Kogi and Kwara States, Nigeria: Unconfirmed reports of over 100 undiagnosed fatalities - July 2017 + - yellow fever suspected?

[alert]

I have merged the two threads as it is clear that, whatever is causing these reports, it is the same situation.

The ProMED report above suggests a wide number of possibilities (including the confirmation of one Lassa fatality), ranging from multiple illnesses, to deliberate poisoning. I wonder if the one confirmed Lassa fatality is enough to make the local attribute every death in the past few months to that illness.

The statement that those that do not vomit die faster might be consistent with ingestion of a poison; vomiting it out would reduce the toxic dose.

[alert]

Here is the confirmed Lassa fatality:

http://www.promedmail.org/post/20170819.5262007

Published Date: 2017-08-19 23:23:34
Subject: PRO/AH/EDR> Lassa fever - West Africa (32): Nigeria
Archive Number: 20170819.5262007
LASSA FEVER - WEST AFRICA (32): NIGERIA
****************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this report:
[1] Kwara Lagos
[2] Lagos University Teaching Hospital

******
[1] Kwara Lagos
Date: Sat 19 Aug 2017, 4:52 AM
Source: Vanguard [edited]
http://www.vanguardngr.com/2017/08/l...ords-new-case/


Kwara State government has said that Lassa fever has claimed the life of one person in the state.

The state Commissioner for Health, Mr. Atolagbe Alege, who disclosed this yesterday [Fri 18 Aug 2017] in Ilorin said the alert became necessary in view of the outcome of the results of the samples taken to Virology Department of Lagos State University Teaching Hospital (LUTH), for verification.

Alege, however, said there was no cause for alarm, said the state government had procured necessary drugs and other medications to prevent the disease from spreading.

Meanwhile, a new Lassa fever case was identified last [Thu 17 Aug 2017] at LUTH among the doctors, who 1st had close contact with the index case, while 65 others are still under watch. Disclosing this while giving an update on the Lassa fever cases at the hospital, the Chief Medical Director, Prof Chris Bode, said the patient, a female, had already commenced treatment and is expected to recover fully very soon.

Bode, who noted that psychological and other supports had also been provided, added that her family contacts were closely being monitored. He also said that 70 of the contacts being followed up had also been let off, having completed their period of observation.

"Last week, we reported the deaths of 2 patients who had been brought to the Lagos University Teaching Hospital and were later diagnosed with Lassa fever. "Three doctors who closely attended to the 1st patient later tested positive for the disease and were admitted while 135 other contacts have been followed up." The 3 doctors admitted with confirmed Lassa Fever in LUTH have all been certified fit and discharged home because subsequent repeated tests on them showed they have now tested negative for Lassa and no longer harbour the disease," the CMD noted.

Meanwhile over 400 LUTH staff attended a grand round on Viral Hemorrhagic Fever on [Fri 18 Aug 2017] at which various aspects of the contagious ailment were discussed.

"The importance of a high-index of suspicion, early diagnosis and referral were highlighted to medical workers who were also enjoined to observe universal precautions while attending to any patient who may be suspected of having Lassa fever.

"There is a fully equipped response squad available round the clock to assess and take over the management of any suspected cases in LUTH. The team has been beefed up by several volunteer staff who are working assiduously to overcome this dreaded disease and we are optimistic, buoyed by the successful discharge of those 3 doctors who had earlier tested positive."

He said the Federal Ministry of Health and the Lagos State Ministry of Health have supported LUTH with the provision of more drugs and Personal Protective Equipment, follow-up services, and decontamination. Free hand sanitizers have been deployed to various wards. Bode said an internal inquiry was empaneled to audit possible breaches in established service.

[Byline: Sola Ogundipe, Demola Akinyemi and Chioma Obinna]

--
Communicated by:
ProMED-mail


******
[2] Lagos University Teaching Hospital
Date: Fri 18 Aug 2017
Source: Today NG [edited]

"The 70 of the contacts being followed up have also been let off, having completed their period of observation.

