Tackling The Outbreak of Lassa Fever in Nigeria

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By Elijah OnucheOjo Oyigu

With confirmation by Federal Ministry of Health that the outbreak of Lassa fever has stretched to over 13 states in Nigeria, stringent cautions and personal hygiene have been advocated to tackling further spread of the scourge.

Lassa virus, a viral pathogen and a member belonging to Arenavirridae virus family, was first discovered in Nigeria in 1969 at Lassa, a town in Borno state and it is a causative organism for a bleeding feverish ailment referred to as Lassa fever or Lassa Hemorrhaging Fever (LHF).    

 Research shows that, Lassa virus is animal-borne and is found in the same family with Ebola virus which causes Ebola Fever Disease (EFD) as well as Marburg virus and they posses similar characteristics especially in their feverish attacks on their victims. 

However, outbreaks of the disease have been observed in countries such as Nigeria, Liberia, Sierra Leone, Guinea, and the Central African Republic.

Though, Lassa virus is zoonotic in nature, implying that, the virus is transmittable from animal such as rodents especially multimammate mice (mastomys natalensis) which is believed to be common in equatorial Africa with sizeable number of them inhabiting residential areas and are eaten as a delicacy in some areas.

The reservoir or host of the Lassa virus is the “multimammate rat” commonly called Mastomys natalensis which has many breasts and lives in the bush and peri-residential areas.

It has incubation period between five and 21 days, after which noticeable symptoms will appear 10 days after infection with repeated vomiting, malaise, headache, sore throat, muscle pain, facial swelling, back and chest pain, bleeding of the eyes, noise and gums, abdominal disorder, among other brain related issues to including encephalitis and hearing loss as common symptoms associated with Lassa fever.

Reports say that, people can contact the virus through direct contact with those rodents who shed the virus in their urine and excreta. Direct contacts with effected persons through their blood, and their feaces can also spread the diseases from one person to another.

 However, recent investigations showed that frequency of transmission by sexual contact and transmission through breast milk has been established alongside other secretions from affected persons.

According to Wikepedia, “Infection in humans typically occurs by exposure to animal excrement through the respiratory tract, making inhalation of tiny particles of infectious material the most significant means of exposure through which infections are contracted through broken skin exposed to infectious material”

While 80% reported cases of Lassa fever are said to be asymptomatic especially at its early stage, the disease is responsible for some deaths in regions it has affected with about 300,000 to 500,000 reported cases yearly while 5, 000 people die annually due to Lassa fever.

“In 80% of cases, the disease is asymptomatic, but in the remaining 20%, it takes a complicated course. The virus is estimated to be responsible for about 5,000 deaths annually. The fever accounts for up to one-third of deaths in hospitals within the affected regions and 10 to 16% of total cases.” A report on Wikepedia, has shown.

The World Health Organization (who) while decrying the outbreak of Lassa fever said that, people living in the rural areas are at the great risk of contracting the disease especially where rats and other rodents are often found.

“People usually become infected with Lassa virus from exposure to infected rodents belonging to Mastomys species. Person-to-person transmission occurs through direct contact with sick patients in both community and health care settings. Those at greatest risk are persons living in rural areas where Mastomys are found. Health care workers are at risk if adequate infection control practices are not maintained.”

In Nigeria,  there is no structured motorized and mobile toilet system in many public places, and reports from the World Health Organization (WHO) revealed that, Nigeria is ranked 5th among other countries with poor and indecent sanitation facilities.

Surprisingly however, some Nigerian schools do not have decent toilet facilities. Even where there are toilets, some hardly warrant the name, making one wonders if the sanitation culture embraced during the outbreak of Ebola Virus Diseases sometimes in 2014 may have disappeared considering the then enforcement of hand washing culture, provision of sanitizers alongside other sanitary paraphernalia.

