Enhancing preparedness, readiness, and response to Lassa fever outbreaks in Nigeria: Reflections from the 2023 Lassa fever outbreak after action review

Introduction Lassa fever is a zoonotic caused by an old world arenavirus, Lassa virus. Although, other rodents carry the virus, the multimammate Rat is the major reservoir and has been found to be abundant in endemic countries in West Africa. This study reviewed the Nigerian outbreak of 2023 to ensure no outbreak lessons goes to waste. Methods The 2023 Lassa fever outbreak was reviewed using the WHO working group After Action Review (AAR) toolkit. Within 6 weeks of de-escalation of the Emergency Operations Centre, the 2023 AAR was conducted between 31st July to 2nd August 2023 with a total of 40 participants drawn from; the State Ministries of Health of reporting states across the country, Nigeria Centre for Disease Control and Prevention, National Lassa Fever TWG, physicians from major treatment centres, and key partners. A qualitative and participatory approach using the standardized WHO framework and tools (WHO guide for AAR; facilitators and participants manual). The AAR focused on the 2024 LF outbreak response that occurred between January and July. Results A total of 75 activities were identified for immediate actions among which 50 key activities were prioritized to improve future Lassa fever outbreaks and other public health emergencies. Top prioritised activities included the need for a One Health implementation research, advocacy, enhanced surveillance and reporting, bolster risk communication/community engagements and increase the number of labs for Lassa fever diagnosis. Conclusion Although, the case fatality rate has been on the decline, it is still a far from the less than 10% national target. Thus, there is a need to ensure that all stakeholders across the human-animal-environment interface are actively involved in the control and management efforts of Lassa fever in, within and around the borders of Nigeria.