Category Archives: Lassa Fever

Poorly Managed Lassa Fever Outbreak in Nigeria

Dr. Obinna O E Oleribe, Chief Executive Officer, E&F Management Care Centre, Abuja Nigeria (Twitter: @OleribeO) shares with readers his view and experiences concerning the August 2015 – May 2016 Lassa Fever outbreak in Nigeria and sees its handling as a strong indicator of weak and failing National Health System.

111435-EPR-Nigeria-Lassa-Fever-Outbreak-20120322On February 6th, 2016, the Vanguard Newspaper reported the growing Lassa Fever outbreak that had killed over 101 persons out of 175 suspected and confirmed cases since August 2015 when the outbreak began in Nigeria. More recently, the World Health Organization (WHO) announced that it had been notified of 273 cases of Lassa fever, including 149 deaths in Nigeria between August 2015 and May 17, 2016. Of the 273, 165 cases and 89 deaths were confirmed through laboratory investigation from 23 states of Nigeria. These deaths include two health care workers out of 10 infected with Lassa fever virus. As at the time of the WHO report (May 17, 2016), eight states were still reporting Lassa fever cases (suspected, probable, and confirmed), deaths and following 248 contacts for the maximum 21-day incubation period.

First diagnosed in Nigeria in 1969, Lassa fever (LF) is an acute viral illness caused by Lassa virus, a zoonotic, rodent-borne (multimammate rat), single-stranded ribonucleic acid (RNA) virus from the Arenaviridae, virus family. Since it first isolation in 1969 from a missionary nurse working in Lassa town of Borno State in North-Eastern Nigeria, Lassa Fever has become almost endemic in not only Nigeria, but the West African sub-region as it has continued to be a major public health concern in Nigeria, Liberia, Sierra Leone and Guinea with over 70 million people at risk of the disease. Annually, there are over 3 million cases and about 67,000 deaths from Lassa Fever globally. High association with nosocomial outbreaks, healthcare workers are at increased risk of infection and death. Also, the disease is fast spreading beyond the shores of West Africa into Europe and America from viremic travelers.

A look at the WHO website revealed that Lassa Fever has gained the importance it demanded and was rightly cited on its first page as a disease of public health importance (disease outbreak news). Also, as it is further decreasing the already very limited human resources for health in Nigeria and the rest of West Africa, one would have thought that healthcare managers across the world would have given it the attention it needed.

Heres how Nigeria beat EbolaIn July 2014, Ebola was identified in Nigeria (Lagos State) after Patrick Sawyer imported the disease from Liberia (where there was already an ongoing epidemic). The Lagos State Government, the National Center for Disease Control (NCDC), the Nigerian Field Epidemiology and Laboratory Training Program (NFELTP) and Federal Ministry of Health (FMOH) with the support of well-meaning Nigerian volunteers and some international organizations rose to the occasion and within four months (July 20 – October 20, 2014) kicked Ebola out of Nigeria. They achieved this unbelievable feat through decisive actions, interdisciplinary collaboration, intensive case management, detailed contact tracing, and active port health services. Using isolation, quarantine and supportive management of the infected, case fatality rate was kept at 40% as eight out of the 20 infected individuals succumbed to the virus including several health workers. What was more interesting was the immediate response of government and all relevant stakeholders. The success recorded was to the amazement of the entire world, and completely against all epidemic projects and statistical reasoning.

However, few months later, there is another epidemic of another viral hemorrhagic fever. This time around, by a virus that is not as deadly or virulent as Ebola.  It has lasted for ten months, killed more people (over 1100% of those killed by Ebola), affected over 800% more cases and with higher case fatality rate of 54%. One, cannot but wonder why Nigeria is finding it difficult to mobilize the same strategies that ended Ebola in Nigeria in 2014 to end Lassa Fever? Or are the structures and personnel not available for this particular outbreak? Or is the will to stop the outbreak lacking among policy makers and healthcare managers?

