title: Lessons learnt from the management of a case of Lassa fever and follow-up of nosocomial primary contacts in Nigeria during Ebola virus disease outbreak in West Africa.
abstract: OBJECTIVE
  To describe our experiences in the management of a case of Lassa fever (LF) and follow-up of nosocomial primary contacts during the 2014 Ebola outbreak in West Africa.
  
  
  METHODS
  Clinical management of the index case and infection control/surveillance activities for primary contacts are described. Laboratory confirmation was by Lassa virus-specific reverse-transcriptase PCR.
  
  
  RESULTS
  A 28-year-old man with a 10-day history of febrile illness was referred to a major tertiary hospital in south-east Nigeria from a city that previously experienced a LF outbreak and was recently affected by Ebola. On observation of haemorrhagic features, clinicians were at a crossroads. Diagnosis of LF was confirmed at a National Reference Centre. The patient died despite initiation of ribavirin therapy. Response activities identified 121 primary contacts comprising 78 (64.5%) hospital staff/interns, 19 (15.7%) medical students, 18 (14.9%) inpatients and 6 (5.0%) relatives. Their mean age was 32.8 ± 6.6 years, and 65.3% were women. Twenty (16.5%) had high-risk exposure and were offered ribavirin as post-exposure prophylaxis. No secondary case of LF occurred. Fatigue (43.8%) and dizziness (31.3%) were the commonest side effects of ribavirin.
  
  
  CONCLUSIONS
  Response activities contained nosocomial spread of LF, but challenges were experienced including lack of a purpose-built isolation facility, absence of local Lassa virus laboratory capacity, failure to use appropriate protective equipment and stigmatisation of contacts. A key lesson is that the weak health systems of Africa should be comprehensively strengthened; otherwise, we might win the Ebola battle but lose the one against less virulent infections for which effective treatment exists.
authors.affiliation: Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Iroezindu
authors.affiliation: Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.
authors.forename: Uche S
authors.initials: US
authors.lastname: Unigwe
authors.affiliation: Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.
authors.forename: Celestine C
authors.initials: CC
authors.lastname: Okwara
authors.affiliation: Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.
authors.forename: Gladys A
authors.initials: GA
authors.lastname: Ozoh
authors.affiliation: Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Ndu
authors.affiliation: Department of Medical Microbiology, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Ohanu
authors.affiliation: Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.
authors.forename: Ugochukwu O
authors.initials: UO
authors.lastname: Nwoko
authors.affiliation: Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.
authors.forename: Uwadiegwu W
authors.initials: UW
authors.lastname: Okoroafor
authors.affiliation: Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria.
authors.forename: Esinulo
authors.initials: E
authors.lastname: Ejimudo
authors.affiliation: Institute of Lassa Fever Research and Control, Irrua Specialist Hospital, Irrua, Edo State, Nigeria.
authors.forename: Ekaete A
authors.initials: EA
authors.lastname: Tobin
authors.affiliation: Institute of Lassa Fever Research and Control, Irrua Specialist Hospital, Irrua, Edo State, Nigeria.
authors.forename: Danny A
authors.initials: DA
authors.lastname: Asogun
keywords: Ebola; Fiebre de Lassa; Lassa fever; contactos primarios; fièvre de Lassa; lecciones; lessons; leçons; premier contact; primary contact; surveillance; vigilancia; Ébola