At the Mercy of Lassa Fever

When it rains in Nigeria, it definitely pours. This best describes the country’s present situation since the beginning of 2018, as myriads of challenges have, all at once, sprang up, leading to avoidable deaths and hardship for the citizens.

The killing of over a hundred persons in Benue and in other parts of the country. The increased cost of transportation due to persistent fuel scarcity, and the growing discord between different ethnic groups are just few among the issues the country has been battling since the past six weeks when this year started.

Unfortunately, the list of the nation’s problems has continued to grow with the inclusion of Lassa fever outbreak that has now claimed at least 31 Nigerians across several states of the federation with almost 500 persons (77 suspected and 405 unsuspected cases) currently receiving treatment to prevent more deaths from the outbreak.

On specifics, the outbreak has been recorded in Bauchi, Plateau, Taraba, Nassarawa, Benue, Kogi, Ebonyi, Rivers, Imo, Anambra, Edo, Delta, Ondo, Osun and Lagos States, with 10 health workers affected in four states, including three in Ebonyi where two doctors died, one each in Nassarawa, Kogi and Benue.

The Minister of Health, Prof. Isaac Adewole, earlier in the week said Edo and Ondo States so far have the worst cases of the disease, while cases from Ebonyi State were largely due to surgical operations done by health workers.

Since the recent outbreak, healthcare practitioners have become increasingly at risk of contracting the fever, leading somewhat to blame games recently. While the minister called for increased precautionary measures by doctors and nurses handling cases of Lassa fever, some health workers believe inadequate facilities by the government have in no small measures added to the current doctors/nurses’ mortality due to the fever.

Records show that since early 2015 through most of2017, Lassa fever outbreaks have been commonplace in the country. On December 20, 2016, the Nigeria Centre for Disease Control, NCDC, confirmed a case of Lassa fever in a healthcare worker who had died at the Federal Medical Centre, Abeokuta.

Between January and December 2017, a total of 733 suspected Lassa fever cases with 143 laboratory confirmed cases and 71 deaths were recorded in 97 LGAs and 29 states of the federation. Two deaths from Lassa fever were also recorded at the Lagos University Teaching Hospital, LUTH, with at least 150 suspected cases, mostly healthcare workers, placed under surveillance.

It is in the light of this that THISDAY visited Nigeria’s most equipped Lassa fever centre in Irrua Specialist Teaching Hospital, (ISTH) Edo State, where it was noticed that the centre was currently recording an over flow of patients with about 25 confirmed or suspected cases under treatment or observation. A makeshift tent has also been erected outside the ward to accommodate the growing number of suspected or confirmed cases.

But one then wonders, if the well known Lassa fever laboratory facility in Irrua is overburdened just from 25 patients, and considering that there are only two or three centres in the entire country with the capacity to diagnose and treat Lassa fever cases, what then happens when there is an increase in incidence level from the outbreak across the country such that the facilities in these two or three functional Lassa fever labs have been overburdened.

While these concerns beggar responses, the Chief Executive Officer, Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu in an interview with THISDAY provides a guide.

He said all tertiary hospitals, especially teaching hospitals and federal medical centres have the capacity to effectively manage Lassa fever patients, adding that NCDC have been providing all teaching hospitals and federal medical centres with the Personal Protective Equipments and medicines that they need.

“We have also published clinical guidelines and lately we have set up a 24-hour call line to support hospitals that are struggling to do this. One of our key messages to all states is to ensure the identification of an isolation centre in at least the state capital. If we can accomplish this as well as ensure the availability of medical supplies for treatment, the burden on Irrua will be reduced.

“In the meantime, we have supported the Irrua with beds and tents to create temporary isolation wards, and will continue to provide support to other states in ensuring proper case management,” he added.

Asked why the virology centre in Abakaliki is not working optimally to address diagnosis and treatment of Lassa fever, he said Federal Ministry of Health has been working through the Federal Teaching Hospital, Abakaliki (FETHA) to fully operationalise the Virology centre donated by the state government.

“FETHA took over the centre in 2017 and the wards have been used for over a year to manage patients with Lassa fever and other infectious diseases. The process to establish a molecular diagnostic centre within the centre for a disease like Lassa fever, is a complex one and requires time, resources and critically expertise.

“We must also ensure the right biosafety and biosecurity equipment and processes are in place to avoid further spread of the virus. This has taken a while but we are now on track to ensure the centre is fully operational.”

Chikwe said the FMoH or Nigeria Centre for Disease Control (NCDC) cannot directly manage the laboratory in Abakiliki but could only support the Federal Teaching Hospital, Abakaliki in doing so. Adding that, one of the main priorities of the Minister of Health was to support the establishment of a testing centre for Lassa fever in all geo-political zones of the country.

He, however noted that the process was complex, requiring trainings, provision of equipments and significant resources.

When asked if apart from ISTH in Irrua and the Lassa fever centre in the Lagos University Teaching Hospital (LUTH) there were other health facilities competent enough to tackle Lassa fever cases in Nigeria, Ihekweazu said the National Reference Laboratory in Gaduwa, Abuja makes it three.

“These three currently have the capacity to test for Lassa fever in Nigeria. We are working very hard to expand to other laboratories in the country, given the special diagnostic level required for this. We will continue working with states to ensure the identification and operationalisation of state public health Reference Laboratories. In terms of providing clinical care, every teaching hospital and  federal medical centre should be able to do this,” he added.

On his part, the Minister of Health, Professor Isaac Adewole, earlier in the week summoned a meeting to discuss the state of public health challenge in Nigeria with focus on how to tackle the challenges, especially on areas of Lassa fever, and other disease outbreaks in the country.

Adewole noted that the country will eventually tackle issues of Lassa fever, adding that with the success made during the 2014 outbreak of Ebola virus, the country has the capacity to also tackle Lassa fever.

To this end, he stressed the need for all stakeholders in the health sector to adopt a contextual multisectoral approach in sharing data on disease outbreak in the country. “We need to intensify our communication sector both at state and federal levels, and actively share data on disease surveillance,” he said.

Adewole called on each state to have operational centre for public health intervention, not only for Lassa fever outbreak. He further stressed on the need to engage in preventive measures of eradicating Lassa fever outbreak than having emergency outbreak.