I believe that there is a need to focus on developing sustainable public health systems that can be mobilized to manage outbreaks across nation; have ready and equipped field workers and foot soldiers who will track, isolate and manage suspected, probable and confirmed cased of any outbreak; and maintain strong surveillance systems able to identify and contain any new, emerging or re-emerging outbreaks.

Nigeria and her leaders should value the lives of the Nigerian people. The government should take health issues more seriously. The citizens of Nigeria need a government that cares. Healthcare workers have a right to live – and not die while working to save other people’s lives. Every hand should be on deck right now to end this outbreak – and as much as possible ensure a delay of its re-emergence.

The time to end Lassa Fever outbreak is NOW. Let us all work towards stopping it once and for all.

Lassa Fever in Nigeria

Fever brings to mind ‘malaria’ for most health workers often resulting in dangerous nmis-diagnoses. Not all fevers are alike, and when health workers do not practice infection procedures in examining a febrile patient, they put themselves, their families and all people at their clinic at risk.

lassa-distribution-map smWitness the Ebola outbreak in Guinea, Liberia and Sierra Leone where health workers disproportionately died. And just as happened with Ebola, the Guardian reported that, “A medical doctor in Rivers State has been confirmed dead after being diagnosed of See WHO’s Lassa fever fact sheetin the state’s apex hospital, the Brewaithe Memorial Specialist Hospital (BMH), Port Harcourt.”

As of 9th January the death toll rose to 35 with 81 cases. The Guardian Newspaper noted that “Non-Specific Symptoms Of Ailment Threaten Interruption Efforts, ” and that at the rate the current Lassa Fever outbreak is ravaging in the country, the federal government may soon have no option but to declare an emergency to hasten containment.”

By January 16th the number of deaths had risen to 44 as reported by MENAFN.com. They also explained that Lassa is “transmitted through the faeces, urine and blood of rats (and subsequently) human bodily fluids,” of those infected via rats. Rats closely inhabit spaces with humans, while fruit bats that carry Ebola are more confined to forests (which unfortunately have been pushed back through human activity).

Lassa is endemic in Nigeria and West Africa across to Liberia, Sierra Leone and Guinea where some suspected the initial Ebola cases might have been Lassa. The first cases were CDC: documented in Nigeria in 1969, and as the AllAfrica.Com, Guardian: Ministry of Health noted, “Lassa fever which has over the years registered its presence in the country, supposed not to have taken us by surprise.”

The US Centers for Disease Control and Prevention/CDC provides the following useful information showing that while infectious, Lassa may not be as dangerous as Ebola:

  • “Signs and symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. For the majority of Lassa fever virus infections (approximately 80%), symptoms are mild and are undiagnosed. Mild symptoms include slight fever, general malaise and weakness, and headache. In 20% of infected individuals, however, disease may progress to more serious symptoms including hemorrhaging (in gums, eyes, or nose, as examples), respiratory distress, repeated vomiting, facial swelling, pain in the chest, back, and abdomen, and shock. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. Death may occur within two weeks after symptom onset due to multi-organ failure.”

7 pricks finger for blood collection 2Finally CDC cautions health workers to protect themselves and not assume every fever is malaria. “When caring for patients with Lassa fever, further transmission of the disease through person-to-person contact or nosocomial routes can be avoided by taking preventive precautions against contact with patient secretions (called VHF isolation precautions or barrier nursing methods). Such precautions include wearing protective clothing, such as masks, gloves, gowns, and goggles; using infection control measures, such as complete equipment sterilization; and isolating infected patients from contact with unprotected persons until the disease has run its course.”

While health workers at the front line are encouraged to use malaria Rapid Diagnostic Tests to determine or exclude a diagnosis of malaria, they must remember that RDTs involve blood. Protective materials are always required, even for ‘simple’ malaria. Health systems – public and private – need to ensure health workers have these life saving materials.