Though, the Federal and State governments have been urged to be more proactive in handling the outbreak by enhancing the disease surveillance for early detection, reinforcing treatment of patients, and conducting awareness campaigns among the affected population, WHO has said that, lack of adequate resources and insecurity are part of the challenges derailing the fight against the endemic scourge

“Major challenges are the ongoing security risks in the country limiting access to some areas as well as the limited availability of resources to respond to the escalating outbreak.” 

According to WHO, “In March 2012, about 623 suspected cases, including 70 deaths had been recorded from 19 of the 36 States of Nigeria following a Laboratory analysis undertaken at the Irrua Specialist Teaching Hospital, Irrua Edo State which confirmed the presence of Lassa virus infection in 108 patients with three doctors and four nurses reported to be among the fatalities”.

However, following the recent outbreak in states such as Bauchi, Nassarawa, Niger, Taraba, Kano, Rivers, Edo, Plateau, Gombe and Oyo, more efforts are needed to sensitizing members of the public to maintain good personal hygiene and exercise cautions on consumption of bush meat especially the rats.

The Minister of Health, Prof Isaac Adewole, in a statement issued  in Abuja in response to the outbreak of the disease in the country, said “the total number of suspected cases so far reported is 76 with 35 deaths, and a Case Fatality Rate of 46 per cent.”

Prof.  Adewole, however, assured Nigerians of government’s promptness to stalk further spread of the bleeding fever now confirmed by  laboratories to be Lassa Fever Disease.

According to him, “the public is hereby assured that the government and its partners, and other stakeholders are working tirelessly to address the outbreak of Lassa fever in the country and bring it to timely end.”

Adewole said: “It is important that I notify the nation that in the last six weeks, Nigeria has been experiencing Lassa fever (LF) outbreak which has so far affected 10 states. The States affected include Bauchi, Nassarawa, Niger, Taraba, Kano, Rivers, Edo, Plateau, Gombe and Oyo States.  The total number so far reported is 81 and 35 deaths, with a mortality rate of 43.2%. Our laboratories have confirmed 17 cases, indicative of a new roundtrip of Lassa fever outbreak.

“About 80% of human infections are asymptomatic; the remaining cases have severe multi-system disease, where the virus affects several organs in the body, such as the liver, spleen and kidneys. The onset of the disease is usually gradual, starting with fever, general weakness, and malaise followed by headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and bleeding from mouth, nose, vagina or gastrointestinal tract, and low blood pressure.” The Health Minister, has explained.

“The virus is shed in the urine and droppings of the rats (and) can be transmitted through direct contact, touching objects or eating food contaminated with these materials or through cuts or sores. Nosocomial transmission also occurs in health facilities where infection prevention and control practices are not observed. Person to person transmission also occurs most especially when a person comes in contact with the virus in the blood, tissue, secretions or excrements of an infected individual.”

He elucidated that “in response to these reported outbreaks, the Federal Ministry of Health has taken the following measures to curtail further spread and reduce mortality among those affected: Immediate release of adequate quantities of ribavirin, the specific antiviral drug for Lassa fever to all the affected states for prompt and adequate treatment of cases,  assisting the affected states  in investigating and verifying the cases as well as tracing of contacts, mobilizing and sensitizing clinicians and relevant healthcare workers in areas of patient management and care in the affected states.”

 Meanwhile, affected states have been advised to intensify awareness campaign on the signs and symptoms including preventive measures such as general hygiene caution in the consumption of rodents.

Since general elimination of rats appears impractical, avoiding contact with rats may  prevent the spread of Lassa virus  by putting food away in rat-proof containers and  maintaining constant house cleaning while trapping around and in homes may also reduce rat populations.

People need to imbibe hygienic culture by making their environment clean enough to deprive rats’ visitation. This should be followed by proper covering of food materials and other eatables to prevent rats from defecating and urinating on them.

There should be fumigation of residential places in a manner that rats will be sent off while those who eat rats and rabbits as delicious meat should have a break and turn other to meat to avoid the further spread of this contagious disease in the land.  

We all need to clean the Augean Stable, if we must win war against Lassa fever.

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