Triumph Over Adversity: Collaborative Victory Against Lassa Fever at Kaduna’s Army Reference Hospital

Blessing Yakubu

The 44 Nigerian Army Reference Hospital, Kaduna, typically a bastion of healing for wounded soldiers, recently found itself grappling with an unseen enemy within its walls with the outbreak of Lassa Fever.

However, through a remarkable display of unity and collaboration, the combined efforts of the Federal Ministry of Health and Social Welfare and Irrua Specialist Teaching Hospital, ISTH, have successfully curtailed the spread of the virus, marking a triumph over adversity.

Lassa fever is an acute and potentially fatal viral haemorrhagic disease endemic in many West African countries. It is caused by the Lassa virus and transmitted primarily through contact with food, household items contaminated by the urine or excreta of the mastomys natalensis rat species and through contact with body fluids of infected individuals, particularly among caregivers.

In Nigeria, Lassa fever is characterized by yearly outbreaks that occur typically during the dry season when rats are dispersed by bush burning and other human activities.

The 44 Nigerian Army Reference Hospital Kaduna is a tertiary healthcare facility established in 1944, offering clinical care, laboratory and radiological services as well as preventive services to military personnels, their relatives and neighbouring communities on inpatient and outpatient basis.

Between February 19 and 21, 2024, the hospital, a sprawling facility housing 600 beds and led by Acting Chief Medical Director, CMD, Colonel N. S. Onuchukwu, faced a grave health crisis. During this period, the facility tragically recorded four deaths- three healthcare workers and a patient, from a suspected outbreak of Lassa Fever.

This occurrence was said to have resulted from the management of a patient with acute severe febrile illness suspected to be the index case on the 2nd of February 2024. Samples taken from the suspected cases and analysed in the Nigeria Centre for Disease Control, Kano office confirmed an outbreak of the disease in the hospital.

In a swift response, the hospital undertook prevention and control measures which include shutting down the accident and emergency department of the hospital for thorough disinfection as well as post exposure prophylaxis with ribavirin tablets given to the staff.

To curtail further fatality, the hospital’s management sounded the alarm, seeking support from medical experts at ISTH and the Federal Ministry of Health and Social Welfare. This collaborative effort underscored the severity of the situation and the urgent need for a coordinated response.

In a letter addressed to the management of ISTH, the Reference Hospital lamented the outbreak of the disease, noting that despite measures to curtail the spread of the virus, much is still needed to stem the tide of the dreaded Viral Haemorrhagic Fever, VHF.

While acknowledging the expertise of lSTH in managing VHFs’ the CMD called for the urgent deployment of its personnel 44 NARHK to support the NA in laboratory, case management and Infection Prevention and Control at the health facility. The objectives of the emergency response are to conduct Lassa fever diagnostic investigation in real time using Lassa virus Reverse Transcriptase Polymerase Chain Reaction, to isolate and treat confirmed cases of the virus in the health facility and to train and retrain the staff of the health facility on Lassa fever prevention and control.

Defying all odds, management of ISTH, after clearance from the ministry, deployed its emergency response team, and upon arrival, the team in collaboration with the medical team of 44 NARHK sprang into action to rescue the hospital from the grip of the virus. The team conducted an assessment, which included identification of suitable site for installation of the mobile laboratory, assessment of existing prevention and control resources and measures in the 44 NARHK and provision of recommendations for improvement among others.

From its findings, the team reported some challenges bothering on inadequate isolation wards, shortage of manpower and health equipment, lack of personnel training and short practice of hand hygiene.

The team, led by Dr Joseph Okoeguale, Director Institute of Viral and Emergent Pathogens Control and Research at ISTH, recommended restructuring of the isolation center, personnel training, provision of equipment and material resources, promotion of hand hygiene, in addition to the provision of personal protective equipment for health workers in the facility.

It also recommended proper management of wastes and methods of serving foods to patients without having to come in physical contact with them.

In swift implementation of the recommendations made by the team of VFH specialists, the management of the Reference Hospital undertook a series of restructuring within the isolation ward.

A new entrance into the isolation ward was created, different from the staff entrance, facilitating streamlining patients’ admission into the ward. The facility also repaired its broken doors, torn window nettings, fans and air conditioners to improve ventilation. To improve hand hygiene, a cleaning facility was provided at the exit of the isolation ward.

A dialysis machine from the hospital’s dialysis unit earmarked for use in the treatment of suspected infectious cases from the isolation ward. The hospital also engaged in the training of its medical, laboratory and support staff of the 44 NARHK. The training session was necessary to enlighten the officials on infection prevention and control practices with special emphasis on measures to prevent and control Lassa fever.

Chief Medical Director, ISTH, Prof. Reuben Eifediyi said it took the combined efforts of the response team to successfully contain the outbreak through real-time laboratory testing, isolation, and treatment of confirmed cases. 

“The incident underscored the importance of effective partnerships and rapid mobilization of expertise in tackling public health emergencies,” said Eifediyi who also made recommendations for ongoing capacity building and the establishment of a biosafety molecular laboratory at the hospital.

Through the combined efforts of the Nigerian Army, ISTH and the Federal Ministry of Health and Social Welfare, under the leadership of Prof. Ali Pate, the 44 Nigerian Army Reference Hospital in Kaduna State has heaved a sigh of relief as the spread of the virus was successfully contained.

Though the battle against Lassa Fever may have been won, the lessons learned from this experience will endure, serving as a testament to the importance of unity, collaboration, and unwavering determination in the face of adversity.