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.

Monkeypox (MPX) is a viral zoonosis with lesions like smallpox. Though rare in Nigeria, sporadic outbreaks have been reported in 17 states since September 2017. Unfortunately, the COVID-19 pandemic has further reduced surveillance and reporting of MPX disease. This study seeks to assess the effect of an enhanced surveillance approach to detect MPX cases and measure the cumulative incidence of MPX in priority states in Nigeria. We identified three priority states (Rivers, Delta and Bayelsa) and their Local Government Areas (LGAs) based on previous disease incidence. We also identified, trained, and incentivized community volunteers to conduct active case searches over three months (January to March 2021). We supported case investigation of suspected cases and followed up on cases in addition to routine active surveillance for MPX in health facilities and communities. Weekly and monthly follow-up was carried out during the same period. Out of the three states, 30 hotspots LGAs out of the 56 LGAs (54%) were engaged for enhanced surveillance. We trained three state supervisors, 30 LGA surveillance facilitators and 600 Community informants across the three priority states. Overall, twenty-five (25) suspected cases of MPX were identified. Out of these, three (12%) were confirmed as positive. Enhanced surveillance improved reporting of MPX diseases in hotspots LGAs across the priority states. Extension of this surveillance approach alongside tailored technical support is critical intra and post-pandemic.

Background: A lot has been documented about the pathophysiology and clinical presentation of coronavirus disease 2019 (COVID-19). We compared the clinical features of real-time reverse transcriptase polymerase-chain-reaction (RT-PCR) confirmed COVID-19 positive and negative patients admitted in Lagos State. Methods: Medical records of all patients admitted in 15 isolation centres across Lagos state between 27th February 2020 and 30th September 2020, were abstracted and reviewed. We compared the clinical features, co-morbidities and clinical outcomes of COVID-19 positive and negative patients. Results: A total of 3157 records of patients admitted in 15 isolation centres in Lagos State were reviewed of which 302 (9.6%) tested negative to RT-PCR COVID-19. There was no gender difference between COVID-19 positive and negative patients (P = 0.687). The average age of the negative patients was higher (46.8 ± 18.3 years) than positive patients (41.9 ± 15.5 years) (P < 0.001). A higher proportion of the COVID-19 negative patients had co-morbidity (38.1% vs. 27.8%), were symptomatic (67.5% vs. 44.6%) and higher mortality (21.9% vs. 6.6%) than positive patients (P < 0.001). The percentages with hypertension (26.2% vs. 21.0%, P = 0.038), diabetes (17.2% vs. 9.4%, P < 0.001), cardiovascular disease (2.3% vs. 0.9%, P < 0.029) and cancer (2.3% vs. 0.5%, P < 0.002) were more among patients without COVID-19. More patients without COVID-19 presented with fever (36.1% vs. 18.8%), cough (33.7% vs. 23.1%) and breathlessness (40.8% vs. 16.1%) than the positive patients (P < 0.001). Conclusion: Anosmia and dysgeusia were strongly associated with COVID-19. Clinical decision-making should only be used to prioritise testing and isolation of patients suspected to have COVID-19, especially in settings with limited access to diagnostic kits.