Outbreak of cerebrospinal meningitis in Kebbi State, Nigeria

Background: Cerebrospinal meningitis (CSM), is a major public health problem still affecting tropical countries particularly in sub-Saharan Africa. Group A and occasionally group C account for large scale epidemics in many countries in the African meningitis belt. The study aimed to describe the pattern of cerebrospinal meningitis outbreak in Kebbi state in 2015.Method: Information on cases and deaths was collected throughout the duration of the meningitis outbreak in all affected local government areas of Kebbi state. During this outbreak, we defined a suspected case as any person with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, altered consciousness or other meningeal signs and any toddler with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, or flaccid neck, bulging fontanel, convulsion or other meningeal signs. All the data was entered into SPSS statistical software and analyzed.Results: A total of 1,992 suspected cases of CSM were seen within the 18 weeks that the outbreak lasted. 1127 (57.0%) were males and 865 (43.0%) were females with a case fatality rate of 4.0%. The highest proportion of cases was found among those above 15 years of age (31.0%), 1252 (62.9%) of cases were immunized against neisseria meningitides type A. Two-thirds (16) of the LGAs in the state were affected and Aliero LGA had about half (n=1106; 55.5%) of cases seen. Most (77.3%) of samples analysed were positive for Nm type C.Conclusion: Kebbi state experienced an outbreak of cerebro-spinal Meningitis in 2015 which was massive. Effective surveillance system and mass vaccination with polyvalent vaccines containing serogroup C will prevent future occurrence.Keywords: Meningitis belt, MenAfriVac, Neisseria meningitidis type C, Sub-Saharan Afric

A Retrospective Study of Rabies Cases Reported at Vom Christian Hospital, Plateau State, Nigeria, 2006 – 2010

Rabies is a zoonosis of public health importance in Nigeria. Exposure to bites of rabid dogs is the cause of over 99% of human cases of rabies worldwide. Post-Exposure Prophylaxis (PEP) is a vital aspect of clinical rabies prevention in humans The aim of this study was to determine the magnitude of rabies disclosure among dogbite victims (DBVs) and their compliance with a PEP regimen. We reviewed patient records of DBVs who were treated at the Vom Christian Hospital, Plateau State, from 2006 – 2010, obtained information on patient demographics and rabies status of implicated dogs from patients' hospital records. A trend of reported rabid dog bites in children was determined. We assessed compliance of DBVs with the recommended dosage regimen for PEP which is local wound treatment followed by vaccine therapy on days 0, 3, 7, 14 and 30. Over the five-year period, 713 DBVs were reported; 377(52.9%) were children <15 years, 404(56.7%) were males and 299 (41.9%) were bitten by laboratory-confirmed rabid dogs.Rabid dog-bites among children increased exponentially from 2007(6/1,000,000) to 2009(41/1,000,000) with a steep decline in 2010 (24/1,000,000). Of all DBVs, 677 (95%) first sought veterinary care. Of all implicated dogs, 305(42.8%) were tested and 299 (98.0%) were positive for rabies. Nearly all (99.6%) DBVs were treated using human diploidcell rabies vaccine, while only 49.1% completed the recommended doses. Of the 299 DBVs bitten by rabies-positive dogs, 59.2% completed the regimen and were likely to be PEP compliant than those bitten by untested dogs (p<0.01). No mortalities among DBVs were reported to the hospital. Rabies in dogs is a serious public health problem in Plateau State, in which children constitute the highest proportion of rabid DBVs reported. We recommend joint sensitization of physicians and veterinarians about the need for detailed DBV and animal information for rabies management.Keywords: Rabies, Dog bite victims, Post Exposure Prophylaxis, NigeriaNigerian Veterinary Journal, VOL:32 (4) 366-37

Urachal Adenocarcinoma

Urachal adenocarcinoma is a rare tumor and represents 0.17–0.34% of all bladder tumors. Most of the reported cases are in western literature and to the best of our knowledge this is the first case report of urachal adenocarcinoma in sub-Saharan Africa. It has an insidious course and variable clinical presentation. We present a case report of a 45 year old female with three month history of hematuria. Imaging showed a bladder dome mass. After cystoscopy and biopsy, urachal adenocarcinoma was diagnosed histologically. After a negative screen for distant metastasis based on CT chest and abdomen, the patient underwent anterior pelvic exenteration and ileal neo-bladder reconstruction. Six months later, the patient presented with chest metastases. Clinicians should have a high degree of suspicion for these rare tumors

