1
|
Ogoina D, Dalhat MM, Denue BA, Okowa M, Chika-Igwenyi NM, Yusuff HA, Christian UC, Adekanmbi O, Ojimba AO, Aremu JT, Habila KL, Oiwoh SO, Tobin EA, Johnson SM, Olaitan A, Onyeaghala C, Gomerep SS, Alasia D, Onukak AE, Mmerem J, Unigwe U, Falodun O, Kwaghe V, Awang SK, Sunday M, Maduka CJ, Na'uzo AM, Owhin SO, Mohammed AA, Adeiza MA. Clinical characteristics and predictors of human mpox outcome during the 2022 outbreak in Nigeria: a cohort study. Lancet Infect Dis 2023; 23:1418-1428. [PMID: 37625431 DOI: 10.1016/s1473-3099(23)00427-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Research from sub-Saharan Africa that contributes to our understanding of the 2022 mpox (formerly known as monkeypox) global outbreak is insufficient. Here, we describe the clinical presentation and predictors of severe disease among patients with mpox diagnosed between Feb 1, 2022, and Jan 30, 2023 in Nigeria. METHODS We did a cohort study among laboratory-confirmed and probable mpox cases seen in 22 mpox-treatment centres and outpatient clinics across Nigeria. All individuals with confirmed and probable mpox were eligible for inclusion. Exclusion criteria were individuals who could not be examined for clinical characterisation and those who had unknown mortality outcomes. Skin lesion swabs or crust samples were collected from each patient for mpox diagnosis by PCR. A structured questionnaire was used to document sociodemographic and clinical data, including HIV status, complications, and treatment outcomes from the time of diagnosis to discharge or death. Severe disease was defined as mpox associated with death or with a life-threatening complication. Two logistic regression models were used to identify clinical characteristics associated with severe disease and potential risk factors for severe disease. The primary outcome was the clinical characteristics of mpox and disease severity. FINDINGS We enrolled 160 people with mpox from 22 states in Nigeria, including 134 (84%) adults, 114 (71%) males, 46 (29%) females, and 25 (16%) people with HIV. Of the 160 patients, distinct febrile prodrome (n=94, 59%), rash count greater than 250 (90, 56%), concomitant varicella zoster virus infection (n=48, 30%), and hospital admission (n=70, 48%) were observed. Nine (6%) of the 160 patients died, including seven (78%) deaths attributable to sepsis. The clinical features independently associated with severe disease were a rash count greater than 10 000 (adjusted odds ratio 26·1, 95% CI 5·2-135·0, p<0·0001) and confluent or semi-confluent rash (6·7, 95% CI 1·9-23·9). Independent risk factors for severe disease were concomitant varicella zoster virus infection (3·6, 95% CI 1·1-11·5) and advanced HIV disease (35·9, 95% CI 4·1-252·9). INTERPRETATION During the 2022 global outbreak, mpox in Nigeria was more severe among those with advanced HIV disease and concomitant varicella zoster virus infection. Proactive screening, management of co-infections, the integration and strengthening of mpox and HIV surveillance, and preventive and treatment services should be prioritised in Nigeria and across Africa. FUNDING None.
Collapse
Affiliation(s)
- Dimie Ogoina
- Infectious Diseases Unit, Department of Internal Medicine, Niger Delta University Teaching Hospital, Niger Delta University, Yenagoa, Bayelsa, Nigeria.
