LASSA PANDEMIC: KILLER FEVER ON THE RAMPAGE

It started gradually and has steadily enveloped the Nigerian landmass. Lassa fever, a viral haemorrhagic disease, is transmitted to humans through contact with food or household items contaminated with rodent urine or faeces. Person-to-person infections and laboratory transmission can also occur, according to findings by ISIOMA MADIKE, who has been following the trend

 

 

Medical doctors in the country are strategising on how best to curtail the rampaging Lassa fever epidemic currently ravaging Nigeria, which they say has no approved vaccine yet. Part of the approach is an advice that people should, for now, avoid drinking ‘raw garri’ as many continue to die as a result of the virus. “This is not the period for people to drink raw garri because you know it is not cooked and people just pour water on it and drink after rat might have urinated on it.

So, Nigerians should, as much as possible, avoid drinking garri and ensure that their food is properly cooked,” Dr. John Oyibundu of Bamgilead Hospital, Ogba, Lagos, said. Oyibundu added that prevention of Lassa fever also relies on community engagement and promoting hygienic conditions to discourage rodents from entering homes.

In healthcare settings, employees, he further said, are equally advised to consistently implement standard infection prevention and control measures when caring for patients to prevent nosocomial infections. However, the public health physician is not alone on this.

Other medics have also warned that Newspapers used in wrapping suya, groundnut and akara should be avoided because, according to them, it can cause Lassa fever. “Newspapers used in wrapping suya, groundnut, boli (roasted plantain), roast yam, fried yam, and akara for us are sometimes from the stores where there are rats and this can expose us to Lassa fever. Newspapers cannot be washed, so, let us be careful. If u must eat suya, akara, groundnut, masa, go with your container,” Director-General, Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu, warned.

Ihekweazu said those in Edo, Ondo, Imo, Ebonyi, Kano, Delta, Taraba, Plateau, Bauchi, Lagos, Kaduna, Kogi and Borno, should be careful as Lassa fever is deadly. He said: “It has NO cure for now, ONLY prevention. But, early supportive care with rehydration and symptomatic treatment, improves survival. Make no mistake, Lassa fever is deadly.

It is caused by a virus from the same family as Ebola. This is not a joke. “Inform other people. Keep your kitchen and homes clean to avoid rats. Lassa fever is spread by contact through the urine and feces of infected rats and rodents. It may be house rats or bush rats. People should completely stay away from eating rats.

This is the time to cultivate healthy habits that discourage rats from thriving in our homes. Use a rat gum/rat poisons if u have to. Don’t eat any leftover food, especially in an environment that rats may be plenty. Those rats may have stooled/urinated in that food. “When you find a dead rat in your house, don’t pick it with bare hands.

The blood and bodily fluid of a living/ dead rat can infect you. Use gloves to pick any living or dead rat you find in your house and bury it safely or burn it totally. Don’t dispose rats anyhow anywhere, please. Keep gutters and drainage clean, especially around the house. “Don’t let garbage and house wastes always accumulate in your home.

Dispose as soon as possible and cover foods in your house properly. Use airtight containers, lock your cupboards, cover holes and opening to prevent rats and keep kitchen clean. And to my friends from where house rats are seen as a delicacy, please STOP EATING RATS. This is not safe. If anyone just suddenly falls ill with a fever, body aches, cough and vomiting, kindly go to a hospital; don’t assume it is malaria.

Supporting the call to avoid drinking garri carelessly, the Medical and Health Workers Union, Lagos State Council, said that it would embark on public enlightenment to discourage consumption of soaked garri for now to prevent more deaths from Lassa fever.

The union stated that house rats that caused Lassa fever are mostly in contact with Nigerian most popular food, garri, a cassava product. “Like any other form of disease, good hygiene practices and taking precautions over all forms of symptoms among family members and friends will also go a long way to curbing the spread of diseases.

Hand washing remains an effective way of preventing diseases. Families as well as corporate organisations should re-adopt the use of tip taps and hand sanitisers placed in public places,” it advised. These warnings, as expected, have already been affecting the sales of the product nationwide.

“I used to sell half bag of garri every week but now it’s been two weeks I have not finished selling quarter of the same bag,” said Deborah Ejike, a garri trader at the popular Mile 12 Market, Lagos. She said she was unaware that medical doctors advised people not to smoke garri but that she observed that market hasn’t been going very well for her.

