After action review of the response to an outbreak of Lassa fever in Sierra Leone, 2019: Best practices and lessons learnt

Abstract

Background In November 2019, an outbreak of Lassa Fever occurred among health workers in a non-endemic district in Sierra Leone. The outbreak resulted in five cases, including two that were exported to the Netherlands. The outbreak tested multiple technical capacities in the International Health Regulations (2005) in a real-life setting. As such, an after action review (AAR) was undertaken as recommended by World Health Organization. We report on the findings of the AAR including best practices and lessons learnt. Methods A two stage review process was employed. The first stage involved national pillar level reviews for each technical pillar and one review of the district level response. The second stage brought together all pillars, including participants from the national and sub-national level as well as health sector partners. National guidelines were used as references during the deliberations. A standardized template was used to report on the key findings on what happened, what was supposed to happen, what went well and lessons learnt. Results This was a hospital associated outbreak that likely occurred due to a breach in infection prevention and control (IPC) practices resulting in three health workers being infected during a surgical operation. There was a delay in detecting the outbreak on time due to low index of suspicion among clinicians. Once detected, the outbreak response contained the outbreak within one incubation period. Areas that worked well included coordination, contact tracing, active case search and ring IPC. Notable gaps included delays in accessing local emergency funding and late distribution of IPC and laboratory supplies. Conclusions The incident management system worked optimally to contain this outbreak. The core technical gaps identified in surveillance, IPC and delay in deployment of resources should be addressed through systemic changes that can mitigate future outbreaks. Author summary The International Health Regulations (IHR) Monitoring and Evaluation Framework was developed by the World Health Organization to provide strategies to monitor and assess how countries are building their core public health capacities under IHR (2005). The framework has four components: annual reporting on IHR capacities (mandatory), Joint External Evaluation, simulation exercises and After Action Review (AAR). In November 2019, an outbreak of Lassa Fever occurred among health workers in a non-endemic district in Sierra Leone. The outbreak resulted in five cases, including two deaths and two exported cases to the Netherlands. The outbreak tested multiple technical capacities in the IHR (2005) in a real-life setting. We therefore conducted an AAR to assess how well the country responded to the outbreak. This hospital associated outbreak likely occurred due to a breach in infection prevention and control (IPC) practices. The response launched after detection of the outbreak successfully contained the outbreak within one incubation period. Areas that worked well included coordination, contact tracing, active case search and ring IPC. Areas that needed improvement were clinicians’ knowledge on Lassa Fever, delays in accessing local emergency funding and late distribution of IPC and laboratory supplies.