1
|
Yinka-Ogunleye A, Dalhat M, Akinpelu A, Aruna O, Garba F, Ahmad A, Adeleye A, Botson I, Oluwafemi B, Ogunbode O, Amao L, Ekripo U, Aliyu GG, Adetifa I, Ihekweazu C, Abubakar I. Mpox (monkeypox) risk and mortality associated with HIV infection: a national case-control study in Nigeria. BMJ Glob Health 2023; 8:e013126. [PMID: 38035733 PMCID: PMC10689363 DOI: 10.1136/bmjgh-2023-013126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/21/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Recent outbreaks of mpox are characterised by changes in the natural history of the disease, the demographic and clinical characteristics of the cases, and widening geographical distribution. We investigated the role of HIV and other sexually transmitted infections (STIs) coinfection among cases in the re-emergence of mpox to inform national and global response. METHODS We conducted a national descriptive and case-control study on cases in the 2017-2019 Nigerian mpox outbreak. Mpox cases were age, sex and geographical area matched each with two randomly selected controls from a representative national HIV/AIDS survey. Logistic regression was used to investigate the association between HIV infection and the risk of mpox acquisition and death. RESULTS Among 204 suspected mpox cases, 86 were confirmed (median age 31 years (IQR 27-38 years), mostly males (61 cases, 70.9%). Three-fifths of mpox cases had serological evidence of one or more STIs with 27.9% (24/86) coinfected with HIV. The case fatality rate was 9.4% (8/86) and 20.8% (5/24) overall and in HIV positive cases respectively. Mpox cases were more likely to have HIV coinfection compared with an age, gender and geography-matched control group drawn from the general population (OR 45 (95% CI 6.1 to 333.5, p=0.002) and when compared with non mpox rash cases (7.29 (95% CI 2.6 to 20.5, p<0.0001)). HIV coinfection and young age were associated with mortality among mpox cases (aOR 13.66 (95% CI 1.88 to 98.95, p=0.010) and aOR 0.90 (0.82-0.97, p=0.008), respectively). CONCLUSION HIV infection was associated with a higher risk of contracting and dying from mpox. Children are also at high risk of death. STIs in mpox cases may be suggestive of high-risk sexual behaviours among these individuals.
Collapse
Affiliation(s)
- Adesola Yinka-Ogunleye
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
- Institute of Global Health, University College London, London, UK
| | - Mahmood Dalhat
- African Field Epidemiology Network, Abuja, Nigeria
- Infectious Diseases Control Centre, Kaduna, Nigeria
| | - Afolabi Akinpelu
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Olusola Aruna
- IHR Strengthening Programme in Nigeria, UK Health Security Agency, London, UK
| | - Fatima Garba
- African Field Epidemiology Network Nigeria, Abuja, Nigeria
| | - Adama Ahmad
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Adesola Adeleye
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Iliya Botson
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Bamidele Oluwafemi
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Oladipo Ogunbode
- Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Lateefat Amao
- Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Udeme Ekripo
- University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Gambo Gumel Aliyu
- Epidemiology and Prevention, Institute of Human Virology, Baltimore, Maryland, USA
| | - Ifedayo Adetifa
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ibrahim Abubakar
- Institute of Global Health, University College London, London, UK
| |
Collapse
|
2
|
Iroezindu MO, Crowell TA, Ogoina D, Yinka-Ogunleye A. Human Mpox in People Living with HIV: Epidemiologic and Clinical Perspectives from Nigeria. AIDS Res Hum Retroviruses 2023; 39:593-600. [PMID: 37646422 DOI: 10.1089/aid.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Sub-Saharan Africa (SSA) is disproportionately affected by mpox and HIV. We described epidemiologic trends and clinical experiences in the management of mpox in people living with HIV (PLWH) in Nigeria and further examined how the rapidly accumulating body of knowledge from the 2022 global mpox outbreak might be explored to improve mpox care in PLWH in SSA. During the 2017/2018 Nigerian mpox outbreak, we reported that 9/40 (22.5%) hospitalized mpox patients with known HIV status were PLWH. In the 2022 global mpox outbreak, 52% of confirmed mpox cases with known HIV status were PLWH, predominantly sexual and gender minority groups. However, substantial missing data on HIV status of confirmed mpox cases highlights a critical gap in HIV testing as a component of mpox management. Before 2022, sexual activity was not commonly linked to mpox transmission, but this was identified as a major driver of transmission during the 2022 mpox outbreak. Notable sexual history observed in Nigerian mpox patients in 2017/2018 suggests that the contribution of sexual activity in human-to-human mpox transmission might have been underappreciated for years. Our cohort of PLWH with mpox, predominantly individuals with advanced or uncontrolled HIV, were significantly more likely to experience severe mpox manifestations and prolonged disease compared with those without HIV. This contrasts with the generally less remarkable differences in mpox presentation between people with and without HIV in Western countries, an observation that can be at least partially explained by more stable HIV disease. The unavailability of mpox antiviral drugs and vaccines in SSA highlights global inequity in mpox response, which requires an urgent attention. As mpox countermeasures become available in SSA, lessons learned from their use in Western countries could provide important guidance for care providers in SSA. Public health measures to mitigate stigmatization in PLWH with mpox is also critical.
Collapse
Affiliation(s)
- Michael O Iroezindu
- Clinical Research Center, HJF Medical Research International, Abuja, Nigeria
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Dimie Ogoina
- Infectious Disease Unit, Niger Delta University Teaching Hospital, Okolobiri, Nigeria
| | | |
Collapse
|
3
|
Ogoina D, Oru Oru I, Yinka-Ogunleye A, Ihekweazu C, Ndodo N, Aruna O. Case Report: Recurrent Mpox in a Healthcare Worker in Nigeria. Am J Trop Med Hyg 2023; 109:858-860. [PMID: 37604469 PMCID: PMC10551069 DOI: 10.4269/ajtmh.23-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/01/2023] [Indexed: 08/23/2023] Open
Abstract
We report the first case of recurrent Mpox from Africa. The patient is a 36-year-old, previously healthy, HIV-negative male healthcare worker who developed two episodes of laboratory-confirmed Mpox in 2017 and 2018, 9 months apart. In both cases, he had prior close contact with confirmed Mpox cases in the hospital setting. On follow-up in 2022, he also reported recurrent postcoital skin eruptions over a previously healed genital scar from the first episode of Mpox. We highlight the need for future studies to investigate the true burden and risk factors for Mpox reinfection, relapse, and recrudescence.