A housewife, Mrs. Fatimoh Ayodele, also told Saturday Telegraph, that ever since she heard about the disease, she had been very careful and vigilant in her home. She said: “Now, I no longer place my spoon used in taking soup from the pot carelessly. I also cover my foodstuffs very well to avoid rats from intruding.”

She however, urged the government to do something very fast to arrest the situation. Another resident of Ketu, Lagos, also said that she has a neighbour, who usually beat his son mercilessly for not covering her garri container lid properly.

“As it is now, I’m even afraid to store garri in my house because we have ‘Rats Company’ in the area. I am afraid because no one can tell if where the garri is coming from has the virus already. For the main time, I will be mindful about garri consumption because prevention, they say, is better than cure.”

The death toll from Lassa fever in Nigeria since the beginning of January has risen to 41 as cases were confirmed in more regions, according to the NCDC, which said that between January 1, and January 26, a total of 258 confirmed cases, including five health workers, were reported across 19 states.

The latest figures were an increase from 29 deaths and 195 earlier confirmed cases given by the authorities for the period up to January 24. The virus, which mainly spread by contact with rat faeces or urine, starts with fever and can, in worst-case scenarios, lead to severe bleeding and organ failure. Gombe and Adamawa were the latest states to announce the arrival of Lassa fever in their domain, which the government officials admitted had already killed three people. This was even as facts emerged that it has spread to other states, where afflicted victims were battling to stay alive. Among the dead, two reportedly occurred in Gombe State, while one person died in Adamawa State.

The Commissioner for Health in Gombe State, Dr. Ahmed Gana, reportedly confirmed the deaths. He was said to have disclosed that the remaining four cases were undergoing treatment at the isolated ward of the Federal Teaching Hospital, Gombe. In like manner, the Adamawa State Government also confirmed the death of a 29-year-old woman said to come from Numan Local Government Area. The State’s Commissioner for Health and Human Services, Professor Abdullahi Isa, was said to have confirmed the incident.

Isa, reports said, explained that the index case of the woman was first seen as a gravid patient, which was someone with pregnancy of about seven month in a private health facility in Yola, before being referred to the Federal Medical Center, where she had a still birth. In Edo State, the Medical Director of the Irrua Specialist Teaching Hospital (ISTH), Prof. Sylvanus Okogbenin, dismissed rumours that two pregnant women and a serving youth corps member in Asaba, Delta State, admitted for the ailment, died in the hospital.

Unlike ISTH however, the Benue State University Teaching Hospital (BSUTH) in Makurdi confirmed a suspected case of Lassa fever in the hospital. The Chief Medical Director of the hospital, Prof. Terlumun Swende, said that a case had so far been reported from Okpoga, headquarters of Okpokwu Local Government Area of the state. Swende, who spoke through the Chairman, Medical Advisory Committee, Prof. Olusaya Alao, said the victim is a 40-year-old woman. Four persons were also confirmed dead in Taraba State just as Kaduna State announced the death of 36-yearold man. According to the Commissioner for Health in Taraba State, Dr. Innocent Vakkai, the ministry had recorded 15 suspected cases of Lassa fever, with only five, found to be positive.

“Four out of these five people that test positive to Lassa fever has died as most of the cases came from six local government areas of Bali, Gashaka, Gassol, Ardo-Kola, Jalingo and Ibi,” Vakkai was quoted to have said. He however, said that the state government has activated its surveillance system for more case detection and proper treatment.

The commissioner, who regretted that challenges such as late reporting of patients to hospitals and difficult terrains of the state had remained major banes to the management of the disease in Taraba, added: “Efforts are ongoing to create awareness for residents of the state to enlighten them about the symptoms of the disease.”

In Kaduna, the State Commissioner for Health, Dr Amina Baloni, also confirmed one death. Baloni said the patient died on Sunday night and had already been buried. Giving the breakdown, she said that the state recorded a total of 11 suspected cases, out of which, eight were returned, seven were negative and one positive who just died. “Thirty-eight others are currently on follow up contact. An active search is ongoing by the state to curb the spread of the disease,” she assured.

In response to the increasing number of Lassa fever cases across states in the country, the NCDC is said to have activated a National Emergency Operations Centre (EOC) to coordinate response activities. Ihekweazu, who disclosed this, noted that out of the confirmed cases, 89 per cent are from Ondo, Edo and Ebonyi states.

