Stopping Incessant Outbreaks of Lassa Fever

Lassa fever is preventable

With the re-emergence of Lassa fever in Ogun State, and the palpable fear that it might spread to other parts of the country, Martins Ifijeh writes on the need for stakeholders and the government to find a lasting solution to the recurring outbreaks

When early last year Nigeria recorded another bout of Lassa fever outbreak, which unfortunately took the lives of over 80 Nigerians, the Minister of Health, Prof. Isaac Adewole promised that the President Muhammadu Buhari-led Federal Government would find a lasting solution to the incessant outbreaks through awareness creation, optimised research, the upgrade of existing Lassa fever centres and the establishment of new centres across the country.

But before the year ended last week, the country recorded at least three outbreaks. Each of which took along with them the lives of Nigerians who ordinarily should live to celebrate the dawn of 2017 if vaccines against the fever were available or had the proper education to prevent the scourge or access treatment on time.

The latest of the outbreaks, being the one reported in the Federal Medical Centre (FMC), Abeokuta, Ogun State, took along with it two casualties, an Assistant Nursing Officer, Adesuyi Abolanle and a serving corp member only identified as Okusaga. The corp member was believed to have contracted the virus through a Lebanese patient who later died, while Abolanle treated the corp member, where in turn she got infected.

In dousing the tension, the State Government, through the Commissioner for Health, Dr. Babatunde Ipaye, said everything would be done to curtail further spread of the deadly virus. He allayed the fear of the staff, particularly the nurses, saying the situation does not call for unnecessary panic.

“We are going to immediately create an isolation centre here at FMC to cater for unexpected cases and emergency on public health issues like Lassa fever to include other communicable diseases and have set officers out to confirm the root of the cases,” he said.

But with a routine assurance given by either the government of states where the outbreaks are recorded or by the Federal Government anytime there was an outbreak, experts believed the governments and stakeholders can make eradication of the hemorrhagic fever a top priority rather than putting palliative and mitigating impacts on ground to curtail every outbreak anytime it occurs.

A Virologist, Dr. Olaolu Akinjide said until a lasting solution was found, there would continue to be outbreaks. “Nigerians will continue to suffer the pain of losing loved ones anytime an outbreak occurs,” he said.

He said with a fairly new government in place, from the Presidency, the Federal Ministry of Health, up to the Nigerian Institute for Medical Research (NIMR) and the Nigeria Centre for Disease Control, (NCDC), old approaches against Lassa fever outbreaks must be suspended, as it has obviously not yielded lasting solution to the menace, adding that thoughts of solving the incessant outbreaks should involve the provision of vaccines, and the establishment of more Lassa fever centres for prompt tackling of the scourge.

They said government must look beyond providing fire brigade approach 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 47 years after, people were still dying from the disease.

Akinjide, believes since the disease originated from Lassa community in Borno State, it behoves on the country to find a lasting solution to the reoccurring bouts of the outbreak, 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 in this regard,” 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 close to that figure.

According to the World Health Organisation, between 300,000 and 500,000 cases are recorded annually, with about 5,000 deaths recorded yearly, especially in sub-Sahara West African region. 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.

Also on his part, the President of the Nigerian Academy of Science (NAS), Prof.

Oyewale Tomori, during an earlier interview wondered why Nigeria was not taking surveillance system seriously, adding that, the country has a weak surveillance system, poor funding of epidemiology studies, inadequate diagnostic centres and poor awareness of the disease

Transmission
According to the WHO, it is a known fact that humans become infected with Lassa fever virus from exposure to urine or faeces of infected Mastomys rats. The virus may be spread among humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person.

It could also be transmitted from person to person through exchange of body fluid and blood, contaminated medical equipments or through sexual intercourse.

Those at risk
Available information suggests that everyone is at risk, as it may occur in all age groups, both sexes, and in all classes of people. However, it has been observed that people with poor hygiene or those in rural areas where Mastomys are usually found are more susceptible to it.

The Health Minister, Adewole, during one of the outbreaks, advised Nigerians to properly cover their foods in order not to get them exposed to the virus-causing vector, as people who refuse to do so are at a high risk of being infected by the virus.

Symptoms
Tomori said the symptoms may start to appear between six to 21 days, and may start with gradual signs like fever, general weakness and malaise.

Other symptoms include headache, sore throat, muscle pain, chest pain, nausea,
vomiting, diarrhoea, cough and abdominal pain may follow. Experts believed in severe cases symptoms may include bleeding from the mouth, nose, ear, vagina, as well as seizures, tremor, coma or even death.

Deafness may occur in 25 per cent of patients who survive the disease. In half of these cases, hearing returns partially after one to three months. Transient hair loss and gait disturbance may occur during recovery as well.

Diagnosis
Experts believe general diagnosis is often difficult because the symptoms are non-specific, since it is difficult to distinguish from other viral hemorrhagic fevers such as Ebola virus and many other diseases causing fever, including malaria and typhoid.

But, it is advised that definitive diagnosis be done in specialised laboratories like the ones in ISTH and LUTH.

Treatment and prophylaxis
The antiviral drug ribavirin seems to be an effective treatment for Lassa fever if given early
in the course of clinical illness. There is no evidence to support the role of ribavirin as post-
exposure prophylactic treatment for Lassa fever. There is currently no vaccine that protects against Lassa fever.