LTAC). LACDPH initiated an investigation to identify risks for infection and disrupt transmission. A case was defined as a LTAC patient with laboratory confirmation for CRKP or carbapenemase-producing organism from June 28- August 7, 2018 and no previous CRE history. LACDPH conducted two site visits of the facility to observe infection prevention practices. Medical records, staff training records, and infection prevention audits were reviewed. Facility-wide surveillance cultures were collected on three dates. The first facility-wide screening yielded 13 additional cases; no further cases were identified during subsequent screenings. Medical record review found one additional case. A total of 22 cases were identified; overall prevalence was 39%. Site observations revealed missed hand hygiene opportunities, unclear contact precaution signage, and a knowledge deficit among staff regarding CRE and control measures. LACDPH recommended enhanced environmental cleaning, infection control trainings for all staff, hand hygiene and personal protective equipment audits, placing new admissions on contact precautions pending CRE screening results, and the use of an interfacility transfer form upon discharge of all known CRE patients. We identified a high prevalence of CRE in an LTAC, a setting where patients generally have higher invasive device and antibiotic utilization than other settings. However, the implementation of evidence-based infection prevention practices enabled the facility to stop the spread of infection. Identification and containment of a CRE outbreak in a healthcare facility relies on several factors, including the collaboration of a facility's IP with the local health department and continuing frontline staff education.

Containment of a Cryptosporidium serpentis outbreak in a snake collection - A case study

Cryptosporidium is a parasitic apicomplexid that causes respiratory and gastrointestinal illnesses across many vertebrate species. Infections in mammals and birds rarely prove fatal in healthy adult animals. However, in reptiles, the infection will most likely become lethal. Specific to snakes, Cryptosporidium serpentis infects the gastrointestinal tract and causes hypertrophy of the mucosa of the stomach resulting in the inability to pass food down the gastrointestinal tract. Disease pathology is known, but a proven cure for this disease in snakes still remains unknown. When infections arise, most zoological institutions rely heavily on quarantining and euthanasia to deal with this highly contagious and lethal disease. On December 1, 2018, a case of the disease was confirmed within the West Liberty University Zoo Science Snake Collection. To maintain the health and safety of the collection and prevent further spread of disease, major steps were taken through sanitation practices and fecal testing to track disease outbreak back to a case 0. Herein, we report individual snakes that had Cryptosporidium spores present but were ultimately able to pass the infection and return to a disease-free state. Therefore, evidence exists within this collection that a particular clade of snakes may prove to be more disease resistant than others. We also report an active strategy to isolate diseased individuals and contain a Cryptosporidium infection outbreak in a large snake collection.

The successful containment of a hospital outbreak caused by NDM-1-producing Klebsiella pneumoniae ST307 using active surveillance.

The worldwide dissemination of high-risk carbapenemase-producing Klebsiella pneumoniae clones has become a major threat to healthcare facilities. This study describes the successful containment of a hospital outbreak caused by NDM-1-producing K. pneumoniae Sequence Type (ST) 307 using active surveillance. The outbreak began when a patient was transferred from a local hospital. After 48 hours in our hospital, a tracheal aspirate was positive for a meropenem resistant and carbapenemase-producing K. pneumoniae. All patients in the medical intensive care unit (ICU) and the neurology wards were subject to contact precautions. The hospital surfaces and devices, healthcare workers, and patients from these wards were screened by cultures. Fecal swabs were placed into broth and PCR for blaKPC, blaOXA-48, blaIMP, blaVIM, and blaNDM, which were performed directly from the broth after 12 hours. PCRs were also performed on DNA extracted from carbapenemase-producing species from subcultured broths. Five and nine days later, two more patients’ rectal swabs tested positive. Molecular assays identified K. pneumoniae blaNDM-1 onto a 130-kb conjugative plasmid (IncY, IncFIIs, and IncFIIY), ST307. After the three patients were discharged, monitoring continued, and after three weeks with negative results, rectal swabbing ended. In conclusion, it was possible to contain a hospital outbreak caused by NDM-1-producing K. pneumoniae ST307 through epidemiological and microbiological surveillance. With the methodology used, the detection of NDM-type genes in fecal samples was obtained in approximately 15 hours after obtaining the fecal sample.

Chikungunya as a paradigm for emerging viral diseases: Evaluating disease impact and hurdles to vaccine development.