Collapse
Affiliation(s)
- Dimie Ogoina
- Infectious Diseases Unit, Department of Internal Medicine, Niger Delta University/Niger Delta University Teaching Hospital, Yenagoa, Nigeria
| | - Inestol Oru Oru
- Department of Internal Medicine, Niger Delta University Teaching Hospital, Okolobiri, Nigeria
| | | | - Chikwe Ihekweazu
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Nnaemeka Ndodo
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Olusola Aruna
- International Health Regulations Strengthening Project, Global Operations, UK Health Security Agency, London, United Kingdom
| |
Collapse
|
4
|
Ndodo N, Ashcroft J, Lewandowski K, Yinka-Ogunleye A, Chukwu C, Ahmad A, King D, Akinpelu A, Maluquer de Motes C, Ribeca P, Sumner RP, Rambaut A, Chester M, Maishman T, Bamidele O, Mba N, Babatunde O, Aruna O, Pullan ST, Gannon B, Brown CS, Ihekweazu C, Adetifa I, Ulaeto DO. Distinct monkeypox virus lineages co-circulating in humans before 2022. Nat Med 2023; 29:2317-2324. [PMID: 37710003 PMCID: PMC10504077 DOI: 10.1038/s41591-023-02456-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/12/2023] [Indexed: 09/16/2023]
Abstract
The 2022 global mpox outbreak raises questions about how this zoonotic disease established effective human-to-human transmission and its potential for further adaptation. The 2022 outbreak virus is related to an ongoing outbreak in Nigeria originally reported in 2017, but the evolutionary path linking the two remains unclear due to a lack of genomic data between 2018, when virus exportations from Nigeria were first recorded, and 2022, when the global mpox outbreak began. Here, 18 viral genomes obtained from patients across southern Nigeria in 2019-2020 reveal multiple lineages of monkeypox virus (MPXV) co-circulated in humans for several years before 2022, with progressive accumulation of mutations consistent with APOBEC3 activity over time. We identify Nigerian A.2 lineage isolates, confirming the lineage that has been multiply exported to North America independently of the 2022 outbreak originated in Nigeria, and that it has persisted by human-to-human transmission in Nigeria for more than 2 years before its latest exportation. Finally, we identify a lineage-defining APOBEC3-style mutation in all A.2 isolates that disrupts gene A46R, encoding a viral innate immune modulator. Collectively, our data demonstrate MPXV capacity for sustained diversification within humans, including mutations that may be consistent with established mechanisms of poxvirus adaptation.
Collapse
Affiliation(s)
| | - Jonathan Ashcroft
- UK Public Health Rapid Support Team, UK Health Security Agency/London School of Hygiene & Tropical Medicine, London, UK
| | - Kuiama Lewandowski
- UK Health Security Agency, Research & Evaluation Services, Porton Down, UK
| | | | | | - Adama Ahmad
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - David King
- CBR Division, Defence Science and Technology Laboratory, Salisbury, UK
| | | | - Carlos Maluquer de Motes
- Department of Microbial Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Paolo Ribeca
- UK Health Security Agency, London, UK
- Biomathematics and Statistics Scotland, Edinburgh, UK
| | - Rebecca P Sumner
- Department of Microbial Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Andrew Rambaut
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK
| | - Michael Chester
- CBR Division, Defence Science and Technology Laboratory, Salisbury, UK
| | - Tom Maishman
- CBR Division, Defence Science and Technology Laboratory, Salisbury, UK
| | | | - Nwando Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - Olusola Aruna
- UK Health Security Agency, International Health Regulations (IHR) Strengthening Project, British High Commission, Abuja, Nigeria
| | - Steven T Pullan
- UK Health Security Agency, Research & Evaluation Services, Porton Down, UK
| | - Benedict Gannon
- UK Public Health Rapid Support Team, UK Health Security Agency/London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - David O Ulaeto
- CBR Division, Defence Science and Technology Laboratory, Salisbury, UK.
| |
Collapse
|
5
|
Meseko C, Adedeji A, Shittu I, Obishakin E, Nanven M, Suleiman L, Okomah D, Tyakaray V, Kolade D, Yinka-Ogunleye A, Muhammad S, Morgan CN, Matheny A, Nakazawa Y, McCollum A, Doty JB. Orthopoxvirus Infections in Rodents, Nigeria, 2018-2019. Emerg Infect Dis 2023; 29:433-434. [PMID: 36692495 PMCID: PMC9881785 DOI: 10.3201/eid2902.221411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
To investigate animal reservoirs of monkeypox virus in Nigeria, we sampled 240 rodents during 2018-2019. Molecular (real-time PCR) and serologic (IgM) evidence indicated orthopoxvirus infections, but presence of monkeypox virus was not confirmed. These results can be used to develop public health interventions to reduce human infection with orthopoxviruses.
Collapse
|
6
|
McCollum AM, Shelus V, Hill A, Traore T, Onoja B, Nakazawa Y, Doty JB, Yinka-Ogunleye A, Petersen BW, Hutson CL, Lewis R. Epidemiology of Human Mpox - Worldwide, 2018-2021. MMWR Morb Mortal Wkly Rep 2023; 72:68-72. [PMID: 36656790 PMCID: PMC9869741 DOI: 10.15585/mmwr.mm7203a4] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Monkeypox (mpox) is a zoonotic disease caused by Monkeypox virus (MPXV), an Orthopoxvirus; the wild mammalian reservoir species is not known. There are two genetic clades of MPXV: clade I and clade II (historically found in central and west Africa, respectively), with only Cameroon reporting both clades (1). Human cases have historically been reported from 1) mostly rural, forested areas in some central and west African countries; 2) countries reporting cases related to population migration or travel of infected persons; and 3) exposure to imported infected mammals (2). The annual number of cases in Africa has risen since 2014 and cumulatively surpassed reports from the previous 40 years for most countries. This reemergence of mpox might be due to a combination of environmental and ecological changes, animal or human movement, the cessation of routine smallpox vaccination since its eradication in 1980, improvements in disease detection and diagnosis, and genetic changes in the virus (2). This report describes the epidemiology of mpox since 1970 and during 2018-2021, using data from national surveillance programs, World Health Organization (WHO) bulletins, and case reports, and addresses current diagnostic and treatment challenges in countries with endemic disease. During 2018-2021, human cases were recognized and confirmed in six African countries, with most detected in the Democratic Republic of the Congo (DRC) and Nigeria. The reemergence and increase in cases resulted in its being listed in 2019 as a priority disease for immediate and routine reporting through the Integrated Disease Surveillance and Response strategy in the WHO African region.* In eight instances, patients with mpox were identified in four countries outside of Africa after travel from Nigeria. Since 2018, introductory and intermediate training courses on prevention and control of mpox for public health and health care providers have been available online at OpenWHO.†,§ The global outbreak that began in May 2022¶ has further highlighted the need for improvements in laboratory-based surveillance and access to treatments and vaccines to prevent and contain the infection, including in areas of Africa with endemic mpox.
