Chima Ohuabunwo1, Celestine Ameh2, Oyin Oduyebo3, Anthony Ahumibe2, Bamidele Mutiu4, Adebola Olayinka5, Wasiu Gbadamosi6, Erika Garcia7, Carolina Nanclares8, Wale Famiyesin9, Abdulaziz Mohammed2, Patrick Nguku10, Richard I Koko9, Joshua Obasanya11, Durojaye Adebayo11, Yemi Gbadegesin11, Oni Idigbe12, Olukayode Oguntimehin13, Sara Nyanti14, Charles Nzuki14, Ismail Abdus-Salam15, Joseph Adeyemi16, Nnanna Onyekwere17, Emmanuel Musa9, David Brett-Major7, Faisal Shuaib14, Abdulsalami Nasidi11. 1. African Field Epidemiology Network, Kampala, Uganda; Department of Medicine, Morehouse School of Medicine, 720 West View Drive SW, Atlanta, GA 30310, USA. Electronic address: cohuabunwo@msm.edu. 2. Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria. 3. College of Medicine, University of Lagos, Lagos, Nigeria. 4. Lagos State University Teaching Hospital, Ikeja, Nigeria. 5. Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria; College of Medicine, Ahmadu Bello University, Zaria, Nigeria. 6. Lagos State Mainland Hospital, Yaba, Lagos, Nigeria. 7. World Health Organization, Geneva, Switzerland. 8. Médecins Sans Frontières, Operational Base, Madrid, Spain. 9. World Health Organization Country Office, Abuja, Nigeria. 10. African Field Epidemiology Network, Kampala, Uganda; Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria. 11. Nigeria Centre for Disease Control, Abuja, Nigeria. 12. Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria. 13. Lagos State Primary Health Care Board, Yaba, Lagos, Nigeria. 14. UNICEF Country Office, Abuja, Nigeria. 15. Lagos State Ministry of Health, Ikeja, Lagos, Nigeria. 16. Department of Psychiatry, University of Lagos, Lagos, Nigeria. 17. Rivers State Ministry of Health, Port Harcourt, Nigeria.
Abstract
INTRODUCTION: The Ebola virus disease (EVD) outbreak in Nigeria began when an infected diplomat from Liberia arrived in Lagos, the most populous city in Africa, with subsequent transmission to another large city. METHODS: First-, second-, and third-generation contacts were traced, monitored, and classified. Symptomatic contacts were managed at Ebola treatment centers as suspected, probable, and confirmed EVD cases using standard operating procedures adapted from the World Health Organization EVD guidelines. Reverse transcription PCR tests confirmed EVD. Socio-demographic, clinical, hospitalization, and outcome data of the July-September 2014 Nigeria EVD cohort were analyzed. RESULTS: The median age of the 20 EVD cases was 33 years (interquartile range 26-62 years). More females (55%), health workers (65%), and persons <40 years old (60%) were infected than males, non-health workers, and persons aged ≥40 years. No EVD case management worker contracted the disease. Presenting symptoms were fever (85%), fatigue (70%), and diarrhea (65%). Clinical syndromes were gastroenteritis (45%), hemorrhage (30%), and encephalopathy (15%). The case-fatality rate was 40% and there was one mental health complication. The average duration from symptom onset to presentation was 3±2 days among survivors and 5±2 days for non-survivors. The mean duration from symptom onset to discharge was 15±5 days for survivors and 11±2 days for non-survivors. Mortality was higher in the older age group, males, and those presenting late. CONCLUSION: The EVD outbreak in Nigeria was characterized by the severe febrile gastroenteritis syndrome typical of the West African outbreak, better outcomes, rapid containment, and no infection among EVD care-providers. Early case detection, an effective incident management system, and prompt case management with on-site mobilization and training of local professionals were key to the outcome.
INTRODUCTION: The Ebola virus disease (EVD) outbreak in Nigeria began when an infected diplomat from Liberia arrived in Lagos, the most populous city in Africa, with subsequent transmission to another large city. METHODS: First-, second-, and third-generation contacts were traced, monitored, and classified. Symptomatic contacts were managed at Ebola treatment centers as suspected, probable, and confirmed EVD cases using standard operating procedures adapted from the World Health Organization EVD guidelines. Reverse transcription PCR tests confirmed EVD. Socio-demographic, clinical, hospitalization, and outcome data of the July-September 2014 Nigeria EVD cohort were analyzed. RESULTS: The median age of the 20 EVD cases was 33 years (interquartile range 26-62 years). More females (55%), health workers (65%), and persons <40 years old (60%) were infected than males, non-health workers, and persons aged ≥40 years. No EVD case management worker contracted the disease. Presenting symptoms were fever (85%), fatigue (70%), and diarrhea (65%). Clinical syndromes were gastroenteritis (45%), hemorrhage (30%), and encephalopathy (15%). The case-fatality rate was 40% and there was one mental health complication. The average duration from symptom onset to presentation was 3±2 days among survivors and 5±2 days for non-survivors. The mean duration from symptom onset to discharge was 15±5 days for survivors and 11±2 days for non-survivors. Mortality was higher in the older age group, males, and those presenting late. CONCLUSION: The EVD outbreak in Nigeria was characterized by the severe febrile gastroenteritis syndrome typical of the West African outbreak, better outcomes, rapid containment, and no infection among EVD care-providers. Early case detection, an effective incident management system, and prompt case management with on-site mobilization and training of local professionals were key to the outcome.
Authors: S Ariane Christie; Benedict C Nwomeh; Sanjay Krishnaswami; George P Yang; Ai-Xuan L Holterman; Anthony Charles; Sudha Jayaraman; Randeep S Jawa; Jennifer Rickard; Mamta Swaroop; Sifri C Ziad; Georges Alain Etoundi Mballa; Martin Ekeke Monono; Alain Chichom Mefire; Catherine Juillard Journal: World J Surg Date: 2019-03 Impact factor: 3.352
Authors: Donna S Jones; Richard C Dicker; Robert E Fontaine; Amy L Boore; Jared O Omolo; Rana J Ashgar; Henry C Baggett Journal: Emerg Infect Dis Date: 2017-12 Impact factor: 6.883