He stressed that the increase in the number of cases at this time of the year is not unusual due to ecological factors. Ihekweazu said the EOC includes representatives from the National Emergency Management Agency (NEMA), Federal Ministry of Agriculture and Rural Development, Federal Ministry of Environment, WHO, UNICEF, US Centers for Disease Control, and other partners.

He said that over the last weeks, NCDC had deployed Rapid Response Teams to support five of the affected states adding that the Minister of Health, Dr. Osagie Ehanire, led a high-level delegation to Kano State on January 25, following the alleged deaths of two health workers infected with the virus. He further said that Lassa fever cases are recorded all year round in the country, which makes it endemic in Nigeria.

There is usually an increase in cases, according to him, between November and May, during the dry season. Ihekweazu emphasised that the virus is transmitted by rodents, which can be found in almost every Nigerian environment. This, he said, contributes largely to the risk of spread that occurs in Nigeria and other countries with similar ecological factors.

He said: “We currently do not have a vaccine to protect against Lassa fever. Therefore, we rely on strengthening measures, such as ensuring proper sanitation, good personal hygiene and standard care precautions by health workers, among others, to prevent the spread of Lassa fever.

These measures also depend on personal responsibility, which means that we all have a role to play in preventing the spread of the infection.” However, the malady appears to have opened new vistas of business opportunities for some Nigerians. For instance, Tunde, a residential fumigator, is delighted that the scourge has been a good thing because he has been making enough money from his customers since the recent outbreak of Lassa fever.

Tunde, nonetheless, advised people not wait for an outbreak of diseases like this before seeking solutions. He added: “Unlike before, fumigators are not really known; it is like they never existed. You would hardly see fumigators in cities like Lagos except you go to the rural areas where some work on the farm.

But now that Lassa fever has been ravaging Nigerians, people know where they can find us. “One of my customers has already introduced me to over 25 people, who want their surroundings fumigated. I wouldn’t tell you how much I have been making but I am earning enough compared to old times.”

Yet, Tunde is not the only one counting his blessings from Lassa fever epidemic. A rat-poison merchant along Agidingbi Road, Ikeja, who craved anonymity, told this reporter that the sales of his product had increased and that he is thankful to God for the increase. Another petty trader at Ogba, who also refused his name in print, also asked: “Does anyone need to inform people before they buy insecticide and rodent poison to ensure safe environment? I wish this Lassa fever could continue till I make it big.

The time is good for some of us now. We are in business and business has been good.” For the Managing Director, PestOFF, Lekki, Lagos, Tunde Aderinto, it is a boom time for the pest control outfit as no less than 10 companies have, since the new burst a few days back, contracted the firm to fumigate their facilities and offices. According to Aderinto, the news of the outbreak of the virus as well as the accompanying commentaries has resulted in increased business for his firm. “Before, if we submitted 20 proposals to organisations seeking to fumigate their offices, maybe only one will respond.

“In fact, at a time in 2014, we offered fumigation services free just to sensitise the citizens. But in the last three weeks, more than 10 companies have sent their officials to us, requesting the fumigation of their offices and facilities. I have had to sublet some jobs to my other colleagues because I am running out of chemicals to meet people’s demands.”

Lassa fever is said to be asymptomatic in 80 per cent of cases but for some, it can cause fever, physical fatigue, nausea, vomiting, diarrhoea, headaches, abdominal pains or sore throat. Swelling of the neck or face can sometimes be observed. According to the WHO, the antiviral drug ribavirin appears to be an effective treatment for Lassa fever “if given early on in the course of the clinical illness”.

It sneaked in like a thief in the night and has left in its trail deaths in some neighbourhoods, and panic in others. It has thus far dispatched hundreds including caregivers to their untimely grave. The young, not so young and the aged have all been victims of this rampaging monster.

Though it kept coming back since its first appearance in a small village of Lassa, in Borno State, Nigeria where it derives its name in 1969. Yet, it threw both the health community and the general populace into quagmire. Like the equally dreaded Ebola that distressed the country not long ago, Lassa fever or Lassa hemorrhagic fever (LHF), an acute viral hemorrhagic fever caused by the natal multimammate mouse or rodent, the primary animal host of the Lassa virus, has rattled the health structures that were supposed to be on red alert.

