Irrua Specialist Teaching Hospital is a federal government of Nigeria teaching hospital located in Irrua, Edo State, Nigeria. The current chief medical director is Sylvanus A. Okogbenin. Okogbenin.
Major advances in tuberculosis diagnostics and biomarker research from 2020 to 2025 have informed updated WHO policy guidance, consolidating recommendations for the detection of tuberculosis disease and drug resistance within a single framework. These recommendations align screening, diagnosis, and drug-resistance testing across populations and specimen types. Digital chest radiography, increasingly supported by computer-aided detection, is now a core WHO-recommended screening and triage tool, improving case detection and referral for confirmatory testing at scale. Decentralised molecular diagnosis has expanded through diversified deployment of WHO-recommended rapid diagnostic test classes, particularly low-complexity automated nucleic acid amplification tests (NAATs), including the Xpert MTB/RIF Ultra and Truenat platforms. These tests are complemented by low-complexity manual NAATs such as tuberculosis loop-mediated isothermal amplification and by emerging near point-of-care molecular platforms under evaluation. Latest WHO policy updates have also introduced a new class of near point-of-care NAATs designed for decentralised use, alongside novel specimen types such as tongue swabs for individuals unable to produce sputum, and programmatic innovations, including sputum pooling, to improve efficiency. Expanded use of molecular diagnostics across non-sputum specimens, including stool, gastric aspirate, and nasopharyngeal samples, together with simplified workflows, has improved bacteriological confirmation in children and other sputum-scarce populations. Rapid molecular drug-resistance testing has advanced with Xpert MTB/XDR, and targeted next-generation sequencing is now recognised as a WHO-endorsed approach for comprehensive drug-susceptibility testing at reference laboratory level. Urine lipoarabinomannan-based assays improve diagnostic yield in people with HIV, particularly those with advanced disease, although performance limitations constrain broader use. Substantial performance, implementation, and equity gaps remain. In parallel, host blood transcriptomic signatures show strong short-term prognostic and triage performance, and additional proteomic, metabolomic, cellular, imaging, and pathogen-derived biomarkers are advancing through clinical evaluation. However, no biomarker has yet met the WHO target product profile criteria for a point-of-care test that reliably distinguishes M tuberculosis infection from tuberculosis disease, including asymptomatic or minimally symptomatic tuberculosis disease, often described in the research literature as subclinical tuberculosis.
BACKGROUND:Lassa fever is an emerging zoonotic disease endemic to west Africa. Several vaccines aimed at preventing Lassa fever are currently under development, creating a need to assess how best to administer them once licensed for human use. We aimed to project the health-economic burden of Lassa fever from 2025 to 2037 across age and sex groups in subnational administrative divisions of west Africa with endemic Lassa mammarenavirus transmission and to estimate the cost-effectiveness of targeting Lassa vaccination to different risk groups. METHODS:In this vaccine-impact modelling study, we developed a mathematical model using a zoonosis risk map and epidemiological data from recent and ongoing cohort studies to predict the health-economic burden of Lassa fever across age and sex groups in endemic regions. We simulated vaccination campaigns targeting different risk groups to estimate the cost-effectiveness of various strategies for Lassa vaccine administration. Threshold vaccine costs (TVCs), which represent the break-even price per dose of vaccine administered, were estimated in international dollars (INT$ 2023), accounting for health-care costs, productivity losses, and monetised disability-adjusted life-years (DALYs) averted by vaccination. FINDINGS:Lassa fever was estimated to cause 6·23 (95% uncertainty interval (UI) 4·21-8·42) hospitalisations, 0·75 (0·48-1·10) deaths and 31·1 (17·7-52·2) DALYs per 100 000 person-years. Vaccine strategies targeting adolescents-adults aged 15-49, older adults aged 50 years and older, and women of childbearing age (WCBA) aged 15-49 years prevented, respectively, the most hospitalisations, deaths, and DALYs per 100 000 vaccine doses. Under base case assumptions, the most cost-effective strategy (greatest net monetary benefit) was untargeted vaccination for a vaccine costing INT$2 per dose, and targeting adolescents-adults at $5 per dose. At $10 per dose or more, none of the considered strategies were cost-effective. The highest TVC for a single-dose vaccine was estimated at $7·39 (95% UI 4·33-11·60) when targeting adolescents-adults, followed by $6·69 (4·17-9·85) when targeting older adults, $6·10 (3·56-9·74) when targeting WCBA, and $1·94 (1·10-3·10) when targeting children. INTERPRETATION:Targeting of adolescents-adults appears to generate the greatest health-economic value per vaccine dose. However, the most cost-effective vaccination strategy will depend on vaccine price. FUNDING:Coalition for Epidemic Preparedness Innovations.