Collapse
|
7
|
Abstract
Background: Human monkeypox (HMPX) is currently spreading outside endemic countries in Africa and the majority of those affected are gay and bisexual men within interconnected sexual networks. We investigated the sexual history of HMPX cases seen at a tertiary hospital in Bayelsa State during the 2017-2018 outbreak in Nigeria.Method: A cross-sectional study was conducted between 20 October 2017 and 2 January 2019 among adult confirmed/probable HMPX cases. A questionnaire was used to collect data on the sexual history of participants, including sexual contact in relation to the first symptom, and high-risk behaviours (HRB) such as a history of condomless casual sex, multiple sexual partners, and transactional sex.Results: Of 21 patients, 16 (76.2%) gave consent to participate in the study: age range of 22-43 years, 75% males, three (18.8%) HIV-1 positive, and 13 (81.2%) with genital ulcers. Nine (56.2%) of participants reported HRB, and all were male heterosexuals. Eight of the 16 participants (50%) reported having sex within a month before their first symptom, and five (62.5%) of this number reported HRB. There were two cases of sex with a partner with a non-genital rash, and a spouse who developed a vulval ulcer four days after sex with her husband.Conclusion: Our results support the role of sexual contact in the transmission of monkeypox among some confirmed cases from Nigeria. However, future elaborate studies are required to confirm if sexual behaviour and sexual transmission are associated with HMPX in Nigeria.
Collapse
Affiliation(s)
- Dimie Ogoina
- Infectious Diseases Unit, Department of Internal Medicine, 146956Niger Delta University/Niger Delta University Teaching Hospital, Amassoma, Nigeria
| | | |
Collapse
|
8
|
Ogoina D, Mohammed A, Yinka-Ogunleye A, Ihekweazu C. A case of suicide during the 2017 monkeypox outbreak in Nigeria. IJID Reg 2022; 3:226-227. [PMID: 35755463 PMCID: PMC9216383 DOI: 10.1016/j.ijregi.2022.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 12/23/2022]
Abstract
We report a case of suicide in a 34-year-old businessman who was admitted to an isolation facility in a tertiary hospital during the 2017/2018 monkeypox outbreak in Nigeria. We describe the possible psychosocial factors associated with suicide and highlight the challenges faced and lessons learnt in the management of the case. To our knowledge, this is the first reported case of suicide linked to human monkeypox.
Collapse
Affiliation(s)
- Dimie Ogoina
- Niger Delta University/Niger Delta University Teaching Hospital, Yenagoa, Bayelsa, Nigeria
- Corresponding author: Dimie Ogoina, Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University/Niger Delta University Teaching Hospital, Yenagoa PMB 100, Bayelsa, Nigeria, Tel: +2348034510717.
| | - Abdulaziz Mohammed
- Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | | |
Collapse
|
9
|
Mauldin MR, McCollum AM, Nakazawa YJ, Mandra A, Whitehouse ER, Davidson W, Zhao H, Gao J, Li Y, Doty J, Yinka-Ogunleye A, Akinpelu A, Aruna O, Naidoo D, Lewandowski K, Afrough B, Graham V, Aarons E, Hewson R, Vipond R, Dunning J, Chand M, Brown C, Cohen-Gihon I, Erez N, Shifman O, Israeli O, Sharon M, Schwartz E, Beth-Din A, Zvi A, Mak TM, Ng YK, Cui L, Lin RTP, Olson VA, Brooks T, Paran N, Ihekweazu C, Reynolds MG. Exportation of Monkeypox Virus From the African Continent. J Infect Dis 2022; 225:1367-1376. [PMID: 32880628 PMCID: PMC9016419 DOI: 10.1093/infdis/jiaa559] [Citation(s) in RCA: 168] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The largest West African monkeypox outbreak began September 2017, in Nigeria. Four individuals traveling from Nigeria to the United Kingdom (n = 2), Israel (n = 1), and Singapore (n = 1) became the first human monkeypox cases exported from Africa, and a related nosocomial transmission event in the United Kingdom became the first confirmed human-to-human monkeypox transmission event outside of Africa. METHODS Epidemiological and molecular data for exported and Nigerian cases were analyzed jointly to better understand the exportations in the temporal and geographic context of the outbreak. RESULTS Isolates from all travelers and a Bayelsa case shared a most recent common ancestor and traveled to Bayelsa, Delta, or Rivers states. Genetic variation for this cluster was lower than would be expected from a random sampling of genomes from this outbreak, but data did not support direct links between travelers. CONCLUSIONS Monophyly of exportation cases and the Bayelsa sample, along with the intermediate levels of genetic variation, suggest a small pool of related isolates is the likely source for the exported infections. This may be the result of the level of genetic variation present in monkeypox isolates circulating within the contiguous region of Bayelsa, Delta, and Rivers states, or another more restricted, yet unidentified source pool.