"However, one new case was identified yesterday [Thursday 17 Aug 2017] from among the doctors that 1st had close contact with the index case and she (the doctor) has already commenced treatment and is expected to recover fully very soon.

"Psychological and other supports have also been provided and her family contacts are closely monitored."

The CMD who said the Federal Ministry of Health and the Lagos State Ministry of Health had provided more drugs, Personal Protective Equipment, follow-up services and decontamination services added that over 400 LUTH staff had been trained on the protocols of identifying and managing haemorrhagic fever to ensure that cases are caught early at the tertiary hospital.

"Overall, the disease is gradually tapering off, but we must remain vigilant while ongoing efforts are maintained to control the disease. There is a fully equipped response squad available round the clock to assess and take over the management of any suspected case in LUTH," Bode added.

[Byline: Kayode Omoyele]

--
Communicated by:
ProMED-mail
https://www.today.ng/news/metro/5797...ve-lassa-fever


Another doctor has tested positive to Lassa fever at the Lagos University Teaching Hospital (LUTH). The Chief Medical Director, Prof. Chris Bode, who confirmed the new case on [Fri 18 Aug 2017], said the doctor had had contact with the index patient.

The 3 doctors who attended to the 1st patient, a 32-year-old pregnant woman who eventually died, had tested positive to the disease; while 135 other contacts were placed under surveillance at the hospital earlier this month [August 2017].

LUTH had discharged the doctors who had been infected with the disease on [Wed 16 aug 2017] after they were certified free of it by experts at the tertiary hospital. Bode, in a statement on [Fri 18 Aug 2017], said the doctor tested positive to Lassa fever on [Thu 17 Aug 2017].

Bode stated, "The 3 doctors admitted with confirmed Lassa fever have all been certified fit and discharged home because subsequent repeated tests on them showed they have now tested negative.

"The 70 of the contacts being followed up have also been let off, having completed their period of observation.

"However, one new case was identified yesterday [Thursday 17 Aug 2017] from among the doctors that 1st had close contact with the index case and she (the doctor) has already commenced treatment and is expected to recover fully very soon.

"Psychological and other supports have also been provided and her family contacts are closely monitored."

The CMD who said the Federal Ministry of Health and the Lagos State Ministry of Health had provided more drugs, Personal Protective Equipment, follow-up services and decontamination services added that over 400 LUTH staff had been trained on the protocols of identifying and managing haemorrhagic fever to ensure that cases are caught early at the tertiary hospital.

"Overall, the disease is gradually tapering off, but we must remain vigilant while ongoing efforts are maintained to control the disease. There is a fully equipped response squad available round the clock to assess and take over the management of any suspected case in LUTH," Bode added.

[Byline: Kayode Omoyele]

--
Communicated by:
ProMED-mail

[These related cases of Lassa fever illustrate the risk of nosocomial transmission of the virus, and the need to appropriately use personal protective equipment and practice good barrier nursing. Transmission of Lassa fever virus in hospitals has been a long-term problem in Nigeria. One hopes that the above situations will result in putting these preventive measures into practice constantly.

There is no indication of the circumstances under which the index case from Kwara state acquired the infection. Virus transmission to humans can occur when people are in contact with the reservoir rodent host, the multimammate mouse (in the genus _Mastomys_) or their excreta.

[Pathfinder]

Issue: Volume 7 No. 31 18th August, 2017

NIGERIA CENTRE FOR DISEASE CONTROL

Weekly
Epidemiological
Report

Main Highlight of the week

COMMUNICATION DURING AN OUTBREAK

Public communication is a very essential part of an outbreak response- whether cases are suspected or
confirmed. Outbreaks are urgent emergencies that require rapid interventions initiated to prevent
further spread and reduce mortality as much as possible. Asides the impact on human lives, outbreaks
are alarming events that can create a lot of anxiety and panic among the general public.