Background: Marburg virus disease (MVD) poses an emerging threat to Nigeria, particularly following the 2022 outbreak in neighbouring Ghana. With Nigeria already managing Lassa fever and Mpox outbreaks, assessing healthcare workers’ preparedness at viral haemorrhagic disease reference centres is crucial for effective outbreak response. Objectives: This study aimed to assess healthcare workers’ knowledge, attitudes and preparedness regarding MVD at Nigeria’s primary viral haemorrhagic fever reference centre. Method: A cross-sectional study was conducted at Irrua Specialist Teaching Hospital, from May 2024 to October 2024. Healthcare workers were recruited using simple random sampling and data collected via semi-structured questionnaires. Descriptive and inferential statistics were analysed using Stata 17. Results: Of the 216 participants, 126 (58.3%) were doctors and 90 (41.7%) were nurses. Doctors demonstrated significantly higher knowledge of MVD symptoms (65.9% vs 46.7%, p 0.001) and risk factors, with fever being the most recognised symptom (68.0%). Only 19.1% of doctors and 10.0% of nurses had received formal MVD training. Confidence in hospital preparedness was paradoxically lower among doctors (32.5%) than nurses (65.6%, p 0.001). Most participants felt inadequately equipped with personal protective equipment, with only 38.1% of doctors and 48.9% of nurses reporting adequate protection. Conclusion: Significant gaps exist in MVD health literacy and outbreak preparedness among Nigerian healthcare workers at a major viral haemorrhagic disease centre. Contribution: Enhanced training programmes, improved resource allocation and systematic preparedness protocols are urgently needed to strengthen Nigeria’s capacity for MVD outbreak response.
Background. Neurological complications of Lassa fever (LF) are associated with fatal outcome. In this study, we aimed to provide further evidence of Lassa virus (LASV) infection of the central nervous system (CNS) by assessing LASV in cerebrospinal fluid (CSF). Methods. We retrospectively screened the database of the LF diagnostic unit at Irrua Specialist Teaching Hospital in Nigeria for patients with suspected or confirmed LF who underwent lumbar puncture as part of their routine clinical management due to CNS symptoms and had CSF samples tested by LASV reverse-transcription polymerase chain reaction (RT-PCR). Results. RT-PCR results for CSF were available for 153 patients, all children. LF was confirmed in 49 of 153 (32%) patients, of whom 42 (86%) were LASV RNA positive in CSF. Of the 42 patients, 33 (79%) were LASV RNA positive in CSF and plasma, whereas 9 (21%) patients were positive in CSF only. The CSF-positive LF patients had a median age of 10.5 years. Sample pairs of CSF and plasma taken within a day of each other on admission were available for 26 patients, of whom 23 (88%) had higher LASV RNA concentration in CSF compared to plasma (cycle threshold, 28.2 vs 36.7, respectively; P < .00001). Conclusions. LASV is frequently detected in CSF of pediatric LF patients with neurological symptoms. The virus load in CSF is usually higher than in plasma, indicating a neuroinvasive infection with active virus replication in CNS. Our findings have implications for clinical management of LF patients and drug development for LF.
OBJECTIVE:Lassa fever is a viral haemorrhagic disease endemic in West Africa. While several vaccine candidates are in development, evidence to guide policy- and decision-making on vaccines remains limited. We convened a Policy Research Working Group (PRWG) to develop a prioritised research agenda to reduce delays related to policy- and decision-making. METHODS:Using the Child Health and Nutrition Research Initiative (CHNRI) methodology, we conducted a two-phase prioritisation exercise. First, a rapid assessment of literature and expert interviews was conducted to identify evidence gaps, which were refined into 29 questions across four thematic categories. In phase two, 235 experts scored these questions using five criteria. RESULTS:Research Priority Scores (RPS) ranged from 80% to 92%, indicating the importance of the identified research questions. Thirteen research questions were prioritised, focusing on defining vaccination target groups, assessing vaccine efficacy in special populations, evaluating economic impact, and understanding vaccine acceptance. High expert agreement (67-85%) reinforced the robustness of the prioritisation outcomes. CONCLUSIONS:This stakeholder-driven agenda highlights the most critical evidence needs to guide vaccination policies, national decision-making, and implementation planning for future Lassa fever vaccines. Early alignment between research and policy can accelerate vaccine introduction and ensure equitable access in endemic regions.
