Lagos And The Outbreak Of Lassa Fever

Dr. Jide Idris, Lagos State Health Commissioner

BILKIS BAKARE

•Dr. Jide Idris, Lagos State Health Commissioner
•Dr. Jide Idris, Lagos State Health Commissioner

Lagos recorded its first official case of the Lassa fever disease following the recent disclosure by Dr Jide Idris, the Lagos State commissioner for Health, that the State Government had placed under surveillance Ahmmadiyyah Hospital, Ojokoro, where the patient with the first Lassa fever virus case was first admitted. According to Idris, 15 in-patients and other 25 health workers in the facility have been put under observation. He confirmed that the disease was contracted by a 25-year-old male undergraduate student of the Ahmadu Bello University, (ABU) Zaria in Kaduna State. The patient, who complained of fever, sore throat and difficulty in swallowing, was taken to Ahmmadiyyah Hospital from where he was referred to the Lagos University Teaching Hospital (LUTH).

In view of the huge population and metropolitan nature of Lagos, the State Government is making efforts to stem the tide of the disease. Currently, isolation centres have been provided to handle suspected and established cases while enlightenment campaigns through the airing of jingles on Lassa fever on electronic media and the distribution of information leaflets by the Medical Directors of LASUTH and 26 General Hospitals in Lagos State have been stepped up. Similarly, the Mainland Hospital and all other General Hospitals have been placed on the alert where anti-viral drugs for the management of cases are available. Ambulances have been dedicated to respond to referral and transportation of cases. Also, the Disease Surveillance and Notification Officers (DSNOs) in all the LGAs in the state have been sensitized on Lassa fever to enhance early detection and prompt reporting of cases. The state government is also collaborating with the Federal Ministry of Health, Virology Reference Laboratory, College of Medicine University of Lagos and World Health Organisation in the prevention and control of the disease.

Lagos residents are advised to keep away from rats and report any case of persistent fever to the nearest public health facility. They are to also shun ingestion of foods and drinks infected by the saliva, urine and faeces of infected rats as well as catching and preparing infected rats as food. They should also avoid inhaling small particles in the air contaminated with infected rat urine or droppings. Getting directly in contact with an ailing person’s blood or body fluids, through mucous membranes, like eyes, nose or mouth should also be avoided. Above all, residents should embrace personal and environmental hygiene.

Other states with reported cases of Lassa fever since its outbreak in August last year include Bauchi which recorded the first case in November, 2015, Nassarawa, Niger, Taraba, Kano, Rivers, Edo, Plateau, Gombe, Osun, Ondo, Lagos and Oyo States. To date, the disease has claimed the lives of over 40 people with not less than 80 reported cases. Lassa fever, a haemorrhagic disease was named after Lassa village in Borno State, North Eastern Nigeria where it was first discovered in 1969. The disease occurs more in the dry season than the rainy season. It is caused by a species of rodents called the Natal multimammate rat, the common African rat, or the African soft-furred rat. The Lassa virus is transmitted when the droppings, that is the urine or faeces of the rat- the natural reservoir for the virus- comes in contact with foodstuffs or in the process of the rat accessing grain stores, either in silos or in residences.

The rodents live in houses with humans and deposit excreta on floors, tables, beds and food. Consequently, the virus is transmitted to humans through cuts and scratches, or inhaled via dust particles in the air. In some regions these rodents are also consumed as food. Secondary transmission of the virus between humans occurs through direct contact with infected blood or bodily secretions. This occurs mainly between individuals caring for sick patients, although anyone who comes into close contact with a person carrying the virus is at risk of infection. Nosocomial transmission, that is the transmission that occurs as a result of treatment in a hospital and outbreaks in healthcare facilities in endemic areas, represent a significant burden on the healthcare system.

In the early stages, Lassa fever is often misdiagnosed as common cold, typhoid or malaria, and as a result many patients fail to receive appropriate medical treatment. Making a correct diagnosis of Lassa fever is made difficult by the wide spectrum of clinical effects that manifest, ranging from asymptomatic to multi-organ system failure and death. The onset of the illness is typically mild, with no specific symptoms that would distinguish it from other febrile illnesses. In 80% of cases, the disease is without symptoms but in the remaining 20%, it takes a complicated course. It has an incubation period of six to 21 days after which an acute illness develops.

Early signs include fever, headache and general body weakness, followed by a sore throat, nausea, vomiting, abdominal pain and diarrhea in some cases. After 4 to 7 days, many patients will start to feel better, but a small minority will present with multi-organ involvement. It can affect the gastro intestinal tract causing nausea, vomiting and stooling of blood as well as difficulty in swallowing; cardiovascular system symptoms include hypertension or hypotension as well as abnormal high heart rate and shock. In the respiratory tract, the victim experiences chest pains, cough and difficulty in breathing. The virus also causes difficulty in hearing, meningitis and seizures as well as symptoms such as swellings, hypertension, bleeding and shock. Death from Lassa fever most commonly occurs 10 to 14 days after symptom onset. Non-specific symptoms are facial swelling, and muscle fatigue, as well as conjunctivitis and mucosal bleeding. And one of the hallmarks of Lassa virus infection is the absence of functional antibodies during acute infection.

There are three ways by which the virus can be treated and also prevented from further spread. These are implementation of barrier nursing, which is isolation of victims, tracing of people that have come in contact with sufferers as well as the initiation of treatment with the only available drug, Ribavirin. The latter is only effective if administered early, within the first 6 days after disease onset.

While providing care for people with Lassa fever, further transmission of the disease through person-to-person contact or other routes may be avoided by taking preventative precautions against contact with secretions from infected persons called ‘VHG isolation precautions,’ or barrier nursing methods. The precautions include wearing protective clothing such as masks, gowns, gloves and goggles; using infection control measures such as the sterilization of equipment. It is vital to isolate infected people from contact with unprotected persons until the disease has run its course.

In addition, all states’ Ministries of Health and Information have a lot to do in educating people who live in high-risk areas as well as those not currently affected about ways to lower the rat populations in their homes which will go a long way in controlling and preventing Lassa fever from gaining ground in the country. With the array of challenges currently facing our beloved country, we cannot afford to treat the outbreak of Lassa fever with kid gloves.

—Bakare is of the Features Unit, Lagos State Ministry of Information & Strategy, Alausa, Ikeja.