Forty-eight years after the
discovery of Lassa fever in Nigeria, the virus has remained a recurring
challenge with hundreds of lives lost every year to the disease. Recent
cases in Lagos, Ogun and other states have again brought to the fore the
need for a permanent solution to the menace.
When in 2015 and 2016 Nigeria recorded one of the largest outbreak of
Lassa fever with 273 reported cases resulting in 149 deaths, spread
across 23 states, the Nigeria Centre for Disease Control (NCDC)
described it as the last straw, saying it was putting measures in place
to prevent future occurrence.
The Centre’s Chief Executive Officer,
Chikwe Ihekweazu, specifically said in Lagos that with the inauguration
of the Lassa Fever Eradication Committee under the leadership of
Professor, Oyewale Tomori, solutions would be proffered towards
preventing future outbreaks and reduce the deaths from the disease.
Corroborating Ihekweazu’s statement, the
Minister of Health, Prof. Isaac Adewole, earlier last year also said
the government would stamp out Lassa fever outbreaks from the country
before the end of the year (that is 2016).
“We are also concerned. We want to find
out why we are still having this Lassa fever in spite of human and
material resources that we have in this country. We inaugurated a Lassa
Fever Eradication Committee chaired by one of the foremost virologists
in this country, and we are committed to signing the obituary of Lassa
fever this year (2016),” he said.
But fast forward a year and half after,
Nigeria is in a familiar scenario. Over 106 persons have so far died
from the recent outbreak which started in December 2016 with more than
200 laboratory confirmed cases and over 1,000 people placed under
surveillance at different times, scattered across 18 states of the
federation.
Like a recurring decimal, the spread of
the present outbreak can almost be predicted, especially by keen
observers who had monitored previous outbreaks and how they played out.
First, an outbreak will be recorded in a
state, then it spreads to neighbouring states, with many confirmed
cases, accompanied by casualty figures, and then suddenly, there will be
interventions by the relevant bodies to tackle it, including sending
out press releases on awareness. Then the outbreak dies down, and in few
months time, picks up again, while exactly the same approach the
government used the last time will be used again to suppress it.
Since the past eight months of this year, the outbreak has occurred in 18 states, including
Anambra, Bauchi, Borno, Cross River, Ebonyi, Edo, Enugu, Gombe, Kaduna, Kano, Kogi, Nasarawa, Ogun, Ondo, Plateau, Rivers, Taraba, and more recently Lagos. It is still very much active in about 10 states with bouts of cases recorded at intervals.
The recent is that of Lagos State, which quickly gained media attention because of the uniqueness of the state in terms of population (22 million residents) and its economic and cosmopolitan nature.
Anambra, Bauchi, Borno, Cross River, Ebonyi, Edo, Enugu, Gombe, Kaduna, Kano, Kogi, Nasarawa, Ogun, Ondo, Plateau, Rivers, Taraba, and more recently Lagos. It is still very much active in about 10 states with bouts of cases recorded at intervals.
The recent is that of Lagos State, which quickly gained media attention because of the uniqueness of the state in terms of population (22 million residents) and its economic and cosmopolitan nature.
Last week, Lagosians were greeted with
the outbreak of the hemorrhagic fever in the state, which unfortunately
killed two persons in the Lagos University Teaching Hospital (LUTH),
Idi-Araba, while three resident doctors of the Department of Anatomy and
Molecular Pathology got infected, and are currently receiving
treatment.
Also, not less than 122 persons are
currently under surveillance in the state. 100 in LUTH and 22 in Imota,
Ikorodu where the index case, the late 32 years old pregnant woman first
received treatment before she was taken to LUTH for further treatment.
She unfortunately died of bleeding following a still birth in the
hospital.
Lagosians, reacting to the outbreak called on the government to contain it considering the volatile nature of the state.
But the Director of Disease Control,
Lagos State Ministry of Health, Dr. Eniola Eniosho, told THISDAY that
there was no need for panic as the state will be declared Lassa fever
free in few days, adding that the three infected were responding to
treatment, and would be discharged this week.
“In few days the 100 health workers in
LUTH and the 22 persons from Ikorodu (including some family members of
the index case from Imota) who are under 21 days surveillance would be
certified free since none of them has so far come down with fever.
Some stakeholders are of the opinion
that old approaches against Lassa fever outbreaks should be suspended,
as it has obviously not yielded lasting solutions to the menace, while
also calling for solutions geared towards vaccines and establishment of
Lassa fever centres for prompt tackling of the scourge.
They said government must look beyond
providing fire brigade approaches to ending disease outbreaks in the
country, adding that, that had been the approach since the very first
outbreak of the virus, which was why at 48 years after, people were
still dying from the disease.
For example, a Virologist, Dr. Olaolu
Akinjide, believes since the disease originated from Lassa community in
Borno State, it behoves on the country to find a lasting solution to its
reoccurring bouts, which he said was becoming a national embarrassment.
“It’s almost 50 years since the first
case of the disease was noticed here. We should not wait for another
country to find a vaccine for us. Researches in this regard should be
given priority by the government. We have a medical research institute
that should be funded to come up with solutions,” he said.
This again brings to fore the level of
priority placed on medical research in the country. While the United
States National Institute of Health will spend about 32.3 billion
dollars this year alone on medical research for the American people, the
entire health budget for Nigeria cannot be said to be anywhere close to
that figure.