Chikungunya fever (CHIKF) is an emerging infectious disease caused by an alphavirus transmitted by Aedes spp. mosquitoes. Because mosquito control programs are not highly efficient for outbreak containment, vaccines are essential to reduce the burden of disease. Although no licensed vaccine against CHIKF is yet available, many highly promising candidates are undergoing preclinical studies, and a few of them have been tested in human trials of phase 1 or 2. Here, we review recent findings regarding the need for a CHIKF vaccine and provide an update on vaccines nearing or having entered clinical trials. We also address needs to tackle bottlenecks to vaccine development—including scientific and financial barriers—and to accelerate the development of vaccines; several actions should be taken: (i) design efficacy trials to be conducted during the course of outbreaks; (ii) evaluate the opportunity for adopting the “animal rule”for demonstration of efficacy for regulatory purposes; (iii) strengthen the collective commitment of nations, international organizations, potential donors and industry; (iv) stimulate public and/or private partnerships to invest in vaccine development and licensure; and (v) identify potential markets for an effective and safe CHIKF vaccine.

Epidemiological investigation and containment of a measles outbreak in New York: Critical appraisal and public health implications for India.

Epidemiological investigation and containment of a measles outbreak in New York: Critical appraisal and public health implications for India.

Artificial Intelligence in Global Health

AbstractArtificial intelligence (AI) is reaching into every aspect of global health. In this essay, I examine one example of AI's potential contributions and limitations in global health: the prediction, treatment, and containment of a global influenza outbreak. The potential advantages are clear. AI can aid global influenza surveillance platforms by improving the capacity of organizations to look for novel influenza outbreak strains in the right places, to identify populations most likely to spread influenza, and to produce real-time information about the disease's spread by monitoring social media communications to track outbreak events. There are also very real limitations to what AI can do, and it is crucial that AI not be used as an excuse not to invest in strengthening health systems and other traditional components of global healthcare. AI may also be able to improve our understanding of who should receive a vaccine and what is most effective for large-scale vaccine delivery, but there will always be blind spots that the data cannot fill. Investment in healthcare, with attention to the danger of minimal access to care for minority groups that are at risk and in fragile situations, remains the best chance to prepare communities for outbreak detection, surveillance, and containment.

Emphasizing on the need of preparedness and antibiotics supply for the containment of the plague outbreak

Emphasizing on the need of preparedness and antibiotics supply for the containment of the plague outbreak

Outbreak investigation and containment measures of dengue fever in rural Wardha: A field epidemiological study

Background: Dengue is a common vector-borne disease in countries like India, where it occurs in specific pockets including many in Maharashtra. During July–August 2018, an outbreak of dengue was suspected in a village of Wardha district, following an increase in the number of fever cases from the village, which demanded an urgent outbreak investigation to be carried out before it progressed into an epidemic/larger outbreak. Objectives: The aim of this study was to find out more cases, source of infection and to recommend necessary actions to control the dengue outbreak. Materials and Methods: This was a cross-sectional epidemiological study, where we used pre-tested, pre-designed epidemiological case sheets obtained from Integrated Disease Surveillance Program (IDSP). A case definition was proposed before beginning the investigation. Line listing, collection of blood samples, distribution of paracetamol tablets to fever cases, and making a spot map were some of the important steps carried out during the investigation. Results: Out of a total of 64 suspected fever cases, 36 cases fulfilled the case definition of dengue, set for the purpose of outbreak investigation. Twenty-three of them got admitted in different hospitals among whom two of them died. Apart from that, four of them were found to be positive for both dengue IgM and NS1 antigen in their blood samples. It was age group of 21–30 years which was mostly affected. Compared to males, the female population suffered more from the illness. House, container, and Breteau index were found to be 0.26, 0.09, and 0.32, respectively. Conclusion: Following the investigation, a detailed report was made, which was shared with the district health authority. The report also contained recommendations for necessary actions to be taken to control this outbreak and to further prevent such outbreaks in future.

ANALYSIS OF MONITORING STUDIES ON AFRICAN SWINE FEVER VIRUS DNA DETECTION CARRIED OUT IN 2017

The paper describes the results of testing of biomaterial from domestic pigs and wild boars by real-time PCR used for African swine fever virus genome detection, carried out in the FGBI “Federal Centre for Animal Health” (Vladimir). In 2017 8,500 samples from 44 subjects of the Russian Federation were tested within the framework of the state laboratory monitoring. African swine fever virus genome was detected in 504 samples. In 2017 ASF outbreaks were registered in the Urals and Siberian Federal Districts of the RF for the first time. The conducted research and persistent ASF infection in the territory of the RF have demonstrated the need for further surveillance in the populations of susceptible animals. Development, organization and implementation of the program for ASF spread surveillance in wild fauna remains a high priority. It is necessary to create and implement sampling schedules with uniform sampling of biomaterial and submission of the collected samples to the research laboratories for timely ASF outbreak containment at the regional level.