Collapse
Affiliation(s)
- Matthew R Mauldin
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrea M McCollum
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yoshinori J Nakazawa
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anna Mandra
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin R Whitehouse
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Whitni Davidson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hui Zhao
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jinxin Gao
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yu Li
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey Doty
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Olusola Aruna
- International Health Regulations Strengthening Project, Global Public Health, Public Health England, London, United Kingdom
| | - Dhamari Naidoo
- World Health Organization Country Office, Abuja, Nigeria
| | | | | | | | - Emma Aarons
- Public Health England, London, United Kingdom
| | | | | | | | - Meera Chand
- Public Health England, London, United Kingdom
| | - Colin Brown
- Public Health England, London, United Kingdom
| | - Inbar Cohen-Gihon
- Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Noam Erez
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Ohad Shifman
- Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Ofir Israeli
- Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Melamed Sharon
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Eli Schwartz
- Institute of Tropical Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Beth-Din
- Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Anat Zvi
- Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Tze Minn Mak
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Yi Kai Ng
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Lin Cui
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Raymond T P Lin
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Victoria A Olson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tim Brooks
- Public Health England, London, United Kingdom
| | - Nir Paran
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | | | - Mary G Reynolds
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
10
|
Angell B, Sanuade O, Adetifa IMO, Okeke IN, Adamu AL, Aliyu MH, Ameh EA, Kyari F, Gadanya MA, Mabayoje DA, Yinka-Ogunleye A, Oni T, Jalo RI, Tsiga-Ahmed FI, Dalglish SL, Abimbola S, Colbourn T, Onwujekwe O, Owoaje ET, Aliyu G, Aliyu SH, Archibong B, Ezeh A, Ihekweazu C, Iliyasu Z, Obaro S, Obadare EB, Okonofua F, Pate M, Salako BL, Zanna FH, Glenn S, Walker A, Ezalarab M, Naghavi M, Abubakar I. Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study. Lancet 2022; 399:1117-1129. [PMID: 35303469 PMCID: PMC8943279 DOI: 10.1016/s0140-6736(21)02722-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Population-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries. METHODS In this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository. FINDINGS Between 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2-66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0-9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9-6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1-3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7-2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians. INTERPRETATION Health outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health. FUNDING The Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Blake Angell
- UCL Institute for Global Health, University College London, London, UK; The George Institute for Global Health, University of New South Wales, Sydney, Sydney, NSW, Australia
| | - Olutobi Sanuade
- UCL Institute for Global Health, University College London, London, UK; Center for Global Cardiovascular Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ifedayo M O Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Epidemiology and Demography, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Aishatu Lawal Adamu
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Epidemiology and Demography, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Fatima Kyari
- College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Diana A Mabayoje
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Adesola Yinka-Ogunleye
- UCL Institute for Global Health, University College London, London, UK; Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rabiu Ibrahim Jalo
- Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Fatimah I Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sarah L Dalglish
- UCL Institute for Global Health, University College London, London, UK
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Tim Colbourn
- UCL Institute for Global Health, University College London, London, UK
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Eme Theodora Owoaje
- Department of Community Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Sani H Aliyu
- Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Stephen Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, Nigeria; University of Medical Sciences, Ondo City, Nigeria
| | - Muhammed Pate
- Health, Nutrition, and Population Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington, DC, USA; Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | | | | | - Scott Glenn
- Institute for Health Metrics and Evaluation, University of Medicine Washington, Seattle, WA, USA
| | - Ally Walker
- Institute for Health Metrics and Evaluation, University of Medicine Washington, Seattle, WA, USA
| | - Maha Ezalarab
- Institute for Health Metrics and Evaluation, University of Medicine Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Medicine Washington, Seattle, WA, USA
| | - Ibrahim Abubakar
- UCL Institute for Global Health, University College London, London, UK.
| |
Collapse
|
11
|
Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, Adetifa IMO, Colbourn T, Ogunlesi AO, Onwujekwe O, Owoaje ET, Okeke IN, Adeyemo A, Aliyu G, Aliyu MH, Aliyu SH, Ameh EA, Archibong B, Ezeh A, Gadanya MA, Ihekweazu C, Ihekweazu V, Iliyasu Z, Kwaku Chiroma A, Mabayoje DA, Nasir Sambo M, Obaro S, Yinka-Ogunleye A, Okonofua F, Oni T, Onyimadu O, Pate MA, Salako BL, Shuaib F, Tsiga-Ahmed F, Zanna FH. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet 2022; 399:1155-1200. [PMID: 35303470 PMCID: PMC8943278 DOI: 10.1016/s0140-6736(21)02488-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Blake Angell
- UCL Institute for Global Health, London, UK; The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Olutobi Sanuade
- UCL Institute for Global Health, London, UK; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Aishatu Lawal Adamu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ifedayo M O Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sani Hussaini Aliyu
- Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Belinda Archibong
- Department of Economics, Barnard College, Columbia University, New York, NY, USA
| | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | | | | | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Aminatu Kwaku Chiroma
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Diana A Mabayoje
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA; International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | | | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria; University of Medical Sciences, Ondo City, Nigeria
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Muhammad Ali Pate
- Health, Nutrition and Population (HNP) Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington DC, WA, USA; Harvard T Chan School of Public Health, Boston, MA, USA
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Fatimah Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | | |
Collapse
|
12
|
Arruda LB, Haider N, Olayemi A, Simons D, Ehichioya D, Yinka-Ogunleye A, Ansumana R, Thomason MJ, Asogun D, Ihekweazu C, Fichet-Calvet E, Kock RA. The niche of One Health approaches in Lassa fever surveillance and control. Ann Clin Microbiol Antimicrob 2021; 20:29. [PMID: 33894784 PMCID: PMC8067790 DOI: 10.1186/s12941-021-00431-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/12/2021] [Indexed: 12/20/2022] Open
Abstract
Lassa fever (LF), a zoonotic illness, represents a public health burden in West African countries where the Lassa virus (LASV) circulates among rodents. Human exposure hinges significantly on LASV ecology, which is in turn shaped by various parameters such as weather seasonality and even virus and rodent-host genetics. Furthermore, human behaviour, despite playing a key role in the zoonotic nature of the disease, critically affects either the spread or control of human-to-human transmission. Previous estimations on LF burden date from the 80s and it is unclear how the population expansion and the improvement on diagnostics and surveillance methods have affected such predictions. Although recent data have contributed to the awareness of epidemics, the real impact of LF in West African communities will only be possible with the intensification of interdisciplinary efforts in research and public health approaches. This review discusses the causes and consequences of LF from a One Health perspective, and how the application of this concept can improve the surveillance and control of this disease in West Africa.
Collapse
Affiliation(s)
- Liã Bárbara Arruda
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK.
