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Lassa fever, an acute
viral disease that occurs in West Africa was first discovered in 1969 when two
missionary nurses died in Lassa village in Borno. It is an animal-borne or
zoonotic illness caused by the Lassa virus, hence, it was named after the town
where the first cases originated.
It is carried by a type of rat that is common
in West Africa and can be life-threatening and hemorrhagic, which means it can
cause bleeding. The virus is transferred to humans via contact with food or
household items that are contaminated with rat urine or feces, commonly by the
infected Mastomys rodent. The virus can spread from person-to-person via bodily
fluids and causes a range of symptoms including vomiting, swelling of the face,
bleeding and pain in the chest, back and abdomen. In Nigeria, Lassa fever
usually occurs during dry season between January and April, claiming many
lives, as other people get quarantined while undergoing treatment. Cases of
deaths arising from fresh outbreak of Lassa fever this year have risen to no
fewer than 41across the country as at Jan. 28, 2020 and has continued to rise
by the day. The Minister of Health, Dr Osagie Ehanire, said on Tuesday while
providing an update at a news conference in Abuja that 258 confirmed cases have
also been recorded in 19 out of the 36 states of the federation since the
beginning of the year, with majority of the cases in the southern states of
Ebonyi, Edo and Ondo. He said that with the tropical climate in Nigeria, there
is risk of infectious diseases like Lassa fever because of the vector – rats
and other rodents — which is also the case in other West African countries with
similar environment.
The minister, however,
adds that health authorities are working toward providing response activities,
surveillance and contact tracing in affected states. He explained that “Nigeria
is contributing to research for the development of Lassa Fever vaccine to
proffer lasting solution to the disease.’’ The Nigeria Centre for Disease
Control (NCDC), a government agency with the mandate to lead the prevention,
detection and control of communicable diseases of national and international
public health importance, says it has five functional molecular laboratories
for diagnosing and detecting the disease in the country. Its Director-General,
Dr Chikwe Ihekweazu, told News Agency of Nigeria (NAN) in Abuja that the
laboratories are located at NCDC’s National Reference Laboratory in Abuja,
Irrua Specialist Teaching Hospital in Edo, Federal Medical Centre Owo in Ondo
State, Alex Ekwueme Federal University Teaching Hospital Abakaliki and Lagos
University Teaching Hospital. Ihekweazu said “presently, samples from suspected
Lassa fever patients from South-South states and some states in the South-West
are tested at the Irrua Specialist Teaching Hospital; while samples from
South-East states are tested at the Alex Ekwueme Federal University Teaching
Hospital, Abakaliki. “Samples from states in the North are tested at the NCDC
National Reference Laboratory in Abuja and samples from South-West states are
tested at Lagos State University Teaching Hospital, while Federal Medical
Centre, Owo in Ondo State, the newest laboratory, collects samples from Ondo
State only.” The NCDC boss noted that the five laboratories have the capacity
to diagnose Lassa fever in the country. He added that each laboratory costs
about N100 million to equip initially, and millions of Naira to maintain
functionality. He explained that NCDC had established a sample transportation
mechanism to ensure that samples were sent from state capitals to designated
laboratories. The director-general, who said that laboratories were critical to
reducing turnaround time between identifying a suspected case and confirmation,
noted that each laboratory provided diagnostic support for a number of states
in the country. “This is to ensure prompt case management and other response
activities, thereby reducing the number of deaths.” According to him, Nigeria
is contributing to research and other activities for the development of a Lassa
fever vaccine. He said that the NCDC headquarters, laboratories in the three
main treatment centres in the country — Irrua Specialist Teaching Hospital,
Federal Medical Centre Owo and Alex Ekwueme Federal University Teaching
Hospital Abakaliki, as well as the Virology Laboratory of Lagos University
Teaching Hospital, Lagos, are contributing to the research. Ihekweazu added
that the laboratories would also play key roles in the Lassa fever
epidemiological study that would provide data to guide research and response
activities. He said that the study would begin before the end of March 2020.
However, some experts lament that with the predictable cycle of the destructive
disease, Nigeria should have learnt and developed a more lasting solution and
approach by now that can save people from the grip of the fever. Although money
is being spent on interventions to curtail the spread of the disease every year
it occurs, casualties are always recorded, including medical doctors who are
supposed to take care of patients. Just like the case in Taraba where the
disease claimed four lives, Dr Ahmed Jatau, the acting Head, Clinical Services
at Federal Medical Centre, Jalingo, said “a medical doctor tested positive.”
He explained that the doctor, a house officer, was currently
undergoing treatment at Irrua Specialist Hospital in Edo. The state’s
Commissioner for Health, Dr Innocent Vakkai, who said that the state government
had activated surveillance system for more case detection and proper treatment,
noted that efforts were ongoing to create awareness about the symptoms of the
disease among residents. He regretted that challenges such as late report of
cases to hospitals and difficult terrain remained major problems to the
management of the disease. He explained that “we sent 10 suspected cases for
test and six tested positive and out of the six confirmed cases, four died even
before their results came in. “Out of the remaining two, one has been
discharged, while the other, who is our own staff, has been transferred to
Irrua Specialist Hospital in Edo for further treatment. “We have, however,
fumigated the house officers quarters against rodents.”
Consequently, diagnosis and prompt treatment should be the
major areas of concern as there is currently no vaccine for Lassa fever, while
symptoms vary. Clinically, the disease can resemble other viral hemorrhagic
fevers, including Ebola, malaria and typhoid. The only definitive tests for
Lassa fever are laboratory-based, and the handling of specimens can be
hazardous as only specialised institutions can conduct it. Lassa fever is
generally diagnosed by using enzyme-linked Immunosorbent Serologic Essays
(ELISA) to detect IgM and IgG antibodies and Lassa antigens. Reverse
Transcription-Polymerase Chain Reaction (RT-PCR) can also be used in the early
stages of the disease. In terms of treatment, rehydration and treatment of
symptoms can improve the chances of survival if diagnosed early. If prescribed
early, the antiviral drug — Ribavirin — has proven useful in fighting the Lassa
virus, but how it works remains unclear. Therefore, there is the need to
increase the number of laboratories for testing the disease in the country so
that medication can commence promptly, as the five molecular labs may not be
adequate to cover the whole nation. Samples of suspected cases from places like
Lassa town of Borno State where the disease originated, or Bama or Biu, all in
Borno, may take time to reach any of the five molecular laboratories for
confirmation due to distance, which may delay the commencement of treatment.
More laboratories should, therefore, be established across the country for easy
access, while sensitisation continues on the dangers of the disease, its
symptoms and how to keep safe, as work is on to get a vaccine that will protect
people even before the commencement of the Lassa season.
(NANFeatures)