Outbreak of Adenovirus in a Neonatal Intensive Care Unit: Critical Importance of Equipment Cleaning During Inpatient Ophthalmologic Examinations

Outbreaks of adenovirus in neonatal intensive care units (NICUs) can lead to widespread transmission and serious adverse outcomes. We describe the investigation, response, and successful containment of an adenovirus outbreak in a NICU associated with contaminated handheld ophthalmologic equipment used during retinopathy of prematurity (ROP) screening. Epidemiologic outbreak investigation. A total of 23 hospitalized neonates, as well as NICU staff and parents of affected infants. Routine surveillance identified an adenovirus outbreak in a level IV NICU in August 2016. Epidemiologic investigation followed, including chart review, staff interviews, and observations. Cases were defined as hospital-acquired adenovirus identified from any clinical specimen (NICU patient or employee) or compatible illness in a family member. Real-time polymerase chain reaction (PCR) and partial- and whole-genome sequencing assays were used for testing of clinical and environmental specimens. We identified 23 primary neonatal cases and 9 secondary cases (6 employees and 3 parents). All neonatal case-patients had respiratory symptoms. Of these, 5 developed pneumonia and 12 required increased respiratory support. Less than half (48%) had ocular symptoms. All neonatal case-patients (100%) had undergone a recent ophthalmologic examination, and 54% of neonates undergoing examinations developed adenovirus infection. All affected employees and parents had direct contact with infected neonates. Observations revealed inconsistent disinfection of bedside ophthalmologic equipment and limited glove use. Sampling of 2 handheld lenses and 2 indirect ophthalmoscopes revealed adenovirus serotype 3 DNA on each device. Sequence analysis of 16 neonatal cases, 2 employees, and 2 lenses showed that cases and equipment shared 100% identity across the entire adenovirus genome. Infection control interventions included strict hand hygiene, including glove use; isolation precautions; enhanced cleaning of lenses and ophthalmoscopes between all examinations; and staff furlough. We identified no cases of secondary transmission among neonates. Adenovirus outbreaks can result from use of contaminated ophthalmologic equipment. Even equipment that does not directly contact patients can facilitate indirect transmission. Patient-to-patient transmission can be prevented with strict infection control measures and equipment cleaning. Ophthalmologists performing inpatient examinations should take measures to avoid adenoviral spread from contaminated handheld equipment.

Public Health Consequences of a 2013 Measles Outbreak in New York City

Internationally imported cases of measles into the United States can lead to outbreaks requiring extensive and rapid control measures. Importation of measles from an unvaccinated adolescent in 2013 led to what has been the largest outbreak of measles in New York City, New York, since 1992. To describe the epidemiology and public health burden in terms of resources and cost of the 2013 measles outbreak in New York City. This epidemiologic assessment and cost analysis conducted between August 15, 2013, and August 5, 2014, examined all outbreak-associated cases of measles among persons residing in New York City in 2013. Measles virus. Numbers of measles cases and contacts. Total personnel time and total direct cost to the New York City Department of Health and Mental Hygiene (DOHMH), calculated as the sum of inputs (supplies and materials, equipment, and logistics) and personnel time (salary and fringe benefits). Between March 13, 2013, and June 9, 2013, 58 persons in New York City with a median age of 3 years (range, 0-32 years) were identified as having measles. Among these individuals, 45 (78%) were at least 12 months old and were unvaccinated owing to parental refusal or intentional delay. Only 28 individuals (48%) visited a medical health care professional who suspected measles and reported the case to the DOHMH at the initial clinical suspicion. Many case patients were not immediately placed into airborne isolation, resulting in exposures in 11 health care facilities. In total, 3351 exposed contacts were identified. Total direct costs to the New York City DOHMH were $394 448, and a total of 10 054 hours were consumed responding to and controlling the outbreak. Vaccine refusals and delays appeared to have propagated a large outbreak following importation of measles into the United States. Prompt recognition of measles along with rapid implementation of airborne isolation of individuals suspected of measles infection in health care facilities and timely reporting to public health agencies may avoid large numbers of exposures. The response and containment of measles outbreaks are resource intensive.