The sector was again caught off-guard, at least in the estimation of ordinary citizens. This perception may be why some peo-ple have been insinuating that the health authorities’ and government’s ineptitude and unseriousness are to blame for the current epidemic. But, to some medical experts, clinically, Lassa infections are sometimes difficult to distinguish from other viral hemorrhagic fevers.

One of those with this opinion is a Professor of Public Health and Consultant Epidemiologist at the Lagos University Teaching Hospital (LUTH), Adebayo Onajole, who insisted that viruses of this nature usually surfaces once in a while. He also claimed to be aware of the government surveillance system in place.

“But, the problem is that it is extremely difficult to distinguish it from other viral hemorrhagic fevers such as Ebola, Marburg and from more common febrile illnesses such as malaria. Most times it comes like the normal fever and there is always a low index of suspicion and most people affected may not present clinical symptoms. Some may just have it and with related treatment, survive without presenting any serious suspicion.

“Haven said that, the government needs to do more to strengthen the health sector, particularly at the local levels as to be able to confront such malady effectively in future because they would always resurface now and again. In any case, that does not mean we have to heap the blame on government or the healthcare systems,” Onajole said. Another Consultant Family Physician and former President of the Nigerian Medical Association (NMA), Dr. Osahon Enabulele, also toed this line of argument. He told Saturday Telegraph that he is at loss as to where people are getting their views concerning the lacklustre attitude of the health officials and government on the issue at hand.

He said: “The much I know is that Lassa is not a new thing and the health authorities are alive to the challenge. What I think we should be talking or thinking now is how to strengthen the health systems at the local level in terms of both primary and secondary structures.

This is because an aggregate of that is what healthcare is supposed to be. “In any case, we need to continue to emphasise research into these areas, this should have been the thinking since the Ebola saga. Given the fatality rate of the current Lassa epidemic, the Federal Government should step up effort like it’s already doing in terms of awareness, particularly at the grassroots and like I said earlier, move to fortify the local health system.

“We should not forget that this type of health challenge will always come and there ought to be system in place to tackle such anytime there is a recurrence. Of course, from the current prevalence, nobody should be blamed for being panicky,” Enabulele said. Yet, a gynaecologist and first vice president, Society of Gynaecology and Obstetrics of Nigeria (SOGON), Dr. Olurotimi Akinola, added another angle to the issue.

He said: “Nigeria is endemic to Lassa; it’s homegrown unlike Ebola which was imported and much more deadly. I don’t think there has been any year without an outbreak of Lassa in the country and so we have been having it.” Another medical doctor and former Chief Medical Director, Lagos State University Teaching Hospital (LASUTH), Ikeja, Dr. Olufemi Olugbile, seemed to agree with Akinola when he said that the disease is indigenous to Nigeria. To him, what is needed now is high incidence of awareness from time to time. “It’s basically a wake-up call for both public health practitioners and the general public, especially in the area of hygiene that we habitually neglect. I won’t admit that the current epidemic took us unawares, rather I’d commend public health sector for the speedy way they have combated it. It could have been worse but for their alertness.

However, I would recommend that government should intensify the consciousness campaign against filth; it should height things that promote cleanliness. Lassa is simply an environmental problem,” Olugbile said. First identified in 1969, the hemorrhagic fever caused by the Lassa virus can be transmitted via contact with urine, faeces and blood of a rodent, commonly known as the multimammate rat. Human to human transmission has also found to be possible. The virus is widespread in West Africa, particularly in Benin, Guinea, Liberia, Sierra Leone and Nigeria.

Lassa fever can be deadly if not cured during its early stage. Typical symptoms of this disease include high fever, general weakness, sore throat, cough, nausea, vomiting, and diarrhea. Later symptoms include bleeding, rashes and swelling of the eyes and genitals.

The incubation period lasts from six to 21 days, according to WHO. Contamination can be prevented by, among other things, storing food in containers not accessible to rodents, disposing of garbage far from home and avoiding contact with bodily fluids of sick people.

While most humans are infected either from contact with an infected rat or inhalation of air contaminated with rat excretions, like other hemorrhagic fevers, Lassa fever can be transmitted directly from one human to another. It can be contracted through direct contact with infected human blood excretions and secretions, including through sexual contact. However, no evidence of airborne transmission from person-to-person has been identified. But, transmission through breast milk has been observed.

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