The 2018 Lassa fever outbreak in Nigeria exposed critical gaps in infection prevention and control (IPC), highlighting vulnerabilities in the country’s healthcare system. Dr. Tochi Okwor, Head of Disease Prevention and Control at the Nigeria Centre for Disease Control and Prevention (NCDC), recently recounted the devastating impact of the epidemic and the urgent need for systemic reforms.
Speaking in an interview on Monday in Abuja, Okwor reflected on how hospitals struggled to contain the outbreak, putting healthcare workers at serious risk. Despite lessons learned from previous crises—such as the Ebola outbreak—the Lassa fever epidemic demonstrated that IPC measures were still not fully integrated into daily hospital practices.
Current State of Lassa Fever in Nigeria
According to Science Nigeria, the NCDC reported a decline in new Lassa fever cases in Epidemiological Week 9, 2025, with 29 new cases recorded across nine states, down from 54 cases the previous week. However, the fatality rate remains high at 18.7%, with 100 deaths recorded so far this year.
The hardest-hit states—Ondo, Bauchi, and Edo—account for 72% of all confirmed cases, with Ondo leading at 31%. Alarmingly, one new healthcare worker has been infected, bringing the total number of affected medical personnel in 2025 to 17.
During the 2018 Lassa fever outbreak, hospitals—meant to be safe spaces—instead became hotspots for disease transmission. Okwor recalled how overcrowded emergency departments and makeshift holding areas for suspected patients put even experienced medical personnel at risk.
“Every infection was a wake-up call, a reminder of the vulnerabilities in our system,” she said.
The crisis saw 44 healthcare workers infected, underscoring the urgent need for systemic change. Okwor stressed that these were not just numbers but frontline defenders whose safety had been compromised due to IPC failures.
Assessing and Reforming Infection Control
In response to the outbreak, Okwor led a nationwide assessment using the WHO Infection Prevention and Control Assessment Framework (IPCAF). This initiative went beyond immediate treatment centres, conducting full hospital evaluations to identify weaknesses and drive long-term reforms.
“It wasn’t enough to merely respond to the outbreak,” she stated. “We needed a lasting system to protect our healthcare workers every day.”
This effort led to the creation of the IPC Scorecard, now used in hospital audits and national health facility assessments to ensure that infection control measures are consistently implemented.
A Call for Sustainable IPC Integration
Okwor emphasized that IPC must be embedded into daily hospital operations, not treated as an afterthought during disease outbreaks. Her leadership in policy reform and infection control advocacy serves as a call to action for healthcare stakeholders.
As Nigeria strengthens its IPC framework, the lessons from 2018 serve as a powerful reminder of the need for systemic change. Okwor’s work stands as a testament to resilience and bold, data-driven leadership in times of public health crises.
Understanding Lassa Fever
Lassa fever is a viral hemorrhagic disease caused by the Lassa virus, primarily spread through contact with food or household items contaminated by the urine, feces, or saliva of infected rodents. Human-to-human transmission also occurs, especially in healthcare settings with inadequate IPC measures.
Nigeria records Lassa fever cases year-round, with peak transmission occurring between October and May. Strengthening infection prevention and control remains critical in the fight against infectious diseases and in ensuring the safety of healthcare workers and patients alike.
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