Characteristics of COVID-19 cases and factors associated with their mortality in Katsina State, Nigeria, April-July 2020

Introduction: COVID-19 was first detected in Daura, Katsina State, Nigeria on 4 April 2020. We characterized the cases and outlined factors associated with mortality. Methods: We analysed the COVID-19 data downloaded from Surveillance Outbreak Response, Management and Analysis System between 4 April and 31 July 2020. We defined a case as any person with a positive SARS-CoV-2 test within that period. We described the cases in time, person, and place; calculated the crude and adjusted odds ratios and 95% confidence intervals for factors associated with mortality. Results: We analysed 744 confirmed cases (median age 35, range 1-90), 73% males and 24 deaths (Case fatality rate 3.2%, Attack rate 8.5/100,000). The outbreak affected 31 districts, started in week 14, peaked in week 26, and is ongoing. Highest proportion of cases in the age groups were 26.7% (184) in 30-39, 21.7% (153) in 20-29 years, and 18.3% (129) in 40-49 years. While the highest case fatality rates in the age groups were 35.7% in 70-79, 33.3% in 80-89 years, and 19.4% in 60-69 years. Factors associated with death were cough (AOR: 9.88, 95% CI: 1.29-75.79), age ≥60 years (AOR: 18.42, 95% CI: 7.48-45.38), and male sex (AOR: 4.4, 95% CI: 0.98-20.12). Conclusion: Male contacts below 40 years carried the burden of COVID-19. Also, persons 60 years and above, with cough have an increased risk of dying from COVID-19. Risk communication should advocate for use of preventive measures, protection of persons 60 years and above, and consideration of cough as a red-flag sign

Emergency response to a cluster of suspected foodborne botulism in Abuja, Nigeria: challenges with diagnosis and treatment in a resource-poor setting

Food-borne botulism is a rare, acute and potentiallyfatal neurologic disorder that results from ingestionof food contaminated by botulinum toxin releasedfrom the anaerobic, spore-forming, gram-positivebacterium Clostridium botulinum. We reported anunusual cluster of botulism outbreak with high casefatality affecting a family following ingestion ofhome-made fish. A suspected outbreak of botulismaffecting three patients in a family of six wasreported to the Nigeria Centre for Disease Control.A rapid response team investigated by line-listing allthe family members, interviewed extended familymembers, caregivers, clinicians, and nurses tocollect socio-demographic and clinicoepidemiological information using a semistructured questionnaires. We collected blood frompatients and food samples and locally made drinkfrom the family home for laboratory testing. Allfamily members ingested the same home-madefood within the 48hrs before onset of symptoms inthe index case. The clinical presentation of the threeaffected cases (AR=50.0%) was consistent withbotulinum poisoning. Two of the affected cases died(CFR=66.7%) within 48hrs of admission, beforeantitoxin was made available. The third case had amilder presentation and survived, afteradministration of appropriate antitoxin. Theremaining three children developed no symptoms.None of the samples cultured Clostridiumbotulinum. The blood samples were negative formouse lethality test. Our report describes thechallenges of diagnosis and management of rareemerging infectious disease outbreaks in resourceconstrained settings