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By Tope Adeboboye
Like the uncontrollable wind that usually heralds an angry rainstorm, Lassa fever is on the prowl again.
Last week, the Federal Government declared a fresh outbreak of the endemic disease in the country. The Nigeria Centre for Disease Control (NCDC) announced that 60 cases of the fever had been confirmed in at least eight states since January 13 this year. According to the centre, 16 people have died of the disease.
Chief executive officer of NCDC, Dr. Chikwe Ihekweazu, also explained that 590 people out of 593 contacts were currently under watch in the affected states since the beginning of the year. The centre, while urging Nigerians not to panic, said it had activated emergency measures to curtail the spread of the acute viral hemorrhagic fever.
“Given this increase in reported cases of Lassa fever, the NCDC has declared this an outbreak and activated an emergency operations centre (EOC) to coordinate the response,” the centre said.
The national EOC is composed of representatives from the World Health Organisation (WHO), Federal Ministry of Agriculture and Rural Development, Federal Ministry of Environment, United States Centre for Disease Control, and other partners.
Ihekweazu said the centre had been providing support to states, including emergency supplies and deployment of rapid response teams (RRT).
“The RRTs would work with states in response coordination, contact tracing, case management, risk communication and strengthening infection prevention and control practices,” Ihekweazu said. “Since the Lassa fever outbreak in 2018, NCDC has worked with states to ensure better preparedness and improved response. In the last one year, guidelines have been revised, new data management tools have been developed and the laboratory network has been strengthened.
“Additionally, risk communications have been strengthened through radio, posters, flyers and social media. A national research plan has been developed, to enable its full integration into the outbreak response to gain a better understanding of the disease.”
Such assurances, have, however, not diminished the apprehension being felt by many Nigerians. Indeed, not a few Nigerians are worried that Lassa fever has become an absolutely indomitable condition for the authorities. And as more cases are discovered, inevitably leading to more deaths, the panic mode naturally escalates.
Fever from Lassa Town
There have been suspected cases since the 1950s, but the Lassa fever virus was first described in 1969 from a case in Lassa, a town in Borno State. The disease is relatively common in West Africa, especially in Nigeria, Liberia, Sierra Leone, Guinea, and Ghana. There are about 300,000 to 500,000 cases that result in 5,000 deaths a year.
Wikipedia sheds more light on what the disease is all about: “Lassa fever, also known as Lassa hemorrhagic fever (LHF), is a type of viral hemorrhagic fever caused by the Lassa virus. Many of those infected by the virus do not develop symptoms. When symptoms occur they typically include fever, weakness, headaches, vomiting, and muscle pains. Less commonly, there may be bleeding from the mouth or gastrointestinal tract. Among those who survive, about a quarter have hearing loss, which improves over time in about half.
“The disease is usually initially spread to people via contact with the urine or faeces of an infected multimammate rat. Spread can then occur via direct contact between people.”
No vaccine has been developed yet for the prevention of the disease. Those that have been infected are usually isolated from other people. Some of the preventive measures that have been advocated include elimination of rats from homes, especially the multi-breasted type that carries the virus, ensuring that foodstuffs are clean and kept in hygienic, sealed containers, as well as the consistent sanitation of the home and the environment. WHO has also advocated the keeping of cats to hunt the rats that spread the disease.
Diagnosis of Lassa fever based on symptoms is difficult, as the symptoms are hardly different from those exhibited in other fevers. Confirmation is usually by laboratory testing.
However, patients may develop fever, facial swelling, muscle fatigue, conjunctivitis and mucosal bleeding. Other signs of Lassa fever may include gastrointestinal tract bleeding, nausea, vomiting, diarrhoea and abdominal pain. Pregnant women and newborns are said to be especially vulnerable. In fact, infected pregnant women must have their foetus evacuated to ensure their survival.
News of dread
Since the outbreak was announced, some states have been issuing warnings to their residents, alerting them to the Lassa fever realities and urging them to be more health-conscious. In Edo State, a statement by the Special Adviser to the Governor on Media and Communication Strategy, Mr. Crusoe Osagie, urged residents to take extra precautions against the disease.
He said, “The disease is prevalent during the dry season, as burning of surrounding bushes is a common practice. The rats, which spread the diseases, may find shelter in human habitation as a result of bush burning.
