International Journal of Infectious Diseases (Jun 2019)

A cluster of nosocomial Lassa fever cases in a tertiary health facility in Nigeria: Description and lessons learned, 2018

  • Chioma C. Dan-Nwafor,
  • Oladipupo Ipadeola,
  • Elizabeth Smout,
  • Elsie Ilori,
  • Ayodele Adeyemo,
  • Chukwuma Umeokonkwo,
  • Damian Nwidi,
  • Williams Nwachukwu,
  • Winifred Ukponu,
  • Emeka Omabe,
  • Uchenna Anaebonam,
  • Nneka Igwenyi,
  • Gordon Igbodo,
  • Womi Eteng,
  • Ikemefule Uzoma,
  • Muhammed Saleh,
  • Joseph Agboeze,
  • Samuel Mutbam,
  • Tanyth de Gooyer,
  • Rosie Short,
  • Everistus Aniaku,
  • Robinson Onoh,
  • Emeka Ogah,
  • Patrick Nguku,
  • John Oladejo,
  • Clement Peter,
  • Olubunmi Ojo,
  • Chikwe Ihekweazu

Journal volume & issue
Vol. 83
pp. 88 – 94

Abstract

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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