Communicable diseases. The case of sexually transmitted infections: A retrospective 3-year study

Introduction Health surveillance is essential for the effective impact assessment, monitoring and control of diseases and risks to health, including communicable diseases, and is necessary for an efficient public health practice capable of effectively protecting and promoting the health of populations. In Portugal, mandatory notification of communicable diseases established since 1949, in Law 2036, August 9. The current mandatory list of notifiable diseases encompasses 65 diseases, six of which are sexually transmitted infections (STIs), which are a public health problem.2 Methods A retrospective and descriptive study conducted through the collection of information from the database of the National Epidemiological Surveillance System. The notified cases of STIs between 2015 and 2017 disaggregated by demographic variables: sex, age and geographical location and clinical variables: disease and case definition. Results The total number of reported cases of STIs throughout these 3 years was 134, with the following distribution: 33.0% syphilis (n = 44), 25.4% gonorrhea (n = 34), 13.4% hepatitis C (n = 18), 13.4% HIV/AIDS (n = 18), 9.7% chlamydiase (n = 13) and 5.2% (n = 7) hepatitis B. Of the reported cases, 54.6% (n = 83) were males and 21.7% (n =33) were female, with ages ranging from 13 to 75 years and mean age of 39.5 years. Most of reported cases of STIs observed in Alto Seixalinho and Baixa da Banheira. Overall, there was an increase in the frequency of reported cases of STI, with a particular focus on gonorrhea. Conclusion Notification should be early because it can protect the health of the population by ensuring identification and follow-up of cases, identification of contacts, investigation and containment of disease outbreaks.

The containment of potential outbreaks triggered by imported Chikungunya cases in Italy: a cost utility epidemiological assessment of vector control measures

The arrival of infected travelers from endemic regions can trigger sustained autochthonous transmission of mosquito-borne pathogens in Europe. In 2007 a Chikungunya outbreak was observed in central Italy, mostly affecting two villages characterised by a high density of Aedes albopictus. The outbreak was mitigated through intervention strategies reducing the mosquito abundance. Ten years later, in 2017, sustained Chikungunya transmission was documented in both central and southern Italy. The proposed analysis identifies suitable reactive measures for the containment and mitigation of future epidemics by combining epidemiological modeling with a health economic approach, considering different arrival times of imported infections and possible delays in the notification of cases. Obtained estimates suggest that, if the first notification will occur in the middle of the mosquito breeding season, the combination of larvicides, adulticides and breeding sites removal represents the optimal strategy. In particular, we found that interventions implemented in 2007 were cost-effective, with about 3200 prevented cases, 1450 DALYs averted and €13.5 M saved. Moreover, larvicides are proven to be more cost beneficial in early summer and warmer seasons, while adulticides should be preferred in autumn and colder seasons. Our results provide useful indications supporting urgent decision-making of public health authorities in response to emerging mosquito-borne epidemics.

Cost-effectiveness analysis of universal influenza vaccination: Application of the susceptible–infectious–complication–recovery model

ObjectivesDespite the fact that vaccination is an effective primary prevention strategy for the containment of influenza outbreaks, health policymakers have shown great concern over the enormous costs involved in universal immunization, particularly when resources are limited. MethodsA two-arm cost-effectiveness analysis (CEA) was conducted that took into account the aspect of herd immunity. The analysis used a study cohort of 100000 residents with a demographic make-up identical to that of the underlying population in Taipei County, Taiwan, during the epidemic influenza season of 2001–2002. The parameters embedded in the dynamic process of infection were estimated through the application of the newly proposed susceptible–infection–complication–recovery (SICR) model to the empirical data, in order to compute the number of deaths and complications averted due to universal vaccination compared to no vaccination. Incremental cost-effectiveness ratios (ICERs) and the cost-effectiveness acceptability curve (CEAC) given maximum amount of willingness-to-pay (WTP) were calculated to delineate the results of the two-arm CEA. ResultsThe incremental costs involved in the vaccinated group as compared to the unvaccinated group were $1195 to reduce one additional complication and $805 to avert one additional death, allowing for herd immunity. The corresponding figures were higher for the results without considering herd immunity. Given the ceiling ratio of WTP equal to $10000 (approximately two-thirds of GDP), the probability of the vaccination being cost-effective for averting death was 100% and for averting complications was 96.7%. ConclusionsUniversal vaccination against seasonal influenza was found to be very cost-effective, particularly when herd immunity is considered. The probability of being cost-effective was almost certain given the maximum amount of WTP within two-thirds of the GDP.