According to the World Health
Organisation, between 300,000 and 500,000 cases of Lassa fever are
recorded annually, with about 5,000 deaths recorded yearly, especially
in sub-Saharan Africa.
Apart from Nigeria, which has one of the
highest burdens of the disease, other countries that have recorded the
outbreak are Liberia, Sierra Leone, Guinea and the Central African
Republic.
Akinjide also wondered why the country
only has two active Lassa fever centres to cater for the several
Nigerians who are infected yearly by the virus. “The government should
scale up the establishment of Lassa fever centres across the country.
The present two centres, which are the ones in Irrua Specialist Teaching
Hospital (ISTH) and that in Lagos University Teaching Hospital (LUTH)
cannot be said to be enough for prompt diagnosis and treatment of
cases,” he explained.
Though the federal government had
consistently said the country has 13 Lassa fever centres, Akinjide
insists that there were only two centres serving the over 180 million
persons living in the country.
Transmission
According to the Chief Medical Director, LUTH, Prof. Chris Bode, the reservoir or host of the Lassa virus is the multi-mammate rat called Mastomysnatalensis, which has many breasts and lives in the bush and around residential areas. “The virus is shed in the urine and droppings of the rats hence can be transmitted through direct contact, touching objects or eating food contaminated with these materials or through cuts or sores. Transmission also occurs in health facilities where infection prevention and control practices are not observed. Person to person transmission also occurs most especially when a person comes in contact with the virus in the blood, tissue, secretions or excrements of an infected individual.”
According to the Chief Medical Director, LUTH, Prof. Chris Bode, the reservoir or host of the Lassa virus is the multi-mammate rat called Mastomysnatalensis, which has many breasts and lives in the bush and around residential areas. “The virus is shed in the urine and droppings of the rats hence can be transmitted through direct contact, touching objects or eating food contaminated with these materials or through cuts or sores. Transmission also occurs in health facilities where infection prevention and control practices are not observed. Person to person transmission also occurs most especially when a person comes in contact with the virus in the blood, tissue, secretions or excrements of an infected individual.”
Who is at risk?
According to Bode, Lassa fever occurs in all age groups and both sexes, adding that persons at greatest risk are those living in rural areas where Mastomys are usually found, especially in communities with poor sanitation or crowded living conditions. “Health workers are at risk if Lassa fever is not suspected or while caring for Lassa fever patients in the absence of proper barrier nursing and infection control practices.
According to Bode, Lassa fever occurs in all age groups and both sexes, adding that persons at greatest risk are those living in rural areas where Mastomys are usually found, especially in communities with poor sanitation or crowded living conditions. “Health workers are at risk if Lassa fever is not suspected or while caring for Lassa fever patients in the absence of proper barrier nursing and infection control practices.
Signs and symptoms
“The onset of the disease when it is symptomatic, is usually gradual, starting with fever, general weakness, muscle and joint pains, prostration and malaise. After a few days, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and abdominal pain may follow.
“The onset of the disease when it is symptomatic, is usually gradual, starting with fever, general weakness, muscle and joint pains, prostration and malaise. After a few days, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and abdominal pain may follow.
“In severe cases, facial swelling, fluid
in the lung cavity, bleeding from the mouth, nose, vagina or
gastrointestinal tract and low blood pressure may develop. Protein may
be noted in the urine. Shock, seizures, tremor, disorientation, and coma
may be seen in the later stages. Deafness occurs in 25 per cent of
patients who survive the disease. In half of these cases, hearing
returns partially after 1-3 months. Transient hair loss and gait
disturbance may occur during recovery. Patients may die from shock,” he
added.
Laboratory diagnosis
“Lassa virus infections can only be diagnosed definitively in a virology laboratory using the following tests: the reverse transcriptase polymerase chain reaction (RT-PCR) assay, testing for IgM, antigen detection tests and virus isolation by cell culture.These tests can be done at Virology Reference Laboratory at Lagos University Teaching Hospital, Idi-Araba, Lagos.”
“Lassa virus infections can only be diagnosed definitively in a virology laboratory using the following tests: the reverse transcriptase polymerase chain reaction (RT-PCR) assay, testing for IgM, antigen detection tests and virus isolation by cell culture.These tests can be done at Virology Reference Laboratory at Lagos University Teaching Hospital, Idi-Araba, Lagos.”
Management
He explained that the only known specific treatment for Lassa fever is Ribavirin, which may be effective if given within the first six days of illness. “It should be given intravenously for 10 days. Supportive treatment should include; Paracetamol, Vitamin K (Phytamenadione), Heamacel, Ringers lactate, antimalaria and antibiotics- start by I.V. If patient is severely anaemic, consider transfusion.There is currently no vaccine that protects against Lassa fever,” he added.
He explained that the only known specific treatment for Lassa fever is Ribavirin, which may be effective if given within the first six days of illness. “It should be given intravenously for 10 days. Supportive treatment should include; Paracetamol, Vitamin K (Phytamenadione), Heamacel, Ringers lactate, antimalaria and antibiotics- start by I.V. If patient is severely anaemic, consider transfusion.There is currently no vaccine that protects against Lassa fever,” he added.
Prevention of Lassa fever
He said 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
He said 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
“In healthcare settings, prevention is
by standard precautions where all blood and body fluids are considered
potentially infectious. Standard precautions are applied to all patients
at all times and in all health care settings. These include hand
hygiene, use of appropriate personal protective equipment (PPE), waste
disposal, cleaning and disinfection of medical equipment and
environment, safe injection practices.”
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