50 years after Lassa fever was discovered in a Nigeria village called Lassa, the disease has continued to wreak havoc in communities across the country.
Statistics show that about 300,000 people across West Africa are affected and about 5,000 lose their lives annually due to the deadly disease caused by multimammate rats.
investigation shows that only a few laboratories in the world can diagnose Lassa virus which often leads to delays in commencing treatment
While the disease has been adjudged to be endemic in Nigeria following its occurrence throughout the year, experts say Lassa fever remains a poorly understood disease that is challenging to diagnose and treat. For them, to stop the raging outbreaks and improve patients’ survival, there is need to better understand the mechanics of the disease, develop better tools to diagnose cases early, evaluate vaccine candidates to prevent future outbreaks as well as improve treatment molecules.
One event that will remain evergreen in the minds of health-conscious Nigerians and stakeholders in 2018 will be Lassa fever outbreak. This is a year adjudged to have recorded the largest Lassa fever cases both in affected and the number of deaths.
In 2018, statistics from the 23 states of the country reported 3,498 suspected cases of Lassa fever with 45 healthcare workers among the 633 confirmed cases. Since then, the disease has continued to wreak havoc despite efforts of the Nigeria Centre for Disease Control (NCDC) and other stakeholders.
Sadly, the deadly outbreak took a new twist in January which led the NCDC to officially declare, on January 22, 2019, another outbreak. Many Nigerians have been admitted in hospital due to Lassa fever. And these patients arrive in advanced stages of the disease, which require more specialised care. At the Federal Medical Centre Owo alone, reports say more than 50 suspected patients have been admitted in the Lassa ward recently.
Currently, in the country, the high number of cases has stretched the treatment capacity while the NCDC and other health workers continue to do their best to care for patients.
Health facilities are now in need of continued support, especially human resources, medical supplies and drugs.
For instance, at the Federal Medical Centre Owo, where a medical Non-Governmental Organisation, Alliance for International Medical Action, ALIMA, is offering support for victims, Dr Marie Jaspard, in a report, called for urgent support for more resources following the increase in cases. According to Jaspard in that report, if the caseload continues to increase, without further funding, the support they are providing to the Owo hospital will stop within a month.
Meanwhile the NCDC says although the country is recording a slight drop in cases when compared with the cases recorded in January when the outbreak hit the rooftop, in the week ending March 3, 2019, 39 new confirmed cases were reported from six states of Edo, Ondo, Ebonyi, Bauchi, Taraba, and Kogi, with eight new deaths in Edo, Ondo, and Kogi.
Overall, 33 states and the FCT have reported a total of 1,447 suspected cases since the onset of the 2019 outbreak with 93 deaths in confirmed cases. At least, 21 states have recorded one confirmed case across 66 local government areas.
According to the NCDC situation report, in the reporting week 09, no new health care worker was affected but a total of 15 health care workers have been infected since the onset of the outbreak in seven states with one death in Enugu, 69 patients are currently being managed at various treatment centres across the country. A total of 4,902 contacts have been identified from 19 states.
However, many Nigerians keep wondering why it is so hard to terminate this outbreak despite huge resources being deployed by government and other partners.
They worry that the disease used to be seasonal but recent outbreaks has taken a new twist as it has continued unabated.
They ask if there no end to Lassa fever outbreak.
However, Sunday Vanguard investigation shows that the fever, a viral haemorrhagic fever that spreads through humans contact with infected multimammate rats, continues to pose a big challenge due to the nature of the disease and the source of infection.
Also, managing Lassa fever entails a lot. But, unfortunately, 50 years after the discovery, Nigeria lacks the necessary equipment to diagnose and treat the disease.
Why outbreak persists
In an interview with Sunday Vanguard during a workshop organised by the Lagos State branch of Nigeria Medical Association, NMA, Ogun State Commissioner for Health, Dr Babatunde Ipaye, explained that the primary source of infection, which is through rat that usually comes in contact with humans during planting season, has made it impossible to eradicate or prevent the outbreak.
Ipaye, who noted that Lassa fever has become a consistent epidemic in Nigeria, said Nigeria will continue to experience the epidemic unless the country is able to establish the multimammate rats in their natural hood.
“Lassa fever is no longer new in Nigeria and we should be able to manage Lassa communications in a very effective well”, he said.
“So what we should be focusing on is to be prepared to prevent the multimammate rat during Lassa epidemic season. We understand the epidemiology of Lassa and because the source is not man it would be difficult to eradicate.”
According to him, the virus does not traditionally affect the multimammate rat which carries them even if they live with it. So as long as there is man-animal contact, there will be an epidemic.
