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Disease surveillance key to controlling outbreak of Lassa in Nigeria

Lassa Outbreak Nigeria by WHO
In January 2017, the World Health Organization (WHO) partnered with the Nigeria’s Centre for Disease Control and the Ministry of Health for training sessions on diseases surveillance and outbreak response in Borno State, north-eastern Nigeria. © WHO

With funding from EU Humanitarian Aid and other partners, the World Health Organization has trained clinicians on disease surveillance in Nigeria. This proved to be critical as the possibility of a Lassa fever outbreak loomed large earlier in 2017.

Isabelle Devaux

By Dr Isabelle Devaux, WHO Epidemiologist in Maiduguri, Nigeria @WHOAFRO

As an epidemiologist with 20 years of experience working in some of the most challenging places in the world, I have seen my fair share of desperate situations, but the scale of suffering in north-eastern Nigeria is unprecedented. Millions of people haven’t had access to health services for several years, but this is changing as access increases and the situation becomes more secure.

Back in January 2017, we, the World Health Organization (WHO) team in Maiduguri, Nigeria, partnered with the Nigeria’s Centre for Disease Control and the Borno State Ministry of Health for a series of training sessions on disease surveillance and outbreak response in Borno State. Little did we know that the training would be put to the test so quickly for an unexpected outbreak of Lassa fever-- a disease not seen in Borno State since 1969.

One of the people we trained was Abba Fori Zarma from Jere Local Government Area (LGA), a county where he works as a disease surveillance officer.
A few weeks after the training, Abba detected a Lassa fever case. He quickly reported the case to the State Ministry of Health and WHO. Without this quick detection, it is likely that the outbreak could have spread to other areas.

Lassa fever is an acute viral illness occurring in West African countries, including Nigeria. The virus is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces. While the main mode of transmission is from rodents to human, direct person-to-person infections and laboratory transmission can also occur by body fluid contacts.

Since then, the initial patient confirmed with Lassa fever has fully recovered, and was discharged following two negative tests. Fifty-nine people were identified who had contact with the initial patient and were monitored for 21 days.

After detecting the outbreak, Abba drove to the affected areas where the contamination began to conduct investigations and set up preventive measures. It is through working with frontline health workers like Abba which helps make all of our efforts effective and worthwhile.

Disease surveillance training Nigeria

Since August 2016 and with the help of funding from the EU, WHO has trained hundreds of disease surveillance officers. © WHO

To help the Borno State government contain the Lassa fever outbreak, WHO mobilised a network of healthcare workers at the hospital and awareness creation. In addition, WHO provided the State Ministry of Health and hospitals with medical equipment.

WHO also produced and distributed information and education materials, including radio jingles, to inform community members about the symptoms of Lassa fever, risks and preventive measures.

In Borno State, at least 5.9 million people, including 1.9 million internally displaced persons, urgently need the expansion of life-saving health services. Disease outbreaks are a major threat for many reasons, including moving populations living in poor conditions, low vaccination rates and limited disease surveillance or detection to identify and contain an outbreak.

With funding from EU Humanitarian Aid  and other partners, we are changing the picture. Since August 2016, WHO has trained hundreds of disease surveillance officers, increasing disease surveillance to 160 sites covering 85% of internally displaced persons.

We know that epidemic-prone-diseases outbreaks will pose a greater threat over the coming months due to their seasonal patterns. Meningitis is a concern during the “hot season” and can be prevented through vaccination in camps where internally displaced people live. The start of the rainy season in June will further heighten the risk of cholera epidemics, and cases of malaria are also expected to rise. This is why expanding training to local health workers and increasing disease surveillance sites is essential.

With support from EU Humanitarian Aid , we plan to scale up our training and surveillance in other parts of Borno State and beyond, and now we have yet another example of the importance of disease surveillance in early detection of outbreaks.