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Health Secur. 2020 Jan;18(S1):S105-S112. doi: 10.1089/hs.2019.0080.

Improving Cross-Border Preparedness and Response: Lessons Learned from 3 Lassa Fever Outbreaks Across Benin, Nigeria, and Togo, 2017-2019.

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Clement Glèlè Kakaī, MD, is Director of Epidemiological Surveillance and Border Health Surveillance Service, and Godjedo Togbemabou Primous Martial, MPH, is Division Director of Epidemiology and Integrated Disease Surveillance; both in the National Directorate of Public Health, Ministry of Health, Cotonou, Benin. Oyeladun Funmi Okunromade, MBBS, is Assistant Director Surveillance/IHR, Department of Surveillance and Epidemiology; Chioma Cindy Dan-Nwafor, MPH, is Deputy Incident Manager, Lassa fever, Department of Surveillance; Elsie Ilori, MSc, is Director and Incident Manager, Lassa fever, Department of Surveillance; Olubunmi Eyitayo Ojo, MSc, is Director, Disease Surveillance and Epidemiology; and Chikwe Ihekweazu, MD, is Director General; all in the Nigeria Centre for Disease Control, Federal Ministry of Health, Abuja, Nigeria. Ali Imorou Bah Chabi, MPH, is Health Program Coordinator, Health Program, and Idrissa Kone, MBA, is Executive Secretary; both in the Abidjan Lagos Corridor Organization, Cotonou, Benin. Mahmood Muazu Dalhat, MBBS, is Technical Advisor to the National Centre for Disease Control, Public Health Technical Department, and Patrick Mboya Nguku, MSc, is Senior West Africa Regional Technical Coordinator; both at the African Field Epidemiology Network (AFENET) Nigeria, Abuja, Federal Capital Territory, Nigeria. Sarah Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Ouyi Tante, a public health engineer, is National Cholera Officer and Other Diarrheal Diseases, Division of Disease Control; Assane Hamadi, MD, is Head of the Division of Integrated Surveillance of Health Emergencies and Response, Directorate of Disease Control and Public Health Programs; and Tamekloe Tsidi Agbeko, DrPH, is Director, Division of Disease Control; all in the Ministry of Health, Lomé, Togo. Virgil Lokossou, MPH, MSci, is Head of Division and Team Lead, Emergency Preparedness and Response Division, and Carlos Brito, MD, is Director, Public Health and Research; both in the West Africa Health Organization, Bobo Dioulasso, Burkina Faso. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention or other participating agencies.


Long-standing cultural, economic, and political relationships among Benin, Nigeria, and Togo contribute to the complexity of their cross-border connectivity. The associated human movement increases the risk of international spread of communicable disease. The Benin and Togo ministries of health and the Nigeria Centre for Disease Control, in collaboration with the Abidjan Lagos Corridor Organization (a 5-country intergovernmental organization) and the US Centers for Disease Control and Prevention, sought to minimize the risk of cross-border outbreaks by defining and implementing procedures for binational and multinational public health collaboration. Through 2 multinational meetings, regular district-level binational meetings, and fieldwork to characterize population movement and connectivity patterns, the countries improved cross-border public health coordination. Across 3 sequential cross-border Lassa fever outbreaks identified in Benin or Togo between February 2017 and March 2019, the 3 countries improved their collection and sharing of patients' cross-border travel histories, shortened the time between case identification and cross-border information sharing, and streamlined multinational coordination during response efforts. Notably, they refined collaborative efforts using lessons learned from the January to March 2018 Benin outbreak, which had a 100% case fatality rate among the 5 laboratory-confirmed cases, 3 of whom migrated from Nigeria across porous borders when ill. Aligning countries' expectations for sharing public health information would assist in reducing the international spread of communicable diseases by facilitating coordinated preparedness and responses strategies. Additionally, these binational and multinational strategies could be made more effective by tailoring them to the unique cultural connections and population movement patterns in the region.


Epidemic management/response; International collaboration; Lassa fever; Surveillance


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