| | - Najmul Haider
- The Royal Veterinary College, University of London, Hatfield, UK
| | - Ayodeji Olayemi
- Natural History Museum, Obafemi Awolowo University, Ile Ife, Nigeria
| | - David Simons
- The Royal Veterinary College, University of London, Hatfield, UK
| | - Deborah Ehichioya
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria.,Department of Microbiology, Ambrose Alli University, Ekpoma, Nigeria
| | | | - Rashid Ansumana
- School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Margaret J Thomason
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Danny Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | | | | | - Richard A Kock
- The Royal Veterinary College, University of London, Hatfield, UK
| |
Collapse
|
13
|
Dan-Nwafor C, Ochu CL, Elimian K, Oladejo J, Ilori E, Umeokonkwo C, Steinhardt L, Igumbor E, Wagai J, Okwor T, Aderinola O, Mba N, Hassan A, Dalhat M, Jinadu K, Badaru S, Arinze C, Jafiya A, Disu Y, Saleh F, Abubakar A, Obiekea C, Yinka-Ogunleye A, Naidoo D, Namara G, Muhammad S, Ipadeola O, Ofoegbunam C, Ogunbode O, Akatobi C, Alagi M, Yashe R, Crawford E, Okunromade O, Aniaku E, Mba S, Agogo E, Olugbile M, Eneh C, Ahumibe A, Nwachukwu W, Ibekwe P, Adejoro OO, Ukponu W, Olayinka A, Okudo I, Aruna O, Yusuf F, Alex-Okoh M, Fawole T, Alaka A, Muntari H, Yennan S, Atteh R, Balogun M, Waziri N, Ogunniyi A, Ebhodaghe B, Lokossou V, Abudulaziz M, Adebiyi B, Abayomi A, Abudus-Salam I, Omilabu S, Lawal L, Kawu M, Muhammad B, Tsanyawa A, Soyinka F, Coker T, Alabi O, Joannis T, Dalhatu I, Swaminathan M, Salako B, Abubakar I, Fiona B, Nguku P, Aliyu SH, Ihekweazu C. Nigeria's public health response to the COVID-19 pandemic: January to May 2020. J Glob Health 2020; 10:020399. [PMID: 33274062 PMCID: PMC7696244 DOI: 10.7189/jogh.10.020399] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | | | - John Oladejo
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Chukwuma Umeokonkwo
- African Field Epidemiology Network, Abuja, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Laura Steinhardt
- Center for Global Health, Centers for Disease Control and Prevention, FCT Abuja, Nigeria
| | - Ehimario Igumbor
- Nigeria Centre for Disease Control, Abuja, Nigeria
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - John Wagai
- World Health Organisation, Abuja, Nigeria
| | - Tochi Okwor
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - Nwando Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Assad Hassan
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Mahmood Dalhat
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Resolve to Save Lives Resolve to Save Lives (Vital Strategies), Abuja, Nigeria
| | - Kola Jinadu
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | - Yahya Disu
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Fatima Saleh
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | | | | | - Saleh Muhammad
- Center for Global Health, Centers for Disease Control and Prevention, FCT Abuja, Nigeria
| | - Oladipupo Ipadeola
- Center for Global Health, Centers for Disease Control and Prevention, FCT Abuja, Nigeria
| | | | | | | | - Matthias Alagi
- Center for Global Health, Centers for Disease Control and Prevention, FCT Abuja, Nigeria
| | | | | | | | | | - Sandra Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Emmanuel Agogo
- Resolve to Save Lives Resolve to Save Lives (Vital Strategies), Abuja, Nigeria
| | | | - Chibuzo Eneh
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | - Ope-Oluwa Adejoro
- Tony Blair Institute, Tony Blair Institute for Global Change, London, UK
| | - Winifred Ukponu
- George Town University Center for Global Health Practice and Impact, Abuja, Nigeria
| | | | | | - Olusola Aruna
- Public Health England International Health Regulations (IHR) Strengthening Project, British High Commission, Abuja, Nigeria
| | - Fatima Yusuf
- Nigeria Port Health Services, Federal Ministry of Health Abuja, Nigeria
| | | | | | - Akeem Alaka
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | - Rhoda Atteh
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | | | - Virgile Lokossou
- ECOWAS Regional Center for Disease Surveillance and Control, Abuja-Nigeria
| | - Mohammed Abudulaziz
- Africa Centers for Disease Control and Prevention, African Union Commission, Addis Ababa Ethiopia
| | - Bimpe Adebiyi
- Department of Hospital Services, Federal Ministry of Health Abuja, Federal Secretariat Abuja, Nigeria
| | - Akin Abayomi
- Lagos State Ministry of Health Ikeja, Lagos, Nigeria
| | | | - Sunday Omilabu
- College of Medicine, University of Lagos Teaching Hospital Lagos, Nigeria
| | - Lukman Lawal
- Health and Human Services Secretariat Federal, Capital Territory Administration, Abuja, Nigeria
| | - Mohammed Kawu
- Health and Human Services Secretariat Federal, Capital Territory Administration, Abuja, Nigeria
| | | | | | | | - Tomi Coker
- Ogun State Ministry of Health Abeokuta, Nigeria
| | - Olaniran Alabi
- Federal Ministry of Agriculture and Rural Development, Federal Secretariat Abuja, Nigeria
| | - Tony Joannis
- National Veterinary Research Institute Vom, Plateau State, Nigeria
| | - Ibrahim Dalhatu
- Center for Global Health, Centers for Disease Control and Prevention, FCT Abuja, Nigeria
| | - Mahesh Swaminathan
- Center for Global Health, Centers for Disease Control and Prevention, FCT Abuja, Nigeria
| | | | - Ibrahim Abubakar
- Institute of Global Health, University College London, London, UK
| | | | | | - Sani H Aliyu
- Department of Infectious Diseases, Cambridge University Hospitals, Cambridge, UK
| | | |
Collapse
|
14
|
Ogoina D, Iroezindu M, James HI, Oladokun R, Yinka-Ogunleye A, Wakama P, Otike-Odibi B, Usman LM, Obazee E, Aruna O, Ihekweazu C. Clinical Course and Outcome of Human Monkeypox in Nigeria. Clin Infect Dis 2020; 71:e210-e214. [PMID: 32052029 DOI: 10.1093/cid/ciaa143] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/10/2020] [Indexed: 11/14/2022] Open
Abstract
In a retrospective review of hospital records of 40 human monkeypox cases from Nigeria, the majority developed fever and self-limiting vesiculopustular skin eruptions. Five deaths were reported. Compared to human immunodeficiency virus (HIV)-negative cases, HIV type 1-coinfected cases had more prolonged illness, larger lesions, and higher rates of both secondary bacterial skin infections and genital ulcers.
Collapse
Affiliation(s)
- Dimie Ogoina
- Infectious Disease Unit, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa, Nigeria
| | - Michael Iroezindu
- Infectious Disease Unit, Federal Medical Centre Owerri/University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Hendris Izibewule James
- Infectious Disease Unit, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa, Nigeria
| | - Regina Oladokun
- Paediatric Infectious Disease Unit, University College Hospital, Ibadan, Oyo State, Nigeria
| | | | - Paul Wakama
- Nigerian Prison Services, Port Harcourt, Rivers State, Nigeria
| | - Bolaji Otike-Odibi
- Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | | | - Emmanuel Obazee
- Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Olusola Aruna
- Global Public Health Department, Public Health England, London, United Kingdom
| | - Chikwe Ihekweazu
- Nigerian Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| |
Collapse
|
15
|
Durski KN, Naidoo D, Singaravelu S, Shah AA, Djingarey MH, Formenty P, Ihekweazu C, Banjura J, Kebela B, Yinka-Ogunleye A, Fall IS, Eteng W, Vandi M, Keimbe C, Abubakar A, Mohammed A, Williams DE, Lamunu M, Briand S, Changa Changa JC, Minkoulou E, Jernigan D, Lubambo D, Khalakdina A, Mamadu I, Talisuna A, Mbule Kadiobo A, Jambai A, Aylward B, Osterholm M. Systems thinking for health emergencies: use of process mapping during outbreak response. BMJ Glob Health 2020; 5:bmjgh-2020-003901. [PMID: 33033054 PMCID: PMC7545503 DOI: 10.1136/bmjgh-2020-003901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 11/28/2022] Open
Abstract
Process mapping is a systems thinking approach used to understand, analyse and optimise processes within complex systems. We aim to demonstrate how this methodology can be applied during disease outbreaks to strengthen response and health systems. Process mapping exercises were conducted during three unique emerging disease outbreak contexts with different: mode of transmission, size, and health system infrastructure. System functioning improved considerably in each country. In Sierra Leone, laboratory testing was accelerated from 6 days to within 24 hours. In the Democratic Republic of Congo, time to suspected case notification reduced from 7 to 3 days. In Nigeria, key data reached the national level in 48 hours instead of 5 days. Our research shows that despite the chaos and complexities associated with emerging pathogen outbreaks, the implementation of a process mapping exercise can address immediate response priorities while simultaneously strengthening components of a health system.
