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2Nd International Conference on (Re-)Emerging Infections Diseases 2nd International Conference on (Re-)Emerging Infections Diseases Oral Presentations Abstracts Abstract 2 Reviews in Antiviral Therapy & Infectious Diseases 2019_2 Abstract 3 To better understand the relationship 1 Aim: between exposure to outbreak information sources and perceiving some Ebola acquisition risk, and to Risk Communication and Risk further examine how such risk perceptions might have been associated with Ebola-specific Perception in the 2014-2015 knowledge, misconceptions, and behaviors. Ebola Outbreak in Sierra Leone Methods: The study is based on three cross- sectional, national surveys that measured Ebola- Winters M1, Jalloh M1,2, Sengeh P3, Jalloh M3, Conteh L4, Zeebari related knowledge, attitudes, and practices in Z1, Nordenstedt H1 Sierra Leone during the 2014-2015 outbreak. The 1Karolinska Institutet, Stockholm, Sweden, 2Centers for Disease Control and Prevention, Atlanta, United States of America, first survey was conducted in the August 2014, 3FOCUS1000, Freetown, Sierra Leone, 4Ministry of Health and n=1413, the second shortly before the peak Sanitation, Freetown, Sierra Leone (October, n=2086) and third shortly after the peak (December, n= 3540). Data were pooled, and composite variables were created for knowledge, Background: Sierra Leone had the highest number misconceptions, protective and risk behavior. Risk of Ebola virus disease (EVD) cases and deaths during perception was captured by asking ‘what level of the 2014-2015 outbreak in West Africa. Risk risk do you think you have in getting Ebola in the communication efforts aimed to provide the next 6 months?’, with answering options ‘no, small, population with life-saving information and medium or great risk’. This was dichotomized to ‘no encourage adoption of protective behaviors. risk perception’ vs ‘some risk perception’. Perceived susceptibility to a disease threat (risk Information sources (electronic media, print media, perception) has shown to be associated with uptake new media (internet, mobile phones), government, of protective behaviors and avoidance of risky community) were dichotomized to exposed and behaviors. During the Ebola outbreak in Sierra unexposed. A variable was created for the sum of Leone, the association between risk perception and information sources exposed to (0-1, 2, 3, 4-5 Ebola-specific knowledge and behavior has not sources). Multilevel logistic regression models were been examined. fitted to account for the clustering of samples obtained by district and time in the these sources can be seen as more personal, with outbreak. Mediation analysis was carried out to the possibility to engage in dialogue. Having at least understand whether risk perception functioned as some risk perception seems to be beneficial for EVD a mediator between information sources and knowledge and for engaging in protective behavior. behavior. Results should be interpreted with caution, as reverse causality cannot be ruled out when using Results: New media (Adjusted Odds Ratio (AOR) cross-sectional data. These results can inform risk 1.6, 95% CI 1.4-1.9) and community sources (AOR communication strategies in health emergency 1.3, 95% CI 1.1-1.4) were significantly associated preparedness with perceiving some Ebola risk. A dose-response association was also observed, showing that the more sources one was exposed to, the higher the likelihood to perceive some risk. Risk perception was further associated with knowledge (AOR 1.4, 95% CI 1.2-1.5) and protective behavior (AOR 1.2, 95% CI 1.1-1.4), but not with risk behavior (AOR 1.0, 95% CI 0.9-1.1). It had an inverse association with misconceptions (AOR 0.7, 95% CI 0.6-0.8). Ebola risk perceptions mediated the associations between new media, community and protective behavior. Discussion: New media and community sources (such as religious and traditional leaders) were associated with risk perception. Compared to information sources such as radio and print media, Reviews in Antiviral Therapy & Infectious Diseases 2019_2 Abstract 4 2A study of the epidemic using the R software and Epi Info Version 7.2.2.2 Effect of Oral Cholera Vaccine Results: We identified 13,595 case-patients; 140 died (Overall case fatality rate [CFR]=1.03%) on Geographical Spread of First epidemic occurred between 16th August-21st December, 2017 with 6,430 case-patients and 61 Cholera Epidemic in Borno deaths (CFR=0.95%); 6,109(95.00%) were IDP and State, Northeastern Nigeria, lived in official and unofficial camps in Jere: 3,512(54.62%), Monguno: 1,870(29.08%), Dikwa: 2017-2018 845(13.14%), Guzamala: 115(1.79%), Maiduguri: 63(0.98%), Mafa: 23(0.36%) and Gubio: 2(0.03%) BALAMI K1, Sufiyan M2, Mshelia L3, Owili C4, Bashir S2, Balogun M1, LGAs. Sabitu K2, Nguku P1, Ihekweazu C5 Overall, 896,919 people were vaccinated (coverage 1Nigerian Field Epidemiology and Laboratory Training Program, rate=105%) using 914,565 OCV doses (wastage Abuja, Nigeria, 2Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria, 3Borno State