Towards a multi-lateral framework for cross-border surveillance and information sharing between Nigeria and neighbouring countries

Nigeria sits at the crossroads of West and Central Africa; two increasingly critical regions for global health security. To strengthen cross-border collaboration for health security between its neighbors from West and Central Africa, the Federal Ministry of Health, Nigeria through the public health authority at the Points of Entry-Port Health Services, led the design of a multi-lateral framework for cross-border collaboration between Nigeria, the Republic of Benin, the Republic of Chad, the Republic of Cameroon and the Republic of Niger. This framework provides a platform for agreeing on bilateral national and district-level infectious disease surveillance information sharing as well as laying the groundwork for expanded collaboration in incident reporting, joint investigation and response across borders.

Tetanus and Diphtheria Seroprotection among Children Younger Than 15 Years in Nigeria, 2018: Who Are the Unprotected Children?

Serological surveys provide an objective biological measure of population immunity, and tetanus serological surveys can also assess vaccination coverage. We undertook a national assessment of immunity to tetanus and diphtheria among Nigerian children aged <15 years using stored specimens collected during the 2018 Nigeria HIV/AIDS Indicator and Impact Survey, a national cross-sectional household-based survey. We used a validated multiplex bead assay to test for tetanus and diphtheria toxoid-antibodies. In total, 31,456 specimens were tested. Overall, 70.9% and 84.3% of children aged <15 years had at least minimal seroprotection (≥0.01 IU/mL) against tetanus and diphtheria, respectively. Seroprotection was lowest in the north west and north east zones. Factors associated with increased tetanus seroprotection included living in the southern geopolitical zones, urban residence, and higher wealth quintiles (p < 0.001). Full seroprotection (≥0.1 IU/mL) was the same for tetanus (42.2%) and diphtheria (41.7%), while long-term seroprotection (≥1 IU/mL) was 15.1% for tetanus and 6.0% for diphtheria. Full- and long-term seroprotection were higher in boys compared to girls (p < 0.001). Achieving high infant vaccination coverage by targeting specific geographic areas and socio-economic groups and introducing tetanus and diphtheria booster doses in childhood and adolescence are needed to achieve lifelong protection against tetanus and diphtheria and prevent maternal and neonatal tetanus.

How prepared is the world? Identifying weaknesses in existing assessment frameworks for global health security through a One Health approach

The COVID-19 pandemic has exposed faults in the way we assess preparedness and response capacities for public health emergencies. Existing frameworks are limited in scope, and do not sufficiently consider complex social, economic, political, regulatory, and ecological factors. One Health, through its focus on the links among humans, animals, and ecosystems, is a valuable approach through which existing assessment frameworks can be analysed and new ways forward proposed. Although in the past few years advances have been made in assessment tools such as the International Health Regulations Joint External Evaluation, a rapid and radical increase in ambition is required. To sufficiently account for the range of complex systems in which health emergencies occur, assessments should consider how problems are defined across stakeholders and the wider sociopolitical environments in which structures and institutions operate. Current frameworks do little to consider anthropogenic factors in disease emergence or address the full array of health security hazards across the social-ecological system. A complex and interdependent set of challenges threaten human, animal, and ecosystem health, and we cannot afford to overlook important contextual factors, or the determinants of these shared threats. Health security assessment frameworks should therefore ensure that the process undertaken to prioritise and build capacity adheres to core One Health principles and that interventions and outcomes are assessed in terms of added value, trade-offs, and cobenefits across human, animal, and environmental health systems.

Reviewing Health Security Capacities in Nigeria Using the Updated WHO Joint External Evaluation and WHO Benchmarks Tool: Experience from a Country-Led Self-Assessment Exercise

Across the world, the level of pandemic preparedness varies and no country is fully prepared to respond to all public health events. The International Health Regulations 2005 require state parties to develop core capacities to prevent, detect, and respond to public health events of international concern. In addition to annual self-assessment, these capacities are peer reviewed once every 5 years through the voluntary Joint External Evaluation (JEE). In this article, we share Nigeria's experience of conducting a country-led midterm self-assessment using a slightly modified application of the second edition of the World Health Organization (WHO) JEE and the new WHO benchmarks tool. Despite more stringent scoring criteria in the revised JEE tool, average scoring showed modest capacity improvements in 2019 compared with 2017. Of the 19 technical areas assessed, 11 improved, 5 did not change, and 3 had lower scores. No technical area attained the highest-level scoring of 5. Understanding the level of, and gaps in, pandemic preparedness enables state parties to develop plans to improve health security; the outcome of the assessment included the development of a 12-month operational plan. Countries need to intentionally invest in preparedness by using existing frameworks (eg, JEE) to better understand the status of their preparedness. This will ensure ownership of developed plans with shared responsibilities by all key stakeholders across all levels of government.