Collapse
Affiliation(s)
- Kara N Durski
- World Health Organization, Geneve, Switzerland
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | | | | | | | | | | | | | - James Banjura
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Benoit Kebela
- Ministry of Health Democratic Republic of Congo, Kinshasa, Democratic Republic of Congo
| | | | | | - Womi Eteng
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Mohamed Vandi
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Charles Keimbe
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Abulazeez Mohammed
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Dan Jernigan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Demba Lubambo
- World Health Organization, Brazzaville, Republic of Congo
| | | | | | | | | | - Amara Jambai
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Michael Osterholm
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| |
Collapse
|
16
|
Elimian KO, Ochu CL, Ilori E, Oladejo J, Igumbor E, Steinhardt L, Wagai J, Arinze C, Ukponu W, Obiekea C, Aderinola O, Crawford E, Olayinka A, Dan-Nwafor C, Okwor T, Disu Y, Yinka-Ogunleye A, Kanu NE, Olawepo OA, Aruna O, Michael CA, Dunkwu L, Ipadeola O, Naidoo D, Umeokonkwo CD, Matthias A, Okunromade O, Badaru S, Jinadu A, Ogunbode O, Egwuenu A, Jafiya A, Dalhat M, Saleh F, Ebhodaghe GB, Ahumibe A, Yashe RU, Atteh R, Nwachukwu WE, Ezeokafor C, Olaleye D, Habib Z, Abdus-Salam I, Pembi E, John D, Okhuarobo UJ, Assad H, Gandi Y, Muhammad B, Nwagwogu C, Nwadiuto I, Sulaiman K, Iwuji I, Okeji A, Thliza S, Fagbemi S, Usman R, Mohammed AA, Adeola-Musa O, Ishaka M, Aketemo U, Kamaldeen K, Obagha CE, Akinyode AO, Nguku P, Mba N, Ihekweazu C. Descriptive epidemiology of coronavirus disease 2019 in Nigeria, 27 February-6 June 2020. Epidemiol Infect 2020; 148:e208. [PMID: 32912370 PMCID: PMC7506173 DOI: 10.1017/s095026882000206x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/18/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023] Open
Abstract
The objective of this study was to describe the epidemiology of COVID-19 in Nigeria with a view of generating evidence to enhance planning and response strategies. A national surveillance dataset between 27 February and 6 June 2020 was retrospectively analysed, with confirmatory testing for COVID-19 done by real-time polymerase chain reaction (RT-PCR). The primary outcomes were cumulative incidence (CI) and case fatality (CF). A total of 40 926 persons (67% of total 60 839) had complete records of RT-PCR test across 35 states and the Federal Capital Territory, 12 289 (30.0%) of whom were confirmed COVID-19 cases. Of those confirmed cases, 3467 (28.2%) had complete records of clinical outcome (alive or dead), 342 (9.9%) of which died. The overall CI and CF were 5.6 per 100 000 population and 2.8%, respectively. The highest proportion of COVID-19 cases and deaths were recorded in persons aged 31-40 years (25.5%) and 61-70 years (26.6%), respectively; and males accounted for a higher proportion of confirmed cases (65.8%) and deaths (79.0%). Sixty-six per cent of confirmed COVID-19 cases were asymptomatic at diagnosis. In conclusion, this paper has provided an insight into the early epidemiology of COVID-19 in Nigeria, which could be useful for contextualising public health planning.
Collapse
Affiliation(s)
- K. O. Elimian
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Edo State, Nigeria
- Nigeria COVID-19 Research Consortium, Abuja, Nigeria
| | - C. L. Ochu
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- Nigeria COVID-19 Research Consortium, Abuja, Nigeria
| | - E. Ilori
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - J. Oladejo
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - E. Igumbor
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- Nigeria COVID-19 Research Consortium, Abuja, Nigeria
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - L. Steinhardt
- Centers for Disease Control and Prevention, U.S. Embassy Abuja, Abuja, Nigeria
| | - J. Wagai
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - C. Arinze
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - W. Ukponu
- Georgetown University, Abuja, Nigeria
| | - C. Obiekea
- Public Health Laboratory Services, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - O. Aderinola
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - E. Crawford
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - A. Olayinka
- Nigeria COVID-19 Research Consortium, Abuja, Nigeria
- World Health Organization, Abuja, Nigeria
- Ahmadu Bello University, Zaria, Nigeria
| | - C. Dan-Nwafor
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - T. Okwor
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Y. Disu
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - A. Yinka-Ogunleye
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - N. E. Kanu
- African Field Epidemiology Network, Abuja, Nigeria
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | | | - O. Aruna
- Public Health England's International Health Regulations Strengthening Project, Abuja, Nigeria
| | | | - L. Dunkwu
- Tony Blair Institute for Global Change, Abuja, Nigeria
| | - O. Ipadeola
- Centers for Disease Control and Prevention, U.S. Embassy Abuja, Abuja, Nigeria
- University of Ilorin, Ilorin, Nigeria
| | - D. Naidoo
- World Health Organization, Abuja, Nigeria
| | - C. D. Umeokonkwo
- African Field Epidemiology Network, Abuja, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - A. Matthias
- Centers for Disease Control and Prevention, U.S. Embassy Abuja, Abuja, Nigeria
| | - O. Okunromade
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - S. Badaru
- Public Health Laboratory Services, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - A. Jinadu
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - O. Ogunbode
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - A. Egwuenu