| | | | | | - Mildred Okowa
- Department of Public Health, Ministry of Health, Asaba, Delta, Nigeria
| | - Nneka Marian Chika-Igwenyi
- Infectious Diseases Unit, Internal Medicine Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi , Nigeria
| | | | - Umenzekwe Chukwudi Christian
- Infectious Diseases and Tropical Medicine Unit, Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | | | - John Tunde Aremu
- Infectious Diseases Unit, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Kambai Lalus Habila
- Kaduna State Emergency Medical Services and Ambulance System, Kaduna, Kaduna, Nigeria
| | | | - Ekaete Alice Tobin
- Institute of Viral Haemorrhagic Fever and Emerging Pathogens, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
| | - Simon Mafuka Johnson
- Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo, Nigeria
| | - Abimbola Olaitan
- Department of Internal Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - Chizaram Onyeaghala
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Simji Samuel Gomerep
- Infectious Diseases Unit, Jos University Teaching Hospital, and Medicine Department, University of Jos, Plateau, Nigeria
| | - Datonye Alasia
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Asukwo E Onukak
- Department of Internal Medicine, University of Uyo, Uyo, Nigeria
| | - Juliet Mmerem
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Uche Unigwe
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Olanrewaju Falodun
- Department of Internal Medicine, National Hospital Abuja, Federal Capital Territory, Nigeria
| | - Vivian Kwaghe
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagalada, Abuja, Federal Capital Territory, Nigeria
| | - Sati Klein Awang
- Infectious Diseases Unit, Department of Internal Medicine, Modibo Adama University Teaching Hospital, Yola, Adamawa, Nigeria
| | - Mogaji Sunday
- Department of Public Health, Federal Medical Centre, Ebute Metta, Lagos, Nigeria
| | | | - Aliyu Mamman Na'uzo
- Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Kebbi, Nigeria
| | - Sampson Omagbemi Owhin
- Department of Medicine, Clinical Haematology Unit, Federal Medical Center, Owo, Ondo, Nigeria
| | - Abdullahi Asara Mohammed
- Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria
| | - Mukhtar Abdulmajid Adeiza
- Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria
| |
Collapse
|
2
|
Mitjà O, Alemany A, Marks M, Lezama Mora JI, Rodríguez-Aldama JC, Torres Silva MS, Corral Herrera EA, Crabtree-Ramirez B, Blanco JL, Girometti N, Mazzotta V, Hazra A, Silva M, Montenegro-Idrogo JJ, Gebo K, Ghosn J, Peña Vázquez MF, Matos Prado E, Unigwe U, Villar-García J, Wald-Dickler N, Zucker J, Paredes R, Calmy A, Waters L, Galvan-Casas C, Walmsley S, Orkin CM. Mpox in people with advanced HIV infection: a global case series. Lancet 2023; 401:939-949. [PMID: 36828001 DOI: 10.1016/s0140-6736(23)00273-8] [Citation(s) in RCA: 123] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND People living with HIV have accounted for 38-50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm3). METHODS A network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm3 or, in settings where a CD4 count was not always routinely available, an HIV infection clinically classified as US Centers for Disease Control and Prevention stage C. We describe their clinical presentation, complications, and causes of death. Analyses were descriptive. FINDINGS We included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30-43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117-291) cells per mm3, with 85 (22%) individuals with CD4 cell counts of less than 100 cells per mm3 and 94 (25%) with 100-200 cells per mm3. Overall, 193 (51%) of 382 had undetectable viral load. Severe complications were more common in people with a CD4 cell count of less than 100 cells per mm3 than in those with more than 300 cells per mm3, including necrotising skin lesions (54% vs 7%), lung involvement (29% vs 0%) occasionally with nodules, and secondary infections and sepsis (44% vs 9%). Overall, 107 (28%) of 382 were hospitalised, of whom 27 (25%) died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. Among people with CD4 counts of less than 200 cells per mm3, more deaths occurred in those with high HIV viral load. An immune reconstitution inflammatory syndrome to mpox was suspected in 21 (25%) of 85 people initiated or re-initiated on ART, of whom 12 (57%) of 21 died. 62 (16%) of 382 received tecovirimat and seven (2%) received cidofovir or brincidofovir. Three individuals had laboratory confirmation of tecovirimat resistance. INTERPRETATION A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death. FUNDING None.