In the last few weeks, there have been news reports of rumours of ?strange illness? in Kogi and Kwara
States. While investigation is ongoing, it is important for States and public health officials to manage
risk communication carefully to prevent panic. This week?s editorial focuses on the importance of early
reporting and managing information during outbreaks.

Outbreaks are always newsworthy events. This interest from the media can be used effectively to
promote prevention messages and help the public understand the implications on their health. States,
Local Government Area officials and other public health officials are reminded to promote preventive
messages such as the importance of personal and environmental hygiene, early presentation to a
health facility and avoidance of self-medication.

As some press reports can fuel public anxiety, it is important for health officials to maintain contact
with the media and proactively provide evidence based information with regular updates. The media
should also direct all questions to the appropriate sources e.g State Ministry of Health for Information
about outbreaks in a State.

Early reporting to the next level on the Surveillance System is very important in curtailing the spread
of outbreaks. If common causes of febrile illnesses in a patient are ruled out, health workers should
inform the Local Government or State Disease Surveillance and Notification Officer (DSNO)
immediately. It is important that this information is also reported to the national level for early
initiation of public health response activities.

The Nigeria Centre for Disease Control has an Event Based Surveillance system that mines
unstructured information daily such as online discussions, newspaper articles, etc to provide local and
near-real-time information on disease outbreaks (biological, rumor or social). This is usually followed
up for confirmation. We are in touch with State Epidemiologists of the affected States and will provide
regular updates.

We advise members of the public to remain calm and report to a health facility immediately if they
experience sudden high fever that is persistent after treatment.

In the reporting week ending on the 6
th of August, 2017:
o There were 344 new cases of Acute Flaccid Paralysis (AFP) reported. None was
confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active
case search for AFP is being intensified as Nigeria has assiduously reinvigorated its
efforts at eradicating Polio.
o 23 suspected cases of Cholera were reported from Ilorin East LGA in Kwara State with
three (3) laboratory confirmed case and no recorded deaths.
o There were 12 suspected cases of Cerebrospinal Meningitis (CSM) reported from nine
LGAs in eight States. Of these, none was laboratory confirmed and no death was
recorded. Ongoing surveillance for CSM has been intensified in the States.
o There were 315 suspected cases of Measles reported from 32 States. None was
laboratory confirmed and one death was recorded.
In the reporting week, Borno State failed to send in any report. Timeliness of reporting remains
83% in the previous and current weeks (Week 30 and 31) while completeness also remains at
100%. It is very important for all States to ensure timely and complete reporting at all times,
especially during an outbreak.
...

For full report, visit: http://www.ncdc.gov.ng/themes/common...1503433735.pdf

[alert]

Is this the same outbreak? The article does refer to the previous "outbreak" and is in the same location.....

Published Date: 2017-10-05 10:42:40
Subject: PRO/AH/EDR> Yellow fever - Africa (09): Nigeria (KW) RFI
Archive Number: 20171005.5360414
YELLOW FEVER - AFRICA (09): NIGERIA (KWARA) REQUEST FOR INFORMATION
************************************************** *****************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Wed 4 Oct 2017
Source: Punch [edited]
http://punchng.com/residents-kwara-g...-fever-deaths/


Residents in 9 local government areas [LGA] of Kwara state have raised the alarm of the spread of suspected yellow fever cases in their communities.

Though the Kwara State Government confirmed only 2 cases of yellow fever in the state, the coordinator, Igbomina Mobile Clinic, Mr Olaitan Oyin-Zubair, said more people had died than the number reported.

Oyin-Zubair claimed that 11 out of 17 yellow fever patients taken to the University of Ilorin Teaching Hospital had died.

According to him, 3 patients died at Sobi Specialist Hospital; another 3 died at Patigi General Hospital, while 2 patients out of 6 active cases in Oro-Ago in Ifelodun LGA also died.

It could be recalled that residents of Oro-Ago had raised the alarm about a strange illness, which they claimed had killed over 60 people in the past few months.

According to Oyin-Zubair, more people are dying of the strange disease at Oro-Ago.