Emergency response to a cluster of suspected food-borne botulism in Abuja, Nigeria: challenges with diagnosis and treatment in a resource-poor setting

Food-borne botulism is a rare, acute and potentially fatal neurologic disorder that results from ingestion of food contaminated by botulinum toxin released from the anaerobic, spore-forming, gram-positive bacterium Clostridium botulinum. We reported an unusual cluster of botulism outbreak with high case fatality affecting a family following ingestion of home-made fish. A suspected outbreak of botulism affecting three patients in a family of six was reported to the Nigeria Centre for Disease Control. A rapid response team investigated by line-listing all the family members, interviewed extended family members, caregivers, clinicians, and nurses to collect socio-demographic and clinico epidemiological information using a semi-structured questionnaires. We collected blood from patients and food samples and locally made drink from the family home for laboratory testing. All family members ingested the same home-made food within the 48hrs before onset of symptoms in the index case. The clinical presentation of the three affected cases (AR=50.0%) was consistent with botulinum poisoning. Two of the affected cases died (CFR=66.7%) within 48hrs of admission, before antitoxin was made available. The third case had a milder presentation and survived, after administration of appropriate antitoxin. The remaining three children developed no symptoms. None of the samples cultured Clostridium botulinum. The blood samples were negative for mouse lethality test. Our report describes the challenges of diagnosis and management of rare emerging infectious disease outbreaks in resource-constrained settings.

Descriptive epidemiology of coronavirus disease 2019 in Nigeria, 27 February-6 June 2020

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.

Clinical presentation, case management and outcomes for the first 32 COVID-19 patients in Nigeria

INTRODUCTION

Success in curtailing the pandemic coronavirus disease (COVID-19) depends largely on a sound understanding of the epidemiologic and clinical profile of cases in a population as well as the case management approach. This study documents the presenting characteristics, treatment modalities and outcomes of the first 32 COVID-19 patients in Nigeria.

METHODS

This retrospective study used medical records of the first 32 patients admitted and discharged from the Mainland Hospital, Lagos State, southwest Nigeria between February 27 and April 6, 2020. The outcomes of interest were death, promptness of admission process and duration of hospitalization.

RESULTS

The mean age of the patients was 38.1 years (SD: 15.5) and 66% were male. Three-quarters (75%) of the patients presented in moderately severe condition while 16% were asymptomatic. The most common presenting symptoms were fever (59%) and dry cough (44%). The mean time between a positive test result and admission was 1.63 days (SD: 1.31). Almost all (97%) the patients were treated with lopinavir-ritonavir with no recorded death. The median duration of hospital stay was 12 days (IQR: 9-13.5).

CONCLUSION

In this preliminary analysis of the first COVID-19 cases in Nigeria, clinical presentation was mild to moderate with no mortality. Processes to improve promptness of admission and reduce hospital stay are required to enhance the response to COVID-19 in Nigeria.

Burden of measles in Nigeria: a five-year review of casebased surveillance data, 2012-2016

Introduction

measles is a vaccine preventable, highly transmissible viral infection that affects mostly children under five years. We reviewed surveillance data on measles from Nigeria over a five-year period to highlights its burden and make recommendations for improvements.

Methods

we conducted a secondary data analysis of measles specific Integrated Disease Surveillance and Response (IDSR) records of all states in Nigeria over a five-year period.

Results

a total of 131,732 cases were recorded between January 2012 and September 2016. Most cases 57,892 (43.95%) were recorded in 2013 while the least 11,061 (8.4%) were recorded in 2012. A total of 817 deaths were recorded, with a case fatality rate (CFR) of 0.62%. The highest CFR (1.43%) was recorded in 2012 while the least CFR (0.44%) was recorded in 2016. Only 8,916 (6.7%) cases were confirmed by laboratory tests. The trend of measles cases followed the same pattern throughout the years under review, with cases peaking at March, then gradually reducing to lowest level at June, which was maintained throughout the rest of the year. States in northern region of Nigeria recorded the highest attack rate (Yobe: 480.29 cases per 100,000 population, Sokoto: 284.63 cases per 100,000 population and Katsina: 246.07 cases per 100,000 population) compared to States in the southern region (Rivers: 11.72 cases per 100,000 population and Akwa Ibom: 13.59 cases per 100,000 population). Conversely, States in the southern region recorded the highest CFR (Ebonyi: 13.43% and Rivers: 3.27%).

Conclusion

measles infection remains a burden especially in the northern region of Nigeria. Although measles fatalities declined over the years, laboratory confirmation was sub-optimal. We recommended improvement on routine immunization and strengthening of regional laboratories diagnostic capacities, for successful eradication of measles from Nigeria.