Collapse
Affiliation(s)
- Oriol Mitjà
- Skin Neglected Tropical diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Andrea Alemany
- Skin Neglected Tropical diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Michael Marks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, and Division of Infection and Immunity, University College London Hospitals, London, UK
| | | | | | | | - Ever Arturo Corral Herrera
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México City, México
| | - Brenda Crabtree-Ramirez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México City, México
| | - José Luis Blanco
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer, Barcelona, Spain
| | - Nicolo Girometti
- Department of HIV and Genitourinary Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Valentina Mazzotta
- National Institute for Infectious Disease, Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Macarena Silva
- Infectious Diseases Department, Hospital San Borja Arriarán, Santiago de Chile, Chile
| | - Juan José Montenegro-Idrogo
- Infectious Diseases Department, Hospital Nacional Dos de Mayo, Lima, Perú; Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, Lima, Perú
| | - Kelly Gebo
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jade Ghosn
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris Nord, Bichat University Hospital, Paris, France; Centre of Research in Epidemiology and Statistics, Université Paris Cité, INSERM UMR 1137 IAME, Paris, France
| | | | - Eduardo Matos Prado
- Infectious Diseases Department, Hospital Nacional Arzobispo Loayza, Lima, Perú
| | - Uche Unigwe
- Infectious Disease Unit Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Judit Villar-García
- Infectious Disease Unit, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Infectious Diseases and Antibiotic Therapy Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Noah Wald-Dickler
- Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Roger Paredes
- Infectious Disease Department, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Laura Waters
- Central and North West London NHS Trust, London, UK
| | - Cristina Galvan-Casas
- Skin Neglected Tropical diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain; Dermatology Department, Hospital Universitario de Móstoles, Madrid, Spain
| | - Sharon Walmsley
- University Health Network, University of Toronto, Toronto, Canada
| | - Chloe M Orkin
- Blizard Institute and SHARE Collaborative, Queen Mary University of London, London, UK; Department of Infection and Immunity, Barts Health NHS Trust, London, UK.
| |
Collapse
|
3
|
Ogoina D, Mahmood D, Oyeyemi AS, Okoye OC, Kwaghe V, Habib Z, Unigwe U, Iroezindu MO, Garbati MA, Rotifa S, Adekanmbi O, Garba I, Dayyab FM, Ibrahim SM, Kida IM, Adamu A, Alasia D, Awang SK, Ohaju-Obodo JO, Usman R, Mohammed Y, Omololu A, Tobin EA, Okogbenin S, Asogun D, Kelly I, Waziri B, Nauzo AM, Jibrin Y, Habib AG. A national survey of hospital readiness during the COVID-19 pandemic in Nigeria. PLoS One 2021; 16:e0257567. [PMID: 34547038 PMCID: PMC8454967 DOI: 10.1371/journal.pone.0257567] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The COVID-19 pandemic continues to overwhelm health systems across the globe. We aimed to assess the readiness of hospitals in Nigeria to respond to the COVID-19 outbreak. Method Between April and October 2020, hospital representatives completed a modified World Health Organisation (WHO) COVID-19 hospital readiness checklist consisting of 13 components and 124 indicators. Readiness scores were classified as adequate (score ≥80%), moderate (score 50–79.9%) and not ready (score <50%). Results Among 20 (17 tertiary and three secondary) hospitals from all six geopolitical zones of Nigeria, readiness score ranged from 28.2% to 88.7% (median 68.4%), and only three (15%) hospitals had adequate readiness. There was a median of 15 isolation beds, four ICU beds and four ventilators per hospital, but over 45% of hospitals established isolation facilities and procured ventilators after the onset of COVID-19. Of the 13 readiness components, the lowest readiness scores were reported for surge capacity (61.1%), human resources (59.1%), staff welfare (50%) and availability of critical items (47.7%). Conclusion Most hospitals in Nigeria were not adequately prepared to respond to the COVID-19 outbreak. Current efforts to strengthen hospital preparedness should prioritize challenges related to surge capacity, critical care for COVID-19 patients, and staff welfare and protection.