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - A. Jafiya
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - M. Dalhat
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- Resolve to Save Lives, Abuja, Nigeria
| | - F. Saleh
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - G. B. Ebhodaghe
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - A. Ahumibe
- Public Health Laboratory Services, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - R. U. Yashe
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - R. Atteh
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - W. E. Nwachukwu
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - C. Ezeokafor
- Nigeria COVID-19 Research Consortium, Abuja, Nigeria
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - D. Olaleye
- Nigeria COVID-19 Research Consortium, Abuja, Nigeria
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Z. Habib
- Nigeria COVID-19 Research Consortium, Abuja, Nigeria
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | - E. Pembi
- Ministry of Health and Human Services, Adamawa State, Nigeria
| | - D. John
- Department of Public Health, Health and Human Services Secretariat, FCT, Abuja, Nigeria
| | | | - H. Assad
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
- Ministry of Health, Kebbi State, Nigeria
| | - Y. Gandi
- Department of Disease Control and Immunisation, Bauchi State Ministry of Health, Bauchi, Nigeria
| | - B. Muhammad
- Department of Public Health, Kano State Ministry of Health, Kano State, Nigeria
| | - C. Nwagwogu
- Department of Public Health, Abia State Ministry of Health, Abia State, Nigeria
| | - I. Nwadiuto
- Department of Public Health, Rivers State Ministry of Health, Rivers State, Nigeria
| | - K. Sulaiman
- Department of Epidemiology and Disease Control, Katsina State Ministry of Health, Katsina, Nigeria
| | - I. Iwuji
- Epidemiology Unit, Department of Public Health, Ministry of Health, Bayelsa State, Nigeria
| | - A. Okeji
- Epidemiology Unit, Department of Public Health, Ministry of Health, Imo State, Nigeria
| | - S. Thliza
- Epidemiology Unit, Department of Public Health, Ministry of Health, Borno State, Nigeria
| | - S. Fagbemi
- Department of Epidemiology and Disease Control, Ministry of Health, Ondo State, Nigeria
| | - R. Usman
- Department of Public Health, Zamfara State Ministry of Health, Zamfara State, Nigeria
| | - A. A. Mohammed
- Department of Public Health Services, Ministry of Health, Sokoto State, Nigeria
| | - O. Adeola-Musa
- Department of Public Health, Ministry of Health, Osun State, Nigeria
| | - M. Ishaka
- Department of Public Health, Yobe State Primary Healthcare Management Board, Yobe State, Nigeria
| | - U. Aketemo
- Department of Public Health, Taraba State Ministry of Health, Taraba State, Nigeria
| | - K. Kamaldeen
- Department of Public Health, Kwara State Ministry of Health, Kwara State, Nigeria
| | - C. E. Obagha
- Anambra State Ministry of Health, Anambra State, Nigeria
| | - A. O. Akinyode
- Directorate of Public Health, Oyo State Ministry of Health, Oyo State, Nigeria
| | - P. Nguku
- African Field Epidemiology Network, Abuja, Nigeria
| | - N. Mba
- Public Health Laboratory Services, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - C. Ihekweazu
- Office of the Director General, Nigeria Centre for Disease Control, Abuja, Nigeria
| |
Collapse
|
17
|
Ihekweazu C, Yinka-Ogunleye A, Lule S, Ibrahim A. Importance of epidemiological research of monkeypox: is incidence increasing? Expert Rev Anti Infect Ther 2020; 18:389-392. [PMID: 32096659 PMCID: PMC9491128 DOI: 10.1080/14787210.2020.1735361] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/24/2020] [Indexed: 12/04/2022]
Affiliation(s)
| | | | - Swaib Lule
- Institute for Global Health, University College London, London, UK
| | - Abubakar Ibrahim
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
18
|
Silenou BC, Tom-Aba D, Adeoye O, Arinze CC, Oyiri F, Suleman AK, Yinka-Ogunleye A, Dörrbecker J, Ihekweazu C, Krause G. Use of Surveillance Outbreak Response Management and Analysis System for Human Monkeypox Outbreak, Nigeria, 2017-2019. Emerg Infect Dis 2020; 26:345-349. [PMID: 31961314 PMCID: PMC6986835 DOI: 10.3201/eid2602.191139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In November 2017, the mobile digital Surveillance Outbreak Response Management and Analysis System was deployed in 30 districts in Nigeria in response to an outbreak of monkeypox. Adaptation and activation of the system took 14 days, and its use improved timeliness, completeness, and overall capacity of the response.
Collapse
|
19
|
Petersen E, Kantele A, Koopmans M, Asogun D, Yinka-Ogunleye A, Ihekweazu C, Zumla A. Human Monkeypox: Epidemiologic and Clinical Characteristics, Diagnosis, and Prevention. Infect Dis Clin North Am 2019; 33:1027-1043. [PMID: 30981594 PMCID: PMC9533922 DOI: 10.1016/j.idc.2019.03.001] [Citation(s) in RCA: 314] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recently, concern has been raised about the emergence of human monkeypox virus and the occasionally severe clinical presentation bearing resemblance to that of smallpox. In 2018 3 patients in the UK were diagnosed with monkeypox, and the frequency and geographic distribution of cases across West and Central Africa have increased in recent years. In Nigeria, most monkeypox patients are aged <40 years and lack cross-protective immunity because they were born after discontinuation of the smallpox eradication campaign. This article reviews the epidemiology, clinical features, and management of monkeypox and discusses its growing public health threat in this context.
Collapse
Affiliation(s)
- Eskild Petersen
- Institute of Clinical Medicine, University of Aarhus, Palle Juul-Jensens Boulevard 82, Aarhus N DK-8200, Denmark; The Royal Hospital, Muscat, Oman; European Society for Clinical Microbiology and Infectious Diseases, Task Force for Emerging Infections, Basel, Switzerland.
