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By Chijioke Ifediora
This publication is a public health advocacy campaign in honor of Nigerian health workers and citizens dying of Lassa fever.
What is Lassa Fever?
According to WHO, Lassa fever is an acute viral haemorrhagic illness caused by Lassa virus, a member of the arenavirus family of viruses. It is transmitted to humans from contacts with food or household items contaminated with rodent excreta.
The disease is endemic in the rodent population in parts of West Africa like Nigeria.
Prevention and Control
Humans usually become infected with Lassa virus from exposure to urine or faeces of infected Mastomys rats.
Lassa virus may also be spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of a person infected with Lassa fever.
There is no epidemiological evidence supporting airborne spread between humans. Person-to-person transmission occurs in both community and health-care settings, where the virus may be spread by contaminated medical equipment, such as re-used needles.
Sexual transmission of Lassa virus has been reported. It also occurs in all age groups and both sexes. 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.
The incubation period of Lassa fever ranges from 2–21 days. The onset of the disease, when it is symptomatic, is usually gradual, starting with fever, general weakness, 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 percent of patients who survive the disease. Death usually occurs within 14 days of onset in fatal cases and severe late in pregnancy, with maternal death and/or fetal loss occurring in more than 80 percent of cases during the third trimester.
Lassa fever is difficult to distinguish from other viral haemorrhagic fevers such as Ebola virus disease as well as other diseases that cause fever, including malaria, shigellosis, typhoid fever and yellow fever. Definitive diagnosis requires testing that is available only in reference laboratories. Laboratory specimens may be hazardous and must be handled with extreme care.
There is currently no vaccine that protects against Lassa fever. 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.
Lassa timeline (please note this)
Lassa fever is not new to Nigerians. The first ever documented case of Lassa fever was reported in Nigeria in 1969 when two missionary nurses died in a town called Lassa in the part of Nigeria now known as Borno State. They had complaints of weakness, headaches, fever and general malaise.
A study in the journal Cell by a team that included Christian Happi of Irrua Specialist Hospital—where experts confirm strains of Lassa fever in samples had traced “ancient roots” of Lassa nearly 1,000 years to a region that is now present-day Nigeria.
Up till 2008, specimens were flown abroad for confirmation. Since 2008, two centres have stepped in to fill the gap in laboratory diagnosis and research into the fever—Lassa Fever Research and Control Centre at Irrua Specialist Hospital, Edo, and Virology laboratory, Lagos University Teaching Hospital
Samples from the latest outbreaks have undergone confirmation at Irrua, which also provided confirmation for cases from 2012 onwards.
In 2012, the number of cases peaked in 2012, when 1,723 cases with 112 fatalities were recorded.
In 2012, half a million vials of Ribavirin, an antiviral drug considered effective were procured after the first case of Lassa was reported in Ebonyi. By then, one doctor and up to four nurses had died, some others were hospitalised at Federal Teaching Hospital, Abakiliki.
Lassa fever has the greatest impact among haemorrhagic fevers—rivalled only by dengue. Up to 300,000 are infected annually in West Africa alone, and an estimated 5,000 of them die.
During 2012 and 2013, more than 2900 cases were reported in widespread outbreaks that occurred across many states. In 2013, three deaths—among them a health worker, it struck in Benue and Ondo States. At last quarter of 2015, the country battled the epidemic disorder, which reached 24 states and killed 154 people.
More than 684 suspected cases were recorded in the Borno, Gombe, Yobe, Taraba, Plateau, Nasarawa, Ebonyi, Edo, Ondo, Rivers, Bauchi, Anambra, Lagos, Niger, Kano, Nassarawa, Plateau, Oyo, Gombe and Ondo, Kano states and the FCT amongst others at the time.
Between 2015 and 2016, 273 reported cases resulted in 149 deaths, the Nigeria Centre for Disease Control, NCDC, reported on 23rd December 2016.
Then, 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. Since the beginning of 2018, Nigeria has recorded 16 deaths from 61 confirmed cases of Lassa fever across the country.
The Nigeria Centre for Disease Control, NCDC in a press statement released on Wednesday said a total number of 107 suspected cases has been recorded in ten states across the country.
The states are Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo and Lagos.
According to NCDC, as at January 21, ten out of the 61 confirmed cases were health care workers from four states Ebonyi- 7 , Nasarawa -1 , Kogi- 1 and Benue -1 out of which four are now deceased.
Health workers are most times secondary victims who get infected while treating patients with the disease.
Between 2005 and 2018, the infection claimed over 40 health workers in Ebonyi according to the state chapter of the Nigerian medical Association, NMA.
Nigerian government should learn to value human life.
Lack of rural/ urban awareness and poor health system is the result of this epidemic. People will be able to protect themselves if they have adequate information of what they are likely to encounter.
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