HISTORY OF HIGHLY PATHOGENIC AVIAN INFLUENZA ERADICATION IN RUSSIAN FEDERATION IN 2016–2017

Epidemic patterns of highly pathogenic avian influenza А/Н5N8 spread in the Russian Federation are demonstrated, history of the disease outbreak eradication in domestic poultry is described, basic reasons of the dangerous virus introduction on the commercial farms are analyzed and issues of the outbreak containment are highlighted. Specific properties of H5N8 disease progression and clinical manifestation are demonstrated against H5N1 disease. Data of epidemic investigations of the virus introduction to the closed-type farms are integrated. Basic attention is given to the destruction of poultry died and stamped out during implementation of anti-epidemic measures, and potential alternative ways of biological waste destruction are demonstrated. Principal risks of introduction of emerging influenza virus subtypes into the Russian Federation are determined. Further spread of avian influenza over the Russian territory is expected due to the current epidemic situation, the virus persistence in the vectors, maintenance of its viability in the environment and seasonal migrations of the wild birds. Major threat of the agent introduction comes from the neighbouring East Asia and Far East countries (China, Japan, Korea). Herewith, introduction of potentially zoonotic viruses is also possible. Risk of the virus introduction from the European countries, Near East countries and Central Asia cannot be excluded. For now, drastic measures still remain the only tool for the disease control and the strategy of limited targeted AI vaccination in the backyards minimizes the virus introduction to the commercial farms located in the risk zones.

Ebola Outbreak Containment: Real-Time Task and Resource Coordination With SORMAS

Background: Since the beginning of the Ebola outbreak in West Africa in 2014, more than 11,000 people died. For outbreaks of infectious diseases like this, the rapid implementation of control measures is a crucial factor for containment. In West African countries, outbreak surveillance is a paper-based process with significant delays in forwarding outbreak information, which affects the ability to react adequately to situational changes. Our objective therefore was to develop a tool that improves data collection, situation assessment, and coordination of response measures in outbreak surveillance processes for a better containment. Methods: We have developed the Surveillance and Outbreak Response Management System (SORMAS) based on findings from Nigeria's 2014 Ebola outbreak. We conducted a thorough requirements engineering and defined personas and processes. We also defined a data schema with specific variables to measure in outbreak situations. We designed our system to be a cloud application that consists of interfaces for both mobile devices and desktop computers to support all stakeholders in the process. In the field, health workers collect data on the outbreak situation via mobile applications and directly transmit it to control centers. At the control centers, health workers access SORMAS via desktop computers, receive instant updates on critical situations, react immediately on emergencies, and coordinate the implementation of control measures with SORMAS. Results: We have tested SORMAS in multiple workshops and a field study in July 2015. Results from workshops confirmed derived requirements and implemented features, but also led to further iterations on the systems regarding usability. Results from the field study are currently under assessment. General feedback showed high enthusiasm about the system and stressed its benefits for an effective outbreak containment of infectious diseases. Conclusions: SORMAS is a software tool to support health workers in efficiently handling outbreak situations of infectious diseases, such as Ebola. Our tool enables a bi-directional exchange of situational data between individual stakeholders in outbreak containment. This allows instant and seamless collection of data from the field and its instantaneous analysis in operational centers. By that, SORMAS accelerates the implementation of control measures, which is crucial for a successful outbreak containment.

Post-earthquake health-service support, Nepal.

ProblemSeven months after the April 2015 Nepal earthquake, and as relief efforts were scaling down, health authorities faced ongoing challenges in health-service provision and disease surveillance reporting.ApproachIn January 2016, the World Health Organization recruited and trained 12 Nepalese medical doctors to provide technical assistance to the health authorities in the most affected districts by the earthquake. These emergency support officers monitored the recovery of health services and reconstruction of health facilities, monitored stocks of essential medicines, facilitated disease surveillance reporting to the health ministry and assisted in outbreak investigations.Local settingIn December 2015 the people most affected by the earthquake were still living in temporary shelters, provision of health services was limited and only five out of 14 earthquake-affected districts were reporting surveillance data to the health ministry.Relevant changesFrom mid-2016, health facilities were gradually able to provide the same level of services as in unaffected areas, including paediatric and adolescent services, follow-up of tuberculosis patients, management of respiratory infections and first aid. The number of districts reporting surveillance data to the health ministry increased to 13 out of 14. The proportion of health facilities reporting medicine stock-outs decreased over 2016. Verifying rumours of disease outbreaks with field-level evidence, and early detection and containment of outbreaks, allowed district health authorities to focus on recovery and reconstruction.Lessons learntLocal medical doctors with suitable experience and training can augment the disaster recovery efforts of health authorities and alleviate their burden of work in managing public health challenges during the recovery phase.

