Last week, the Commissioner of Health, Ekiti State said three persons were confirmed dead in a fresh case of Lassa fever in the state. He revealed that five out of the eight new suspected cases in the state tested negative and one was uncertain with the rest were pending as a press time.
The Commissioner assured that there was no cause for alarm in the state because the government was taking proactive steps in its surveillance activities. He also revealed that the State Disease Control team has been activated while the process of sensitising the people with jingles and other communication media were on-going.
According to World Health Organization (WHO), From 1 January through 25 February 2018, 1081 suspected cases and 90 deaths have been reported from 18 states (Anambra, Bauchi, Benue, Delta, Ebonyi, Edo, Ekiti, Federal Capital Territory, Gombe, Imo, Kogi, Lagos, Nasarawa, Ondo, Osun, Plateau, Rivers, and Taraba). During this period, 317 cases have been classified as confirmed and eight as probable, including 72 deaths (case fatality rate for confirmed and probable cases = 22%). A total of 2845 contacts have been identified in 18 states.
Fourteen health care workers have been affected in six states (Benue, Ebonyi, Edo, Kogi, Nasarawa, and Ondo), with four deaths (case fatality rate= 29%). As of 18 February, four out of the 14 healthcare workers were confirmed positive for Lassa fever. “We are observing an unusually high number of cases for this time of year.
Meanwhile, the Nigeria Centre for Disease Control (NCDC) released an update report showing 615 reported cases, 193 confirmed and death toll at 57.
The Director of the NCDC, Dr Chikwe Ihekweazu, asserts that the Country’s growing population, coupled with its dwindling land is responsible for bringing individuals closer to the disease host; the Multimammate rat.
“Nigeria’s growing population density worsened, which is worsened by lack of hygiene in its cities, are some factors driving this present outbreak.
“Rats are not attracted to clean environments, and our cities are not the cleanest of places”.
The acute viral haemorrhagic fever is endemic in Nigeria but for the current outbreak the hot spots are the Southern states of Edo, Ondo, and Ebonyi.
Unhealthy Health System Complicating Epidemic
Dr Oyewale Tomori, Professor of Virology, Redeemer’s University in Nigeria, and former regional Virologist for the WHO’s Africa Region, iterates that, although heightened human-to-rodent contact plays a role in transmission, delayed diagnosis of cases in health systems and failure to institute ideal infection-control practices in hospitals have caused a surge in cases.
“Preparedness is the key. Get disease surveillance up and running. Equip and provide reagents and other resources for laboratories. Increase public awareness of Lassa fever. Get the health system — doctors and other health workers — to practice and abide by infection-control procedures”.
Officials also speculate that infection numbers are under-reported, as Lassa fever symptoms such as headaches and joint pain can mimic malaria, a disease that is also endemic in the Country.
“Unfortunately, many of the cases were self-managed and not tested at the onset because they thought it was malaria.
“It was until the fever didn’t go that they reported to the hospital. There is a drug for Lassa fever, but it is only effective when taken early” Ihekweazu said.
How Lassa fever spreads
Symptoms of Lassa fever mimic the dreaded Ebola Virus, but it is caused by the Lassa Virus which is transmitted by the Multimammate rats.
Primary means of contacting the Lassa fever is by touching, eating or sniffing foods and other household items contaminated by the faeces or urine of the Multimammate rat.
Professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine, Dr David Heymann said “Rats move closer to humans during drought, when they can’t forage for food in the forest.
“Rats move into houses to eat rice and other grains and urinate or excrete on food products, and when that is eaten, that’s one of the ways humans also get infected”.
Heymann also asserts that human-to-human transmission can occur in hospitals where infection control guidelines are not effective.
However, Casual contact with an infected person without exchange of bodily fluids does not spread the virus.
WHO Risk Assessment
Lassa fever is a viral haemorrhagic fever that is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces. Person-to-person infections and laboratory transmission can also occur. The overall case fatality rate is 1%; it is 15% among patients hospitalized with severe illness.
Early supportive care with rehydration and symptomatic treatment improves survival. The antiviral drug ribavirin seems to be an effective treatment for Lassa fever if given early on in the course of clinical illness. There is no evidence to support the role of ribavirin as post-exposure prophylactic treatment for Lassa fever. Lassa fever is known to be endemic in Benin, Guinea, Ghana, Liberia, Mali, Sierra Leone, Togo and Nigeria, and most likely exists in other West African countries.
The current Lassa fever outbreak in Nigeria shows an increasing trend in the number of cases and deaths in recent weeks with 317 confirmed cases reported in 2018 so far. This is the largest outbreak of Lassa fever ever reported in Nigeria.
The infection of 14 health care workers that were not working in Lassa fever case management centres highlights the urgent need to strengthen infection prevention and control practices in all health care setting for all patients, regardless of their presumed diagnosis. Given the high number of states affected, the clinical management will likely happen in health centres that are not appropriately prepared to care for patients affected by Lassa fever and the risk of infection in health care workers will increase.
The reporting of confirmed cases in different parts of the country and porous borders with neighbouring countries indicate a risk of spread nationally and to neighbouring countries. An overall moderate level of risk remains at the regional level. WHO says Public health actions should be focused on enhancing on-going activities including surveillance, contact tracing, laboratory testing, and case management.
FG’s Renewed Efforts to make treatment available to all
The Federal Government has released a statement to debunk a media report stating that the high cost of treating Lassa fever is responsible for the high mortality rate recorded so far in the country.
The disease has become a major threat across states and has caused over 100 deaths in the past three months across several states. According to Chikwe Ihekweazu, CEO, Nigeria Centre for Disease Control (NCDC):
“Federal Government of Nigeria has ensured that Ribavirin, the major drug used for the treatment of Lassa fever, has been provided free-of-charge to patients, for every single case of Lassa fever reported in Nigeria.’
“In addition to Ribavirin, the treatment centres have been provided with other essential commodities required for the prevention, diagnosis and treatment of Lassa fever cases. The Nigeria Centre for Disease Control (NCDC) has had rapid response teams, supporting the state governments of Edo, Ondo and Ebonyi for six weeks supporting all aspects of the response.
“The state governments of the Edo, Ondo and Ebonyi states, with the highest burden of Lassa fever have also contributed significantly to the management of cases, ensuring that every single patient received the best treatment possible. All three state governments have supported treatment centres with dialysis machines and other equipment necessary for the treatment of Lassa fever patients.”
