Nigeria and the Lassa Fever Menace: The Way Forward

Nigeria and the Lassa Fever Menace: The Way Forward

Author ~ Funmi Akindejoye

The death of three missionary nurses in the town of Lassa in Borno State, Nigeria, after caring for an infected obstetrical patient in 1969, led to the discovery of the virus in Nigeria. Lassa fever (LF) is a zoonotic disease that is spread to people through contact with items or food contaminated with the dropping or urine of infected multimammate rat, which has multiple breasts and are found in bushes and residential areas.

Lassa fever has an incubation period (time between exposure an appearance of first symptom) of 6 – 21 days. About 80% of human infections are without symptoms but when it is symptomatic it begins with a flu like illness, fever, general weakness, sore throat, severe headache, chest pain and ringing ears, nausea, vomiting and diarrhoea. In severe cases, other symptons include Haemorrhage, swelling of the face, encephalitis, which can result in tremor, confusion and coma. In expectant mothers, the common complications of LF includes sudden deafness, especially in the third trimester, and this increases the risk of spontaneous abortion (this occurs in 95% of pregnancies).

The virus is endemic in countries such as, Benin Republic, Ghana, Guinea, Sierra Leone, Liberia, and Nigeria, and other West African countries as well. Furthermore, migrants to West Africa, health-care and laboratory professionals serving in affected areas and persons living in areas of poor sanitation or crowding are most at risk.

Currently, Nigeria is faced with the worst hit of Lassa fever since the discovery of the virus in Nigeria in 1969. According to the situation report by the Nigeria Centre for Disease Control (NCDC) of December 2017: a total of 1022 suspected cases and 127 deaths have been reported since the onset of Lassa fever outbreak in December 2016. As at December 2017, nineteen (19) states of the Federation reported at least one confirmed case. Also, from the beginning of this year, 2018 till date, a total of 297 suspected cases, and 22 deaths have been reported in 13 active States (i.e. Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba and Delta).

Below is a graph that shows the Lassa fever outbreak trend from December 2016 to December 2017, plotted using available data from the NCDC situation report.

From the above, recurrent spikes in the LF outbreak is observed. This is a clear indication that there is need to improve and upgrade the total Lassa fever prevention and containment strategy in Nigeria. The situation has become even more disturbing especially because health workers on duty are dying of the virus in the respective locations they have been deployed to control and prevent.

While world leaders, professionals, academia and international organisations have acknowledged Nigeria for preventing the spread of the Ebola virus disease (EVD) in 2014 -2015, such rapid responses that led to the successful prevention of the EVD provides some vital lessons for addressing yet another public health emergency. Nigeria’s success during the EVD emergency has been attributed to strategic action plan, rapid response by the government to declare an emergency, easy communication flow, as well as intergovernmental partnership and surveillance. The aforementioned action plans can serve as lessons for addressing the current Lassa fever outbreak.

Furthermore, improving the present state of Nigeria’s primary health care system will help reduce the prevalence and outbreaks of LF as more deaths have been recorded in rural communities. Primary health care centres need to be targeted to put in place a good surveillance for disease. When outbreaks occur in communities with no access to primary health centres (which are the foundation of a nation’s health care delivery system), such cases may not be reported on time. Thus, the delay in notifying the authorities increase the morbidity rate in such regions.

It is important for health care workers to use personal protective equipment and observe universal best practices always.

There is currently no vaccine that act against the virus, thus control of the virus is limited to proper environmental sanitation and personal hygiene, which should keep such disease vectors out of homes and food supply centres. Citizens are advised to keep their surrounding clean, ensure proper waste disposal, avoid dumping of refuse indiscriminately. All unnecessary openings in buildings that serve as outlets for rodents should be covered. Frequent hand washing with soap and water should be practiced. Clean or wash with soap and water the opening of canned drinks before drinking because it is possible for rodents to have urinated on them in the process of storage. Wash fruits/food or cook properly before eating, cover all cooked food, store grains and other food stuffs in rodent-proof containers. The high risk of contracting LF in Nigeria has been attributed with the common practice of eating soaked garri (cassava derivative) because of exposure of such food products to the urine and faeces of infected rats that might crawl over them in market places. It is recommended that if one must take soaked garri during this period, it should be refried because the LF virus cannot survive beyond 56 degrees centigrade.

In conclusion there is need to provide health education at community level that will trigger behavioural change in people. While emphasising proper waste management and personal hygiene as primary preventive measures of the Lassa fever virus.

Other articles by author
  1. The Need for Sustainability in the Nigerian Healthcare Sector

  2. WHO Ranks Nigeria Ranks 187 out of 191 in World Health Systems

Reference
  1. Nigeria Centre for Disease control (NCDC), 28 January, 2018. 2018 Lassa Fever Outbreak in Nigeria: Situation report
  2. Nigeria Centre for Disease control (NCDC), 24 December, 2017. 2016/2017 Lassa Fever Outbreak in Nigeria: Situation report
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