Determination of the antimicrobial susceptibility pattern of extended spectrum beta lactamase (esbl) producing and the non-esbl producing strains of Escherichia coli

Background: The extended spectrum beta lactamases producing bacteria are bacteria of great concern among Gram negative bacilli. Escherichia coli stand out as major carrier of this enzyme. The appropriate control of this resistance pattern depends on using the antimicrobial regimen of best choice. Therefore the value of the susceptibility profile of organism harboring this enzyme cannot be overemphasized.Objectives: To determine the antimicrobial susceptibility of extended spectrum beta lactamases (ESBL) producing and the non-ESBL producing strains of Escherichia coli from clinical isolates of Escherichia coli in University of Maiduguri Teaching Hospital.Methodology: Confirmed variants of Escherichia coli were screened and confirmed for ESBL possession. Subsequently, modified Kirby Bauer method was utilized to test for antibiotic susceptibility using the commercially available Oxoid single disc for some major antibiotics.Results: A total of 172 strains of Escherichia coli were identified during the study period. Out of this number; 131 were identified as ESBL positive while a total of 41 were ESBL negative. The highest sensitivity for both the ESBL positive and ESBL negative strains of Escherichia coli was observed with Imipenem followed closely by Gentamicin.Conclusion: The study reveals narrow choice of antibiotics for the ESBL positive isolates of Escherichia coli although Imipenem antibiotic still retains its sensitivity.Keywords: Cephalosporins, Resistance, Maiduguri, Nigeri

Epidemiological profile of the Ebola virus disease outbreak in Nigeria, July-September 2014

Introduction: In July 2014, Nigeria experienced an outbreak of Ebola virus disease following the introduction of the disease by an ill Liberian Traveler. The Government of Nigeria with the support of Technical and Development Partners responded quickly and effectively to contain the outbreak. The epidemiological profile of the outbreak that majorly affected two States in the country in terms of person, place and time characteristics of the cases identified is hereby described. Methods: Using field  investigation technique, all confirmed and probable cases were identified, line-listed and analysed using Microsoft Excel 2007 by persons, time and place. Results: A total of 20 confirmed and probable cases; 16 in Lagos (including the index case from Liberia) and 4 in Port Harcourt were  identified. The mean age was 39.5 ± 12.4 years with over 40% within the age group 30-39 years. The most frequent exposure type was direct physical contact in 70% of all cases and 73% among health care workers. The total case-fatality was 40%; higher among healthcare workers (46%) compared with non-healthcare workers (22%). The epidemic curve initially shows a typical common source outbreak, followed by a propagated pattern. Conclusion: Investigation revealed the size and spread of the outbreak and provided information on the characteristics of persons, time and place. Enhanced surveillance measures, including contact tracing and follow-up proved very useful in early case detection and containment of the outbreak

Vaccination with DNA plasmids expressing Gn coupled to C3d or alphavirus replicons expressing Gn protects mice against rift valley fever virus

Background: Rift Valley fever (RVF) is an arthropod-borne viral zoonosis. Rift Valley fever virus (RVFV) is an important biological threat with the potential to spread to new susceptible areas. In addition, it is a potential biowarfare agent. Methodology/Principal Findings: We developed two potential vaccines, DNA plasmids and alphavirus replicons, expressing the Gn glycoprotein of RVFV alone or fused to three copies of complement protein, C3d. Each vaccine was administered to mice in an all DNA, all replicon, or a DNA prime/replicon boost strategy and both the humoral and cellular responses were assessed. DNA plasmids expressing Gn-C3d and alphavirus replicons expressing Gn elicited high titer neutralizing antibodies that were similar to titers elicited by the live-attenuated MP12 virus. Mice vaccinated with an inactivated form of MP12 did elicit high titer antibodies, but these antibodies were unable to neutralize RVFV infection. However, only vaccine strategies incorporating alphavirus replicons elicited cellular responses to Gn. Both vaccines strategies completely prevented weight loss and morbidity and protected against lethal RVFV challenge. Passive transfer of antisera from vaccinated mice into naïve mice showed that both DNA plasmids expressing Gn-C3d and alphavirus replicons expressing Gn elicited antibodies that protected mice as well as sera from mice immunized with MP12. Conclusion/Significance: These results show that both DNA plasmids expressing Gn-C3d and alphavirus replicons expressing Gn administered alone or in a DNA prime/replicon boost strategy are effective RVFV vaccines. These vaccine strategies provide safer alternatives to using live-attenuated RVFV vaccines for human use. © 2010 Bhardwaj et al