In a letter to the Senator Representing Kwara South, Dr Rafiu Ibrahim, the coordinator urged the state government to take urgent steps to prevent further spread of the disease.

"Going by the active case charge carried out by the National Centre for Disease Control, the World Health Organisation, African Field Epidemiology Network, with medical experts from the state Ministry of Health, we have jointly concluded that there is a yellow fever outbreak in Kwara State.

"From their research, the following areas were declared as endemic: All the 18 wards of Ifelodun LGA; there are cases in Idofin Odo Ase in Oke-Ero LGA; Okeaba and Olla Wards in Isin LGA; Akanbi Ward in Ilorin South LGA; Agbeyangi/Gbadamu/Osin; Apado; Maraba/Pepele, and Moy?/Ile Apa in Ilorin East LGA," Oyin-Zubair stated.

He also said that the disease had spread to some areas in Patigi LGA.

"The team also discovered a prevalence of mosquitoes which are carriers of the disease in all the areas where the research was undertaken. The fears of the spread became heightened because the nomadic Fulani were the 1st to die of the disease in these areas." he added.

He suggested that the entire population of Kwara State be immunised against the disease. He identified lack of resources for massive investigation, ignorance, and fear of disclosure as reasons for the poor detection of yellow fever cases in the state.

The head of the research team at NCDC [Nigerian Center for Disease Control] in Kwara State, Dr William Nwachuku, had during the stakeholders' meeting in Ilorin, said that findings in communities revealed the prevalence of yellow fever virus and its carriers, a special breed of mosquitoes, in all the areas.

In addition to mass vaccination and immunisation, he urged the state government to embark on personal hygiene and environmental sanitation enlightenment campaign.

But the Kwara State Commissioner for Health, Dr Sulaiman Alege, said he was neither aware of the spread of the disease nor any death as a result of yellow fever in the state.

Alege said, "Basically, the information (of the spread of the disease) is not to my own confirmation because we are on ground here and we are working with the National Primary Child Development Agency National Primary Health Care Development Agency and the NCDC.

"Maybe the information they are giving you is not that it has spread to other LGAs, but that we want to conduct immunisation in 9 other LGAs of Kwara State. The NPHDA [National Primary Healthcare Development Agency] intends to extend the programme to 2 wards of Yagba East and Yagba West of Kogi State that are very close to Ifelodun.

"None of such deaths is our information and there is no reported case of any death as regards yellow fever in Kwara State. UITH [University of Ilorin Teaching Hospital] had been on strike and is just resuming, I do not know where they got it."

[Byline: Success Nwogu]

--
Communicated by:
ProMED-mail


[The number of yellow fever (YF) cases is not clear. The original report is of a single case. Then a 2nd case was diagnosed with YF in Oro-Ago in Ifelodun local government area of Kwara state. Later, only one laboratory confirmed yellow fever (YF) case was mentioned. The report above is conflicting. The Kwara state Government confirmed only 2 cases of YF in the state, but that number is immediately contradicted stating that 11 out of 17 yellow fever patients taken to the University of Ilorin Teaching Hospital had died. Apparently there are 8 additional deaths at 3 other hospitals. If, in fact, there are more than the 2 cases reported originally, the situation there is serious and immediate response with a vaccination campaign in all the affected areas is needed. The previous report indicated that a vaccination campaign was planned to begin in Ifelodun local government area of Kwara by 30 Sep 2017. The report above does not mention that the vaccinations have begun. YF can quickly get out-of-hand if vaccination is not started immediately, as happened in the outbreak in Angola recently.

ProMED-mail would appreciate receiving a clarification of the number of confirmed and suspected cases and the status of the vaccination effort

[Pathfinder]

See also:

Nigeria: Case of Yellow Fever detected in Kwara State

https://flutrackers.com/forum/forum/emerging-diseases-other-health-threats-alphabetical-i-thru-z/yellow-fever/782607-nigeria-case-of-yellow-fever-detected-in-kwara-state