| | - Anu Kantele
- Inflammation Center, Helsinki University Hospital and Helsinki University, Stenbäckinkatu 9, PO BOX 100, Helsinki FI-00029 HUS, Finland
| | - Marion Koopmans
- Viroscience Department, Erasmus Medical Centre, Postbus 2040, Rotterdam 3000 CA, the Netherlands
| | - Danny Asogun
- Department of Public Health, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria; Department of Public Health, and Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | | | - Chikwe Ihekweazu
- Nigeria Centre for Disease Control, Plot 801, Ebitu Ukiwe Street, Jabi, Abuja, Nigeria
| | - Alimuddin Zumla
- Division of Infection and Immunity, Center for Clinical Microbiology, University College London, The National Institute of Health Research Biomedical Research Centre at UCL Hospitals, Gower Street, London WC1E 6BT, UK
| |
Collapse
|
20
|
Oyebanji O, Ofonagoro U, Akande O, Nsofor I, Ukenedo C, Mohammed TB, Anueyiagu C, Agenyi J, Yinka-Ogunleye A, Ihekweazu C. Lay media reporting of monkeypox in Nigeria. BMJ Glob Health 2019; 4:e002019. [PMID: 31799006 PMCID: PMC6861118 DOI: 10.1136/bmjgh-2019-002019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/28/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Oyeronke Oyebanji
- Office of the Director General, Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - Oluwatosin Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Chika Ukenedo
- University of Maryland, Baltimore, Baltimore, Maryland, USA
| | | | - Chimezie Anueyiagu
- Department of Prevention and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Jeremiah Agenyi
- Office of the Director General, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Adesola Yinka-Ogunleye
- Department of Disease Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Chikwe Ihekweazu
- Office of the Director General, Nigeria Centre for Disease Control, Abuja, Nigeria
| |
Collapse
|
21
|
Yinka-Ogunleye A, Aruna O, Dalhat M, Ogoina D, McCollum A, Disu Y, Mamadu I, Akinpelu A, Ahmad A, Burga J, Ndoreraho A, Nkunzimana E, Manneh L, Mohammed A, Adeoye O, Tom-Aba D, Silenou B, Ipadeola O, Saleh M, Adeyemo A, Nwadiutor I, Aworabhi N, Uke P, John D, Wakama P, Reynolds M, Mauldin MR, Doty J, Wilkins K, Musa J, Khalakdina A, Adedeji A, Mba N, Ojo O, Krause G, Ihekweazu C. Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report. Lancet Infect Dis 2019; 19:872-879. [PMID: 31285143 PMCID: PMC9628943 DOI: 10.1016/s1473-3099(19)30294-4] [Citation(s) in RCA: 404] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/25/2019] [Accepted: 04/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND In September, 2017, human monkeypox re-emerged in Nigeria, 39 years after the last reported case. We aimed to describe the clinical and epidemiological features of the 2017-18 human monkeypox outbreak in Nigeria. METHODS We reviewed the epidemiological and clinical characteristics of cases of human monkeypox that occurred between Sept 22, 2017, and Sept 16, 2018. Data were collected with a standardised case investigation form, with a case definition of human monkeypox that was based on previously established guidelines. Diagnosis was confirmed by viral identification with real-time PCR and by detection of positive anti-orthopoxvirus IgM antibodies. Whole-genome sequencing was done for seven cases. Haplotype analysis results, genetic distance data, and epidemiological data were used to infer a likely series of events for potential human-to-human transmission of the west African clade of monkeypox virus. FINDINGS 122 confirmed or probable cases of human monkeypox were recorded in 17 states, including seven deaths (case fatality rate 6%). People infected with monkeypox virus were aged between 2 days and 50 years (median 29 years [IQR 14]), and 84 (69%) were male. All 122 patients had vesiculopustular rash, and fever, pruritus, headache, and lymphadenopathy were also common. The rash affected all parts of the body, with the face being most affected. The distribution of cases and contacts suggested both primary zoonotic and secondary human-to-human transmission. Two cases of health-care-associated infection were recorded. Genomic analysis suggested multiple introductions of the virus and a single introduction along with human-to-human transmission in a prison facility. INTERPRETATION This study describes the largest documented human outbreak of the west African clade of the monkeypox virus. Our results suggest endemicity of monkeypox virus in Nigeria, with some evidence of human-to-human transmission. Further studies are necessary to explore animal reservoirs and risk factors for transmission of the virus in Nigeria. FUNDING None.
Collapse
Affiliation(s)
| | - Olusola Aruna
- Nigeria Centre for Disease Control, Abuja, Nigeria; International Health Regulations Strengthening Programme in Nigeria, Public Health England, Abuja, Nigeria
| | | | - Dimie Ogoina
- Niger Delta University Teaching Hospital, Niger Delta University, Yenagoa, Nigeria
| | - Andrea McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yahyah Disu
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | - Adama Ahmad
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Joel Burga
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Adolphe Ndoreraho
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Edouard Nkunzimana
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Lamin Manneh
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | | | | | - Daniel Tom-Aba
- Helmholtz Centre for Infection Research, Braunschweig, Germany; German Centre for Infection Research, Braunschweig, Germany
| | - Bernard Silenou
- Helmholtz Centre for Infection Research, Braunschweig, Germany; German Centre for Infection Research, Braunschweig, Germany
| | - Oladipupo Ipadeola
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Muhammad Saleh
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Patience Uke
- Cross State Ministry of Health, Calabar, Nigeria
| | - Doris John
- Department of Health, Federal Capital Territory, Abuja, Nigeria
| | - Paul Wakama
- Nigeria Prison Services, Port Harcourt, Rivers State, Nigeria
| | - Mary Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew R Mauldin
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeffrey Doty
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kimberly Wilkins
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joy Musa
- University Of Maryland, Abuja, Nigeria
| | | | | | - Nwando Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Olubunmi Ojo
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Gerard Krause
- Helmholtz Centre for Infection Research, Braunschweig, Germany; German Centre for Infection Research, Braunschweig, Germany
| | | |
Collapse
|
22
|
Eteng WE, Mandra A, Doty J, Yinka-Ogunleye A, Aruna S, Reynolds MG, McCollum AM, Davidson W, Wilkins K, Saleh M, Ipadeola O, Manneh L, Anebonam U, Abdulkareem Z, Okoli N, Agenyi J, Dan-Nwafor C, Mahmodu I, Ihekweazu C. Notes from the Field: Responding to an Outbreak of Monkeypox Using the One Health Approach - Nigeria, 2017-2018. MMWR Morb Mortal Wkly Rep 2018; 67:1040-1041. [PMID: 30235181 PMCID: PMC6147416 DOI: 10.15585/mmwr.mm6737a5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
23
|
Yinka-Ogunleye A, Aruna O, Ogoina D, Aworabhi N, Eteng W, Badaru S, Mohammed A, Agenyi J, Etebu EN, Numbere TW, Ndoreraho A, Nkunzimana E, Disu Y, Dalhat M, Nguku P, Mohammed A, Saleh M, McCollum A, Wilkins K, Faye O, Sall A, Happi C, Mba N, Ojo O, Ihekweazu C. Reemergence of Human Monkeypox in Nigeria, 2017. Emerg Infect Dis 2018; 24:1149-1151. [PMID: 29619921 PMCID: PMC6004876 DOI: 10.3201/eid2406.180017] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
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.
Collapse
|