title: Containing a Lassa fever epidemic in a resource-limited setting: outbreak description and lessons learned from Abakaliki, Nigeria (January-March 2012).
abstract: OBJECTIVE
  Despite the epidemic nature of Lassa fever (LF), details of outbreaks and response strategies have not been well documented in resource-poor settings. We describe the course of a LF outbreak in Ebonyi State, Nigeria, during January to March 2012.
  
  
  METHODS
  We analyzed clinical, epidemiological, and laboratory data from surveillance records and hospital statistics during the outbreak. Fisher's exact tests were used to compare proportions and t-tests to compare differences in means.
  
  
  RESULTS
  The outbreak response consisted of effective coordination, laboratory testing, active surveillance, community mobilization, contact and suspected case evaluation, and case management. Twenty LF cases (10 confirmed and 10 suspected) were recorded during the outbreak. Nosocomial transmission to six health workers occurred through the index case. Only 1/110 contacts had an asymptomatic infection. Overall, there was high case fatality rate among all cases (6/20; 30%). Patients who received ribavirin were less likely to die than those who did not (p=0.003). The mean delay to presentation for patients who died was 11 ± 3.5 days, while for those who survived was 6 ± 2.6 days (p<0.001).
  
  
  CONCLUSIONS
  The response strategies contained the epidemic. Challenges to control efforts included poor local laboratory capacity, inadequate/poor quality of protective materials, fear among health workers, and inadequate emergency preparedness.
authors.affiliation: Department of Internal Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
authors.forename: Nnennaya A
authors.initials: NA
authors.lastname: Ajayi
authors.forename: Chinedu G
authors.initials: CG
authors.lastname: Nwigwe
authors.forename: Ben N
authors.initials: BN
authors.lastname: Azuogu
authors.forename: Benson N
authors.initials: BN
authors.lastname: Onyire
authors.forename: Elizabeth U
authors.initials: EU
authors.lastname: Nwonwu
authors.forename: Lawrence U
authors.initials: LU
authors.lastname: Ogbonnaya
authors.forename: Francis I
authors.initials: FI
authors.lastname: Onwe
authors.forename: Tobin
authors.initials: T
authors.lastname: Ekaete
authors.forename: Stephan
authors.initials: S
authors.lastname: Günther
authors.forename: Kingsley N
authors.initials: KN
authors.lastname: Ukwaja
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004196:Disease Outbreaks; D005260:Female; D006295:Health Resources; D006801:Humans; D007835:Lassa Fever / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D007836:Lassa virus / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D018571:Sentinel Surveillance; D016896:Treatment Outcome; D055815:Young Adult
keywords: Case report; Epidemiology; Infection control; Lassa fever; Nigeria; Outbreak report