Lassa fever outbreak investigation and response among workers at Ebonyi state university teaching hospital, Abakaliki, Nigeria

Background: Lassa fever (LF), a zoonotic viral hemorrhagic fever is a recognized nosocomial infection. LF outbreaks were reported at Ebonyi-State University Teaching hospital (ESUTH), in 2005 and 2008. In February 2011, an outbreak of LF at ESUTH was reported to the Federal Ministry of Health. We investigated the outbreak and assessed infection control measures. Methods: We reviewed hospital records to identify suspected cases. A suspected case was anyone with high fever unresponsive to treatment and had either bloody-diarrhoea, vomiting or bleeding. We collected blood from suspected cases and confirmed LF using reverse-transcriptase-polymerase-chain-reaction (RT-PCR) test. We interviewed ESUTH staff on knowledge, attitudes and practices (KAP) of LF using a structured questionnaire. We compared KAP of staff by Chi-square test. Results: The index case (IC) was reported on 11 February, 2011 and died at ESUTH on 13 February. Of 7 suspected cases, 3 (42.9%) were laboratory-confirmed. Case-1 was a managing nurse for the IC; case-2 visited IC at ESUTH, and case-3 was a neighbour of IC. Of 51 respondents interviewed, 36 (70.6%), 40 (78.4%) and 48 (94.1%) knew clinical symptoms, modes-of-transmission and methods of personal-protection respectively. Doctors (n=10, 90.9%) were most knowledgeable of LF symptoms (p<0.01) compared to 19 nurses and 5 health-attendants. Of 36 (70.6%) respondents who managed cases, 13 (36.1%) wore personal protective equipment (PPE): 4 (36.4%) doctors, 6 (27.3%) nurses and 3 (20%) health-attendants. Conclusion: Most health-care workers did not observe standard infection control measures when attending to suspected cases of LF. A workshop was organized at ESUTH with emphasis on use of PPE.