Lassa Fever: A Deadly Disease

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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. Martins Ifijeh writes

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.

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.”

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.

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.

“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.”

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.

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

“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.”

Bode said in case of any suspected case of Lassa fever, LUTH response team should be notified on 08058019466, 08058744780, 07035521015 and 08023299445.