Intended for healthcare professionals

Education And Debate

Review of cases of nosocomial Lassa fever in Nigeria: the high price of poor medical practice

BMJ 1995; 311 doi: (Published 30 September 1995) Cite this as: BMJ 1995;311:857
  1. S P Fisher-Hoch, deputy branch chief G Perez-Oronoz, medical technologist (jbm{at},
  2. O Tomori, professorb,
  3. A Nasidi,
  4. G I Perez-Oronoz,
  5. Y Fakile, visiting scientista,
  6. L Hutwagner,
  7. J B McCormick, branch chiefa
  1. a Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA,
  2. b Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
  3. Biostatistic Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases L Hutswagner, biostatistician. Federal Epidemiological Division, Federal Ministry of Health, Lagos, Nigeria A Gneissoid, chief, vaccine laboratory.
  1. Correspondence to: Dr S P Fisher-Hoch, Aga Khan University Medical School, PO Box 3500, Stadium Road, Karachi 74800, Pakistan.
  • Accepted 14 July 1995


Objective: To investigate two hospital outbreaks of Lassa fever in southern central Nigeria.

Setting: Hospitals and clinics in urban and rural areas of Imo State, Nigeria.

Design: Medical records were reviewed in hospitals and clinics in both areas. Patients with presumed and laboratory confirmed Lassa fever were identified and contracts traced. Hospital staff, patients, and local residents were questioned, records were carefully reviewed, and serum samples were taken. Serum samples were assayed for antibody specific to Lassa virus, and isolates of Lassa virus were obtained.

Results: Among 34 patients with Lassa fever, including 20 patients, six nurses, two surgeons, one physician, and the son of a patient, there were 22 deaths (65% fatality rate). Eleven cases were laboratory confirmed, five by isolation of virus. Most patients had been exposed in hospitals (attack rate in patients in one hospital 55%). Both outbreak hospitals were inadequately equipped and staffed, with poor medical practice. Compelling, indirect evidence revealed that parenteral drug rounds with sharing of syringes, conducted by minimally educated and supervised staff, fuelled the epidemic among patients. Staff were subsequently infected during emergency surgery and while caring for nosocomially infected patients.

Conclusion: This outbreak illustrates the high price exacted by the practice of modern medicine, particularly use of parenteral injections and surgery, without due attention to good medical practice. High priority must be given to education of medical staff in developing countries and to guidelines for safe operation of clinics and hospitals. Failure to do so will have far reaching, costly, and ultimately devastating consequences.


  • Conflict of interest None.

  • Accepted 14 July 1995
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