After action review of the response to an outbreak of Lassa fever in Sierra Leone, 2019: Best practices and lessons learnt

Charles Njuguna*, Mohamed Vandi, Evans Liyosi, Jane Githuku, James Sylvester Squire, Ian Njeru, Ian Rufus, Victoria Katawera, Wilson Gachari, Robert Musoke, Claudette Amuzu, Mukeh Fahnbulleh, Joseph Bunting-Graden, Janet Kayita, James Bunn, Ambrose Talisuna, Zabulon Yoti

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background In November 2019, an outbreak of Lassa Fever occurred among health workers in a non-endemic district in Sierra Leone. The outbreak resulted in five cases, including two that were exported to the Netherlands. The outbreak tested multiple technical capacities in the International Health Regulations (2005) in a real-life setting. As such, an after action review (AAR) was undertaken as recommended by World Health Organization. We report on the findings of the AAR including best practices and lessons learnt. Methods A two stage review process was employed. The first stage involved national pillar level reviews for each technical pillar and one review of the district level response. The second stage brought together all pillars, including participants from the national and sub-national level as well as health sector partners. National guidelines were used as references during the deliberations. A standardized template was used to report on the key findings on what happened, what was supposed to happen, what went well and lessons learnt. Results This was a hospital associated outbreak that likely occurred due to a breach in infection prevention and control (IPC) practices resulting in three health workers being infected during a surgical operation. There was a delay in detecting the outbreak on time due to low index of suspicion among clinicians. Once detected, the outbreak response contained the outbreak within one incubation period. Areas that worked well included coordination, contact tracing, active case search and ring IPC. Notable gaps included delays in accessing local emergency funding and late distribution of IPC and laboratory supplies. Conclusions The incident management system worked optimally to contain this outbreak. The core technical gaps identified in surveillance, IPC and delay in deployment of resources should be addressed through systemic changes that can mitigate future outbreaks.

Original languageEnglish
Article numbere0010755
JournalPLoS Neglected Tropical Diseases
Issue number10
Publication statusPublished - Oct 2022
Externally publishedYes

Bibliographical note

Funding Information:
The World Health Organization Sierra Leone provided technical and financial support for the meetings that generated data for this article. WHO technical staff supported the Ministry of Health and Sanitation in study design, data collection, data analysis and manuscript preparation. Funding provided by WHO was from routine funds available at the country office and no special grant was received for this work.

Publisher Copyright:
© 2022 Njuguna et al.


Dive into the research topics of 'After action review of the response to an outbreak of Lassa fever in Sierra Leone, 2019: Best practices and lessons learnt'. Together they form a unique fingerprint.

Cite this