title: Clinical profile and containment of the Ebola virus disease outbreak in two large West African cities, Nigeria, July-September 2014.
abstract: BACKGROUND
  The Ebola virus disease (EVD) outbreak in Nigeria began when an infected diplomat from Liberia arrived in Lagos, the most populous city in Africa, with subsequent transmission to another large city.
  
  
  METHODS
  First-, second-, and third-generation contacts were traced, monitored, and classified. Symptomatic contacts were managed at Ebola treatment centers as suspected, probable, and confirmed EVD cases using standard operating procedures adapted from the World Health Organization EVD guidelines. Reverse transcription PCR tests confirmed EVD. Socio-demographic, clinical, hospitalization, and outcome data of the July-September 2014 Nigeria EVD cohort were analyzed.
  
  
  RESULTS
  The median age of the 20 EVD cases was 33 years (interquartile range 26-62 years). More females (55%), health workers (65%), and persons <40 years old (60%) were infected than males, non-health workers, and persons aged ≥40 years. No EVD case management worker contracted the disease. Presenting symptoms were fever (85%), fatigue (70%), and diarrhea (65%). Clinical syndromes were gastroenteritis (45%), hemorrhage (30%), and encephalopathy (15%). The case-fatality rate was 40% and there was one mental health complication. The average duration from symptom onset to presentation was 3±2 days among survivors and 5±2 days for non-survivors. The mean duration from symptom onset to discharge was 15±5 days for survivors and 11±2 days for non-survivors. Mortality was higher in the older age group, males, and those presenting late.
  
  
  CONCLUSIONS
  The EVD outbreak in Nigeria was characterized by the severe febrile gastroenteritis syndrome typical of the West African outbreak, better outcomes, rapid containment, and no infection among EVD care-providers. Early case detection, an effective incident management system, and prompt case management with on-site mobilization and training of local professionals were key to the outcome.
authors: African Field Epidemiology Network, Kampala, Uganda; Department of Medicine, Morehouse School of Medicine, 720 West View Drive SW, Atlanta, GA 30310, USA. Electronic address: cohuabunwo@msm.edu.
authors: Chima
authors: C
authors: Ohuabunwo
authors: Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
authors: Celestine
authors: C
authors: Ameh
authors: College of Medicine, University of Lagos, Lagos, Nigeria.
authors: Oyin
authors: O
authors: Oduyebo
authors: Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
authors: Anthony
authors: A
authors: Ahumibe
authors: Lagos State University Teaching Hospital, Ikeja, Nigeria.
authors: Bamidele
authors: B
authors: Mutiu
authors: Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria; College of Medicine, Ahmadu Bello University, Zaria, Nigeria.
authors: Adebola
authors: A
authors: Olayinka
authors: Lagos State Mainland Hospital, Yaba, Lagos, Nigeria.
authors: Wasiu
authors: W
authors: Gbadamosi
authors: World Health Organization, Geneva, Switzerland.
authors: Erika
authors: E
authors: Garcia
authors: Médecins Sans Frontières, Operational Base, Madrid, Spain.
authors: Carolina
authors: C
authors: Nanclares
authors: World Health Organization Country Office, Abuja, Nigeria.
authors: Wale
authors: W
authors: Famiyesin
authors: Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
authors: Abdulaziz
authors: A
authors: Mohammed
authors: African Field Epidemiology Network, Kampala, Uganda; Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
authors: Patrick
authors: P
authors: Nguku
authors: World Health Organization Country Office, Abuja, Nigeria.
authors: Richard I
authors: RI
authors: Koko
authors: Nigeria Centre for Disease Control, Abuja, Nigeria.
authors: Joshua
authors: J
authors: Obasanya
authors: Nigeria Centre for Disease Control, Abuja, Nigeria.
authors: Durojaye
authors: D
authors: Adebayo
authors: Nigeria Centre for Disease Control, Abuja, Nigeria.
authors: Yemi
authors: Y
authors: Gbadegesin
authors: Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria.
authors: Oni
authors: O
authors: Idigbe
authors: Lagos State Primary Health Care Board, Yaba, Lagos, Nigeria.
authors: Olukayode
authors: O
authors: Oguntimehin
authors: UNICEF Country Office, Abuja, Nigeria.
authors: Sara
authors: S
authors: Nyanti
authors: UNICEF Country Office, Abuja, Nigeria.
authors: Charles
authors: C
authors: Nzuki
authors: Lagos State Ministry of Health, Ikeja, Lagos, Nigeria.
authors: Ismail
authors: I
authors: Abdus-Salam
authors: Department of Psychiatry, University of Lagos, Lagos, Nigeria.
authors: Joseph
authors: J
authors: Adeyemi
authors: Rivers State Ministry of Health, Port Harcourt, Nigeria.
authors: Nnanna
authors: N
authors: Onyekwere
authors: World Health Organization Country Office, Abuja, Nigeria.
authors: Emmanuel
authors: E
authors: Musa
authors: World Health Organization, Geneva, Switzerland.
authors: David
authors: D
authors: Brett-Major
authors: UNICEF Country Office, Abuja, Nigeria.
authors: Faisal
authors: F
authors: Shuaib
authors: Nigeria Centre for Disease Control, Abuja, Nigeria.
authors: Abdulsalami
authors: A
authors: Nasidi
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000453:epidemiology* / Q000401:mortality; D002947:Cities; D003967:Diarrhea; D004196:Disease Outbreaks; D005221:Fatigue; D005260:Female; D005334:Fever; D005759:Gastroenteritis / Q000453:epidemiology* / Q000401:mortality; D006282:Health Personnel; D006470:Hemorrhage / Q000453:epidemiology* / Q000401:mortality; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D014839:Vomiting; D014944:World Health Organization
keywords: Clinical profile; Ebola virus disease; Gastroenteritis; Hemorrhagic fever; Nigeria; Outbreak containment