In Nigeria, before 2017 the most recent case of human monkeypox had been reported in 1978. By mid-November 2017, a large outbreak caused by the West African clade resulted in 146 suspected cases and 42 laboratory-confirmed cases from 14 states. Although the source is unknown, multiple sources are suspected.

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IntroductionCholera outbreaks in rural communities are associated with high morbidity and mortality. Effective interventions to control these outbreaks require identification of source and risk factors for infection. In September, 2010 we investigated a cholera outbreak in Bashuri, a cholera naïve rural community in northern Nigeria to identify the risk factors and institute control measures.MethodsWe conducted an unmatched case-control study. We defined a case as any resident of Bashuri community two years and above with acute watery diarrhea with or without vomiting and a control as any resident two years and above without acute watery diarrhea and vomiting. We recruited 80 hospital-based cases and 80 neighborhood controls. We collected and analyzed data on demographic characteristics, clinical information and risk factors. Laboratory analysis was performed on 10 stool samples and 14 open-well samples.ResultsMean age was 29 years (± 20 years) for cases and 32 years (± 16 years) for controls; 38 (47.5%) of cases and 60 (75%) of controls were males. Compared to controls, cases were less likely to have washed hands with soap before eating (age-adjusted odds ratio (AAOR) = 0.27, 95% confidence interval (CI): 0.10-0.72) and less likely to have washed hands with soap after using the toilet (AAOR = 0.34, 95% CI: 0.15-0.75). Vibrio cholerae O1 was isolated from six stool samples but not from any open-well samples.ConclusionUnhygienic hand washing practices was the key risk factor in this outbreak. We educated the community on personal hygiene focusing on the importance of hand washing with soap.

A young single male health worker was admitted to the isolation ward of the infectious disease hospital in Lagos with Ebola virus disease, which he had contracted in the course of rendering services to the index case in Nigeria. Three weeks after the admission, he appeared confused and was sleeping poorly, talking tangentially, and exhibiting unruly, disruptive behavior toward those caring for him. His behavioral symptoms were worse during relatives' visits. The clinical management team considered a diagnosis of permanent brain injury secondary to the Ebola virus infection but could not conduct the relevant investigations because of the contagious nature of the illness. The patient was referred to the psychosocial team.On evaluation, the psychosocial team found the patient to be apprehensive and fearful about the outcome of his illness. He lamented having contracted the virus, despite having taken what he considered adequate precautions while attending to an infected patient. He had feelings of sadness and self-pity, saying that God had forsaken him and at other times saying that God did not exist. He often paced up and down the corridor. His poor sleep seemed to contribute to his daytime anxiety. He was angry with his clinical colleagues, who were now his clinical management team, and his relatives for "ostracizing" him in the isolation ward. He felt very sad about both groups seeing him in "this helpless situation." He had no past history of mental disorder.Mental state examination revealed a restless and agitated young man. He described his mood as not happy. His thinking was slowed but goal directed. He worried that some patients admitted after him had already been discharged after achieving remission and believed that his condition was probably not responding to treatment. He had no delusions, obsessions, or hallucinations. He was oriented in time, place, and person, but his attention and concentration were impaired. He could recall only one of five objects in 5 minutes. He lacked insight into his mental problem. Further cognitive and neurological evaluation was not attempted because of the patient's contagious status. He had been physically stable for several days prior to consultation, although his blood test was still positive for Ebola virus. A diagnosis of adjustment disorder with mixed disturbances of emotion and conduct was made. The psychosocial team commenced supportive psychotherapy and problem solving therapy. The patient was encouraged to cooperate with the management team and caregivers for the desired therapeutic outcome. Because of his poor sleep and anxiety, we prescribed 25 mg of amitriptyline at night, and increased the dose to 37.5 mg 48 hours later. The primary management team was educated on the nature of his psychological disorder, which could mimic cognitive impairment secondary to Ebola virus disease-induced brain encephalopathy. They were informed that his behavior could be ascribed to the psychological stress of having a life-threatening disorder. The patient's relatives were also g...

Introduction Despite the availability of vaccines, pertussis outbreaks still occur in developing countries. In December 2015 we investigated a pertussis outbreak in Kaltungo, Nigeria to identify determinants of infection and institute control measures. Methods We enrolled 155 cases and 310 unmatched controls. We defined cases as residents of Kaltungo with paroxysmal or whooping cough lasting 2 weeks with or without vomiting and randomly selected neighborhood controls. Using structured questionnaire, we collected data on socio-demographics, clinical and risk factors. We collected twelve nasopharyngeal swabs for laboratory analysis using Polymerase Chain Reaction. Results Median age was 24 months (range 1-132 months) for cases and 27 months (range 1-189 months) for controls. Female cases and controls were 86 (55.5%) and 150 (48.4%) respectively. A total of 83 (56.6%) cases were in age group 12-59 months. Age-specific-attack-rate was 83/1,786 (4.7%); Age-specific-case-fatality-rate was 21/83 (25.3%); Age-specific-proportional-mortality-ratio was 21/24 (87.5%). A total of 61 (39.4%) zero doses and 30.1% Pentavalent dropouts were documented. Multivariate analysis revealed parental refusal (adjusted OR = 27.8; CI = 8.8-87.7), contact with a case (AOR = 7.9, CI = 4.3-14.7, P = 0.000), belonging to the Muslim faith (AOR = 2.0; CI = 1.1-3.5) and having mothers with informal education only (AOR = 4.7, CI-2.6-8.4) as independent predictors of pertussis infection. Conclusion Sub-optimal vaccination due to parental refusal and informal education of mothers were major determinants of pertussis infection. We conducted awareness campaigns of key immunization messages targeted at the informal education sector. We ensured appropriate case management, contact vaccination and health education in public gatherings, worship places and schools.