The One Health approach to incident management of the 2019 Lassa fever outbreak response in Nigeria

Chioma Dan Nwafor*, Elsie Ilori, Adebola Olayinka, Chinwe Ochu, Rosemary Olorundare, Edwin Edeh, Tochi Okwor, Oyeronke Oyebanji, Esther Namukose, Winifred Ukponu, Michael Olugbile, Usman Adekanye, Nastassya Chandra, Hikaru Bolt, Geofrey Namara, Oladipupo Ipadeola, Yuki Furuse, Solomon Woldetsadik, Adejoke Akano, Akanimo IniobongMichael Amedu, Chimezie Anueyiagu, Lawal Bakare, Anthony Ahumibe, Gbenga Joseph, Chibuzo Eneh, Muhammad Saleh, Naidoo Dhamari, Ihekerenma Okoli, Mairo Kachalla, Rita Okea, Collins Okenyi, Favour Makava, Catherine Makwe, Nkem Ugbogulu, Fritz Fonkeng, Everistus Aniaku, Emmanuel Agogo, Nwando Mba, Olusola Aruna, Patrick Nguku, Chikwe Ihekweazu

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Globally, effective emergency response to disease outbreaks is usually affected by weak coordination. However, coordination using an incident management system (IMS) in line with a One Health approach involving human, environment, and animal health with collaborations between government and non-governmental agencies result in improved response outcome for zoonotic diseases such as Lassa fever (LF). We provide an overview of the 2019 LF outbreak response in Nigeria using the IMS and One Health approach. The response was coordinated via ten Emergency Operation Centre (EOC) response pillars. Cardinal response activities included activation of EOC, development of an incident action plan, deployment of One Health rapid response teams to support affected states, mid-outbreak review and after-action review meetings. Between 1st January and 29th December 2019, of the 5057 people tested for LF, 833 were confirmed positive from 23 States, across 86 Local Government Areas. Of the 833 confirmed cases, 650 (78%) were from hotspot States of Edo (36%), Ondo (26%) and Ebonyi (16%). Those in the age-group 21–40 years (47%) were mostly affected, with a male to female ratio of 1:1. Twenty healthcare workers were affected. Two LF naïve states Kebbi and Zamfara, reported confirmed cases for the first time during this period. The outbreak peaked earlier in the year compared to previous years, and the emergency phase of the outbreak was declared over by epidemiological week 17 based on low national threshold composite indicators over a period of six consecutive weeks. Multisectoral and multidisciplinary strategic One Health EOC coordination at all levels facilitated the swift containment of Nigeria's large LF outbreak in 2019. It is therefore imperative to embrace One Health approach embedded within the EOC to holistically address the increasing LF incidence in Nigeria.

Original languageEnglish
Article number100346
JournalOne Health
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
Disease surveillance, outbreak investigation and immediate response activities are primarily the responsibilities of state governments; nevertheless, funding gaps at subnational levels negatively impact the implementation of the incident action plans. Dedicating a substantial budget line for public health emergencies at both national and subnational level is recommended to mitigate this challenge. The national level response was primarily funded by the Regional Disease Surveillance Systems Enhancement (REDISSE) project through the World Bank. The use of this fund at the subnational level could significantly improve preparedness and response in the States. Private sector participation in health emergency funding as part of corporate social responsibility should also be explored through strong advocacy.

Funding Information:
Animal and environmental strategies for LF control include implementation of food safety and hygiene practices, environmental sanitation, LF animal surveillance and vector control measures such as use of rodenticides with active local community sensitization and engagement by the LGA environmental health officers and veterinary officers [20]. Using an integrated One Health approach, the pillar supported by WHO, conducted rodent control and community environmental sanitation in high burden Esako-West, Esan-West, Owo and Ose LGAs in Edo and Ondo states, the two major LF hotspot states; collaboratively led by the IPC and risk communication pillars aimed at interrupting the disease transmission pathway.

Publisher Copyright:
© 2021


  • Emergency operation centre
  • Incident management system
  • Lassa fever
  • One Health


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