Zika virus epidemiology: from Uganda to world pandemic, an update.

Zika virus (ZIKV) infection is an emergent worldwide public health problem. Historically, 84 countries have reported vector-borne ZIKV transmission, 61 of which report on-going transmission. It is a Flavivirus transmitted through arthropods belonging to the Aedes genus. Since 2015, ZIKV infections have increased dramatically; with 1.3 million people infected during 2015 in Brazil alone. This paper's objective is to highlight the conjectural epidemiological points of the virus' dissemination. The digital archives Pubmed, MEDLINE, EMBASE and Cochrane were searched for papers that assessed aspects of ZIKV transmission and epidemiology. The first isolation occurred in Uganda in 1947. Since then, important outbreaks were documented globally. Consequently, an emergent public health problem arose from a rapidly increasing incidence and its association with the development of neurological diseases such as microcephaly and Guillain-Barré syndrome. Key factors in the successful containment of outbreaks include surveillance of mosquitos in the neighbourhood, an early mosquito control treatment, an assertive information campaign, and the involvement of the local population and healthcare workers. As such, while ZIKV seems to be spreading globally in a similar manner to other arboviruses, such as Dengue and Chikungunya viruses, it can also be rapidly contained due to the pre-existing availability of necessary resources and regulatory tools as control measures. This review aims to provide a description of those characteristics of ZIKV infection that may be useful in the construction of effective outbreak control strategies.

State’s preparedness for coordination of Lassa fever outbreak containment in Nigeria, April 2017

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.

The role of a national-emergency operations center in 2016/2017 meningitis outbreak response

Introduction : outbreaks of bacterial Cerebrospinal Meningitis are known to result in high morbidity and mortality. Outbreaks with such a high impact attract a multi-level, multi-partner response. While the accompanying deployment of human and material resources is beneficial for response, effective utilization may be compromised without a central coordinating structure. Activating an Incident Management System (IMS) is therefore vital. This paper describes the role of an IMS in coordinating response to the 2017 CSM outbreak, which resulted in 14,280 cases with CFR of 8%. Methods : on the 3rd of April, 2017, a national IMS led by the Nigeria Centre for Disease Control (NCDC) was activated coinciding with the peak of the outbreak (Epi-week 14, 2017). Terms of Reference and an emergency response plan was defined based on five response pillars- Coordination, Case management, Surveillance and Epidemiology, Risk Communications and Vaccines management. Activities implemented include: Bi-weekly CSM EOC meetings and situational report development, deployment of rapid response teams (RRT) to affected States, technical support to States to support reactive vaccination campaigns. Other activities included sensitization of stakeholders, monitoring of epidemiological trends using dashboards, development and review of SOPs, weekly feedbacks to affected States as well as multi-layered advocacies. Results : the IMS activation enhanced coordination of all response activities by the Government and partners. A long tail of the epidemic prior to EOC activation was shortened and CFR reduced from 11.2% to 8.0%. Reactive vaccination campaigns were better coordinated yielding high coverage rates in Zamfara (97%), Sokoto (97%) and Yobe (105%) States. Multi-level mapping and strategic deployment of all partners’ resources was achieved. Development and dissemination of bi-weekly situational reports aided response decisions and kept stakeholders and the general public abreast of outbreak status. Decision making was evidence-based as outbreak dashboards were used to review epidemic trends. Engagement with stakeholders (media, traditional and religious institutions) helped in social mobilization. Guidelines and SOPs development improved sub-national response by eliminating the use of multiple guidelines on same thematic area. Conclusion : the containment of CSM outbreak is partly attributable to the activation of the IMS, which aided timely identification of response gaps and proffering solutions. Although the IMS was activated only at the peak of the outbreak, a drastic reduction in new cases was recorded. The use of an IMS for coordinating future outbreaks is highly recommended.