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Lessons learnt from the management of a case of Lassa fever and follow‐up of nosocomial primary contacts in Nigeria during Ebola virus disease outbreak in West Africa
Author(s) -
Iroezindu Michael O.,
Unigwe Uche S.,
Okwara Celestine C.,
Ozoh Gladys A.,
Ndu Anne C.,
Ohanu Martin E.,
Nwoko Ugochukwu O.,
Okoroafor Uwadiegwu W.,
Ejimudo Esinulo,
Tobin Ekaete A.,
Asogun Danny A.
Publication year - 2015
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12565
Subject(s) - lassa fever , ribavirin , medicine , outbreak , lassa virus , ebola virus , isolation (microbiology) , index case , pediatrics , emergency medicine , virology , virus , hepatitis c virus , microbiology and biotechnology , biology
Objective To describe our experiences in the management of a case of Lassa fever ( LF ) and follow‐up of nosocomial primary contacts during the 2014 Ebola outbreak in West Africa. Methods Clinical management of the index case and infection control/surveillance activities for primary contacts are described. Laboratory confirmation was by Lassa virus‐specific reverse‐transcriptase PCR . Results A 28‐year‐old man with a 10‐day history of febrile illness was referred to a major tertiary hospital in south‐east Nigeria from a city that previously experienced a LF outbreak and was recently affected by Ebola. On observation of haemorrhagic features, clinicians were at a crossroads. Diagnosis of LF was confirmed at a National Reference Centre. The patient died despite initiation of ribavirin therapy. Response activities identified 121 primary contacts comprising 78 (64.5%) hospital staff/interns, 19 (15.7%) medical students, 18 (14.9%) inpatients and 6 (5.0%) relatives. Their mean age was 32.8 ± 6.6 years, and 65.3% were women. Twenty (16.5%) had high‐risk exposure and were offered ribavirin as post‐exposure prophylaxis. No secondary case of LF occurred. Fatigue (43.8%) and dizziness (31.3%) were the commonest side effects of ribavirin. Conclusions Response activities contained nosocomial spread of LF , but challenges were experienced including lack of a purpose‐built isolation facility, absence of local Lassa virus laboratory capacity, failure to use appropriate protective equipment and stigmatisation of contacts. A key lesson is that the weak health systems of Africa should be comprehensively strengthened; otherwise, we might win the Ebola battle but lose the one against less virulent infections for which effective treatment exists.