Ministry of Health, rate=0.4%) Maiduguri, Nigeria, 4World Health Organisation, Maiduguri, Second epidemic occurred between 13th February- Nigeria, 5Nigeria Centre for Disease Control, Nigeria's National 16th July, 2018 with 935 case-patients and 6 deaths Public Health Institute, Abuja, Nigeria (CFR=0.64%) in Kukawa: 785(83.96%), Askira-Uba: 111(11.87%), Bama: 31(3.32%), Jere: 6(0.64%) and Background: Oral Cholera Vaccine (OCV) has been Damboa: 2(0.21%) LGAs. known to play an important role as a preventive and Third epidemic occurred between 5th September- control measure in epidemics especially amongst 24th November, 2018 with 6,230 case-patients who Internally Displaced Persons (IDP) and areas facing did not receive OCV and 73 deaths (CFR=1.17%) in complex emergencies. The ongoing humanitarian Jere: 2,388(38.33%), Maiduguri: 1,520(24.40%), crises in North-eastern Nigeria disrupted social Ngala: 1,052(16.89%), Magumeri: 340(5.46%), services and displaced thousands into overcrowded Konduga: 166(2.66%), Kwaya-Kusar: 161(2.58%), IDPs camps with the scarcity of water, sanitation Chibok: 136(2.18%), Kala-Balge: 106(1.70%), Askira- and hygiene. Borno State is the epicentre of the Uba: 91(1.46%), Guzamala: 70(1.12%), Dikwa: humanitarian crises where epidemics likely occur. 57(0.91%), Bama: 56(0.90%), Damboa: 42(0.67%), We confirmed and characterized three cholera Kaga: 34(0.55%) and Shani: 11(0.18%) LGAs. epidemics. We mounted an emergency response with Shancol Cholera Vaccine the first ever use of Conclusion: With a high reactive OCV coverage, we oral cholera vaccine in Nigeria. We also determined controlled the protracted cholera epidemic which the effect of OCV on the geographical spread of the increased in magnitude and strength affecting cholera epidemic in Borno State to guide targeted mostly IDPs in camps and spreading to host intervention and future epidemic control communities despite combining several control strategies. measures. The second epidemic occurred in an entirely different geographical location while the Methods: We investigated three cholera epidemics third epidemic was in wards not previously between 16th August, 2017-24th November 2018 vaccinated with OCV. We recommend preventive in Borno State. We defined a case-patient as any OCV campaigns in high-risk areas to boost herd- person ≥2years presenting with acute watery immunity and prevent the geographical spread of diarrhoea with or without vomiting and severe cholera epidemic. dehydration or died as a result. We launched a reactive two-dose OCV campaign during the first epidemic. The first dose was between 18th-22nd September 2017 while the second dose between 8th-18th November 2017. We targeted all persons ≥1year of age (target population=855,492). We vaccinated eligible persons in selected hot-spot wards of Jere (3 wards), Maiduguri (3 wards), Konduga (3 wards), Mafa (2 wards), Monguno (1 ward) and Dikwa (1 ward) Local Government Areas (LGAs). We conducted a descriptive and analytic Reviews in Antiviral Therapy & Infectious Diseases 2019_2 Abstract 5 2B Conclusion: There was a Protracted cholera outbreak that increased in magnitude and strength Cholera Outbreak Response in affecting mostly children in IDP camps. Rapid detection and response were a possible reason for a Complex Emergency: The low CFR. Reactive OCV might have influenced the ending of the outbreak. Despite the complex and Importance of Oral Cholera challenging context, the outbreak was contained Vaccine in Borno State, within four months with a case fatality (CFR) of 0.95% Northeastern Nigeria, 14th August–21st December, 2017 Balami K1, Suffiyan M2, Balogun S1 1Nigerian Field Epidemiology And Laboratory Training Program, Maiduguri, Nigeria, 2Ahmadu Bello University, Zaria, Nigeria Background: Cholera Outbreak is a global health problem amongst Internally Displaced Persons (IDPs) and areas facing complex emergencies. The insurgency in North Eastern Nigeria caused disruption in social services, and displacement of thousands into IDP camps which are overcrowded with sub-optimal Water, Sanitation and Hygiene. We confirmed, characterise the outbreak and instituted control measures which include the first- ever use of Oral Cholera Vaccine (OCV) Shanchol Cholera vaccine was licenced for use in Nigeria. Methods: We defined a suspected Cholera case as any person ≥ 2years in Borno State presenting with acute watery diarrhoea with or without vomiting and severe dehydration or died as a result, between 14th August to 21st December 2017. We did a descriptive and analytic study. Using the Polio vaccination structure, we conducted an OCV campaign in two phases targeting all people above one year of age in the affected communities and IDP camps. Results: We line-listed 6,430 suspected cholera cases. Of these, total deaths were 61 (CFR: 1.1%) 3512 (54.6%) cases were reported from Jere, 1870(29.1%) Monguno, 845 (13.3%) Dikwa, 115 (1.8%) Guzamala, 63 (1.0%) Maiduguri, 23 (0.4%) Mafa and 2 (0.03%) from Gubio LGAs. 6109 (95%) of the cases were seen in IDP camps.
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