title: Review of cases of nosocomial Lassa fever in Nigeria: the high price of poor medical practice.
abstract: OBJECTIVE
  To investigate two hospital outbreaks of Lassa fever in southern central Nigeria.
  
  
  METHODS
  Hospitals and clinics in urban and rural areas of Imo State, Nigeria.
  
  
  METHODS
  Medical records were reviewed in hospitals and clinics in both areas. Patients with presumed and laboratory confirmed Lassa fever were identified and contracts traced. Hospital staff, patients, and local residents were questioned, records were carefully reviewed, and serum samples were taken. Serum samples were assayed for antibody specific to Lassa virus, and isolates of Lassa virus were obtained.
  
  
  RESULTS
  Among 34 patients with Lassa fever, including 20 patients, six nurses, two surgeons, one physician, and the son of a patient, there were 22 deaths (65% fatality rate). Eleven cases were laboratory confirmed, five by isolation of virus. Most patients had been exposed in hospitals (attack rate in patients in one hospital 55%). Both outbreak hospitals were inadequately equipped and staffed, with poor medical practice. Compelling, indirect evidence revealed that parenteral drug rounds with sharing of syringes, conducted by minimally educated and supervised staff, fuelled the epidemic among patients. Staff were subsequently infected during emergency surgery and while caring for nosocomially infected patients.
  
  
  CONCLUSIONS
  This outbreak illustrates the high price exacted by the practice of modern medicine, particularly use of parenteral injections and surgery, without due attention to good medical practice. High priority must be given to education of medical staff in developing countries and to guidelines for safe operation of clinics and hospitals. Failure to do so will have far reaching, costly, and ultimately devastating consequences.
authors.affiliation: Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Fisher-Hoch
authors.forename: O
authors.initials: O
authors.lastname: Tomori
authors.forename: A
authors.initials: A
authors.lastname: Nasidi
authors.forename: G I
authors.initials: GI
authors.lastname: Perez-Oronoz
authors.forename: Y
authors.initials: Y
authors.lastname: Fakile
authors.forename: L
authors.initials: L
authors.lastname: Hutwagner
authors.forename: J B
authors.initials: JB
authors.lastname: McCormick
mesh_terms: D002983:Clinical Competence; D016358:Contact Tracing; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks; D006801:Humans; D017053:Infection Control; D007267:Injections / Q000009:adverse effects; D007835:Lassa Fever / Q000453:epidemiology* / Q000517:prevention & control; D008505:Medical Staff, Hospital / Q000193:education; D016485:Needle Sharing; D009549:Nigeria / Q000453:epidemiology; D010564:Personnel, Hospital; D011364:Professional Practice