Ipaye identified preparedness as one of the strategies to respond to the epidemic response, stressing the need for Nigeria to start early communication and information provision for people, particularly farmers in rural communities who displace these multimammate rats when they clear bushes which serve as their natural habitation.
“When these rats are displaced from their natural habitations, they will come close to man and live. And when they come close to man, they contaminate our food items and, when the food items are contaminated, we consume them and get infected. Through education, we can enlighten our people. What we should do is to start early education more than we do before the epidemic started.
“And after every rainy season, we should try to educate our farmers on how to dry their foods to make sure that foods in our kitchens are well covered to make sure that the foods and drinks are not contaminated. We must maintain good environmental hygiene. Stop putting dirt around our homes because it attracts rats,” he stated.
“Every fever that exceeds three days after treating malaria should be investigated. Healthcare providers must maintain a high level of caution and ensure that universal precaution is adopted as they manage every patient. Once we do all of these, we will be able to limit the impact of Lassa fever but to say Lassa will not come that is not possible. Until we vaccinate everyone and make sure that their immunity is very high. At the national response level, what we need to do is to commence early education of our people and also expect that Lassa will come and when it comes we should be prepared to manage it”.
Stating that government had been offering free dry season vaccination in epidemic-prone areas, he noted that until the country develops level health immunity for people, Lassa will continue to live with the people.
Reasons patients die
investigation shows that only a few laboratories in the world can diagnose Lassa virus which often leads to delays in commencing treatment.
According to Dr Hilde De Clerck, who spoke during the first-ever international conference on Lassa fever, held in Abuja in January, despite half a century since the fever was discovered in Nigeria, healthcare workers in West Africa still urgently need appropriate equipment and training to safely manage patients of all ages affected by the disease.
While the NCDC recently announced the review of its Lassa fever outbreak response which, it claimed, was yielding positive results, health watchers are of the view that to effectively tackle outbreak, Nigeria needs not only better understanding of the mechanics of the disease but also needs to develop better tools to diagnose cases early, evaluate vaccine candidates to prevent future outbreaks and improve treatment molecules, in order improve patients’ chances of survival.
Ebonyi State Commissioner for Health, Dr Umezurike Daniel, pointed out that one of the major challenges of treating Lassa fever is the nature of the disease itself because, at the onset, it mimics ailments like malaria
He explained that a lot of time is wasted before the patient actually presents for treatment, and the prognosis gets very bad if treatment is not commenced within six days from the onset of symptoms.
Also, treating Lassa fever requires appropriate use of personal protective equipment and other infection prevention and control measures, to protect healthcare workers and relatives of patients.
Efforts to curb disease
The Nigerian government, through the NCDC, may not have relented in its efforts to tackle Lassa outbreaks. Only last week in a report, the NCDC Director General, Dr Chikwe Ihekweazu, said the body had launched an intensive response to the latest outbreak.
According to him, in the last three weeks, there has been a downward trend in new cases.
Ihekweazu said the number of new cases being reported has become lower compared to the same period during the 2018 outbreak.
He added that despite the reduction in new cases, response activities were being intensified at the national and state levels. “Rapid Response Teams (RRTs), which include officials from the Federal Ministries of Agriculture and Rural Development and Environment, are supporting the response in high burden states like Edo, Ondo, Ebonyi, Plateau and Bauchi”, he said.
Ihekweazu noted that NCDC was also supporting states in ensuring full availability of drugs, personal protective equipment, reagents and other supplies required for case management and diagnosis of Lassa fever.
The Centre has also attributed improvements to various factors including the early deployment of One-Health national RRTs, strengthening of Lassa fever treatment centres, enforcement of environmental sanitation, the introduction of the Infection Prevention and Control among others. NCDC further noted that the surveillance data from previous outbreaks indicate that the typical peak transmission season for Lassa fever has not passed, calling on Nigerians to practice preventive measures to avoid infection.
“Prevention of Lassa fever relies on promoting good community hygiene to discourage rodents from entering home”, he said.
Prevention and control
According to WHO, prevention of Lassa fever relies on promoting good ‘community hygiene’ to discourage rodents from entering homes. Effective measures include storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, maintaining clean households and keeping cats. In health-care settings, staff should always apply standard infection prevention and control precautions when caring for patients, regardless of their presumed diagnosis.
Health-care workers caring for patients with suspected or confirmed Lassa fever should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding.
Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Lassa virus infection should be handled by trained staff and processed in suitably equipped laboratories under maximum biological containment conditions.