Collapse
Affiliation(s)
- Dimie Ogoina
- Department of Internal Medicine, Niger Delta University/Niger Delta University Teaching Hospital, Yenagoa, Bayelsa State, Nigeria
- * E-mail:
| | | | - Abisoye Sunday Oyeyemi
- Department of Community Medicine, Niger Delta University/Niger Delta University Teaching Hospital, Yenagoa, Bayelsa State, Nigeria
| | - Ogochukwu Chinedum Okoye
- Department of Internal Medicine, Faculty of Clinical Medicine, Delta State University, Abraka, Delta State, Nigeria
| | - Vivian Kwaghe
- Department of Internal Medicine, University of Abuja Teaching Hospital, Federal Capital Territory, Gwagwalada, Nigeria
| | - Zayaid Habib
- Department of Internal Medicine, University of Abuja Teaching Hospital, Federal Capital Territory, Gwagwalada, Nigeria
| | - Uche Unigwe
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | | | - Musa Abubakar Garbati
- University of Maiduguri/University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Stella Rotifa
- Department of Community Medicine, Federal Medical Centre Yenagoa, Yenagoa, Bayelsa State, Nigeria
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
| | - Iliyasu Garba
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | | | - Sanusi Mohammed Ibrahim
- University of Maiduguri/University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Ibrahim Musa Kida
- University of Maiduguri/University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Adamu Adamu
- University of Maiduguri/University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Datonye Alasia
- Department of Internal Medicine, College of Health Sciences University of Port Harcourt, Port Harcourt, Nigeria
| | - Sati Klein Awang
- Department of Internal Medicine, Federal Medical Centre, Yola, Adamawa State, Nigeria
| | | | - Rabi Usman
- Zamfara State Ministry of Health, Zamfara, Nigeria
| | - Yahaya Mohammed
- Department of Medical Microbiology and Parasitology, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
| | - Ayanfe Omololu
- Department of Medicine, Federal Medical Centre Abeokuta, Ogun State, Nigeria
| | - Ekaete Alice Tobin
- Institute of Lassa fever research and control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Sylvanus Okogbenin
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Danny Asogun
- Dept of Community Health, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Iraoyah Kelly
- Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Bala Waziri
- Department of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Minna, Niger State, Nigeria
| | - Aliyu Mamman Nauzo
- Department of Paediatrics, Federal Medical Centre Birnin Kebbi, Kebbi State, Nigeria
| | - Yusuf Jibrin
- Department of Medicine, Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Bauchi, Nigeria
| | - Abdulrazaq Garba Habib
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| |
Collapse
|
4
|
Chika-Igwenyi N, Harrison R, Unigwe U, Psarra C, Ogah EO, Ajayi N, Onoh R, Ugwu C, Reid A. Another form of Lassa fever? Early neurological symptoms and high mortality reveal differences in two outbreaks in Ebonyi State, Nigeria 2017–2019. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
5
|
Ilori EA, Furuse Y, Ipadeola OB, Dan-Nwafor CC, Abubakar A, Womi-Eteng OE, Ogbaini-Emovon E, Okogbenin S, Unigwe U, Ogah E, Ayodeji O, Abejegah C, Liasu AA, Musa EO, Woldetsadik SF, Lasuba CLP, Alemu W, Ihekweazu C. Epidemiologic and Clinical Features of Lassa Fever Outbreak in Nigeria, January 1-May 6, 2018. Emerg Infect Dis 2019; 25:1066-1074. [PMID: 31107222 PMCID: PMC6537738 DOI: 10.3201/eid2506.181035] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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: 02/02/2023] Open
Abstract
The outbreak, which resulted in 423 confirmed cases and 106 deaths, was the largest recorded Lassa fever outbreak. Lassa fever (LF) is endemic to Nigeria, where the disease causes substantial rates of illness and death. In this article, we report an analysis of the epidemiologic and clinical aspects of the LF outbreak that occurred in Nigeria during January 1–May 6, 2018. A total of 1,893 cases were reported; 423 were laboratory-confirmed cases, among which 106 deaths were recorded (case-fatality rate 25.1%). Among all confirmed cases, 37 occurred in healthcare workers. The secondary attack rate among 5,001 contacts was 0.56%. Most (80.6%) confirmed cases were reported from 3 states (Edo, Ondo, and Ebonyi). Fatal outcomes were significantly associated with being elderly; no administration of ribavirin; and the presence of a cough, hemorrhaging, and unconsciousness. The findings in this study should lead to further LF research and provide guidance to those preparing to respond to future outbreaks.
Collapse
|
6
|
Ilori EA, Frank C, Dan-Nwafor CC, Ipadeola O, Krings A, Ukponu W, Womi-Eteng OE, Adeyemo A, Mutbam SK, Musa EO, Lasuba CLP, Alemu W, Okogbenin S, Ogbaini E, Unigwe U, Ogah E, Onoh R, Abejegah C, Ayodeji O, Ihekweazu C. Increase in Lassa Fever Cases in Nigeria, January-March 2018. Emerg Infect Dis 2019; 25:1026-1027. [PMID: 30807268 PMCID: PMC6478197 DOI: 10.3201/eid2505.181247] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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
We reviewed data pertaining to the massive wave of Lassa fever cases that occurred in Nigeria in 2018. No new virus strains were detected, but in 2018, the outbreak response was intensified, additional diagnostic support was available, and surveillance sensitivity increased. These factors probably contributed to the high case count.
Collapse
|
7
|
Unigwe U. Variation in lineage 2 strain of Lassa fever virus in Nigeria. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|