User evaluation indicates high quality of the Surveillance Outbreak Response Management and Analysis System (SORMAS) after field deployment in Nigeria in 2015 and 2018

During the West African Ebola virus disease outbreak in 2014-15, health agencies had severe challenges with case notification and contact tracing. To overcome these, we developed the Surveillance, Outbreak Response Management and Analysis System (SORMAS). The objective of this study was to measure perceived quality of SORMAS and its change over time. We ran a 4-week-pilot and 8-week-implementation of SORMAS among hospital informants in Kano state, Nigeria in 2015 and 2018 respectively. We carried out surveys after the pilot and implementation asking about usefulness and acceptability. We calculated the proportions of users per answer together with their 95% confidence intervals (CI) and compared whether the 2015 response distributions differed from those from 2018. Total of 31 and 74 hospital informants participated in the survey in 2015 and 2018, respectively. In 2018, 94% (CI: 89-100%) of users indicated that the tool was useful, 92% (CI: 86-98%) would recommend SORMAS to colleagues and 18% (CI: 10-28%) had login difficulties. In 2015, the proportions were 74% (CI: 59-90%), 90% (CI: 80-100%), and 87% (CI: 75-99%) respectively. Results indicate high usefulness and acceptability of SORMAS. We recommend mHealth tools to be evaluated to allow repeated measurements and comparisons between different versions and users

Field Epidemiology and Laboratory Training Programs in sub-Saharan Africa from 2004 to 2010: need, the process, and prospects

As of 2010 sub-Saharan Africa had approximately 865 million inhabitants living with numerous public health challenges. Several public health initiatives [e.g., the United States (US) President’s Emergency Plan for AIDS Relief and the US President’s Malaria Initiative] have been very successful at reducing mortality from priority diseases. A competently trained public health workforce that can operate multi-disease surveillance and response systems is necessary to build upon and sustain these successes and to address other public health problems. Sub-Saharan Africa appears to have weathered the recent global economic downturn remarkably well and its increasing middle class may soon demand stronger public health systems to protect communities. The Epidemic Intelligence Service (EIS) program of the US Centers for Disease Control and Prevention (CDC) has been the backbone of public health surveillance and response in the US during its 60 years of existence. EIS has been adapted internationally to create the Field Epidemiology Training Program (FETP) in several countries. In the 1990s CDC and the Rockefeller Foundation collaborated with the Uganda and Zimbabwe ministries of health and local universities to create 2-year Public Health Schools Without Walls (PHSWOWs) which were based on the FETP model. In 2004 the FETP model was further adapted to create the Field Epidemiology and Laboratory Training Program (FELTP) in Kenya to conduct joint competencybased training for field epidemiologists and public health laboratory scientists providing a master’s degree to participants upon completion. The FELTP model has been implemented in several additional countries in sub-Saharan Africa. By the end of 2010 these 10 FELTPs and two PHSWOWs covered 613 million of the 865 million people in sub-Saharan Africa and had enrolled 743 public health professionals. We describe the process that we used to develop 10 FELTPs covering 15 countries in sub-Saharan Africa from 2004 to 2010 as a strategy to develop a locally trained public health workforce that can operate multi-disease surveillance and response systems.Key words: Field epidemiology, laboratory management, multi-disease surveillance and response systems, public health workforce capacity buildin