“Governor Godwin Obaseki has made efforts to halt the spread of Lassa fever in the state. If residents ignore this warning, it may expose them to the disease, as experts have linked the dry season when bush burning is rampant to the resurgence of the disease. It is important for residents in the state to be cautious and guard against the resurgence of the disease. People should protect their foodstuff and water from rats through storage in well-covered containers. Avoid bush burning that can drive rats into people’s homes from the surrounding bush. The environment should be clean always.”
He urged residents to ensure that they report suspected cases to officials of the state ministry of health or the nearest health facility, “People should ensure that they wash their hands frequently in addition to avoiding contact with infected persons. Any person with fever should go to the hospital promptly. Eliminate rats from your homes and communities. Cook your food thoroughly.”
The Delta State government also confirmed that a woman had died of Lassa fever in the state. The Commissioner for Health, Dr. Mordi Ononye, said the woman, Mrs. Roseline Ekev, a native of Umuolu community in Ndokwa East Local Government Area, had been battling with the disease since August last year. The commissioner added that two others suspected to have contracted the fever had been quarantined, adding that health managers were working across the state to intervene in the case of any suspicious outbreak or fresh cases. He also urged those that have been treating malaria with no headway to report to the nearest hospital for treatment.
“There is already a solution to the disease’s outbreak, and the state government, being passionate about the health of Deltans, will do everything possible to protect them,” the commissioner said.
In Plateau State, the situation is hardly encouraging. At least 17 Lassa fever cases have been recorded by the authorities, and five victims have been confirmed dead.
Commissioner for health in the state, Dr. Kunden Deyin, regretted that many people hardly reported to the hospital during health crisis. He stressed that prompt checks were imperative to reducing the mortality rate associated with Lassa fever. Deyin said it was unfortunate that patients usually reported to the hospital when it was already too late. He charged health workers to quickly make referrals to higher health facilities whenever cases presented to them become unmanageable. He also advised residents to keep their environment clean to ward off rodents, while grain stores should be sealed.
Annual ritual
It is not the first time that the fear of Lassa fever would pervade the entire country. In fact, the outbreak of the disease has become an annual ritual.
Every year, a fresh outbreak occurs at the beginning of the year, putting the country in panic mode. The predictable response from the authorities is hardly altered from year to year. Fresh cases are announced, warnings are given, and deaths are recorded. Then the nation patiently awaits outbreaks in the following year, while families and friends of the victims mourn their loss.
In 2018, at least 3,016 suspected cases of Lassa fever were recorded in 22 states and 90 local government areas in the country, according to official data. Out of this number, at least 143 died.
It is believed that Lassa fever usually occurs in Nigeria during the dry season, notably between January and April each year.
Fear of rats
Indeed, Lassa fever should induce the fear of rats in many people. Geographically, the Lassa belt currently includes Guinea, Nigeria, Sierra Leone and Liberia. In Guinea, the disease is prevalent in Kindia, Faranah and Nzerekore regions; in Liberia, it occurs mostly in Lofa, Bong, and Nimba counties, while in Sierra Leone the disease is in Kenema and Kailahun districts. But in Nigeria, Lassa fever is common in all parts of the country as the rat is found in all the states.
Why Lassa fever spreads fast
The natal multimammate rat, or African rat, also called the natal multimammate mouse (Mastomys natalensis) is probably the most common mouse in equatorial Africa. It is easily found in human households and devoured as a delicacy in some parts of Nigeria.
Wikipedia explains further: “The multimammate rat can quickly produce a large number of offspring, tends to colonise human settlements, increasing the risk of rodent-human contact, and is found throughout the west, central and eastern parts of the African continent.
“Once the rat has become a carrier, it will excrete the virus throughout the rest of its lifetime through faeces and urine, creating ample opportunity for exposure.
“The virus is probably transmitted by contact with the faeces or urine of animals accessing grain stores in residences.
“Individuals who are at a higher risk of contracting the infection are those who live in rural areas where mastromys are discovered, and where sanitation is not prevalent. Infection typically occurs by direct or indirect exposure to animal excrement through the respiratory or gastrointestinal tracts.”
Experts have suggested that the disease is common in the dry season partly as a result of bush burning by game hunters. Animals escaping the fury of the wild fire would naturally find better, more welcoming habitations in human residences.
WHO has warned that the Lassa virus might be the cause of a future epidemic, and urgent research must be carried out to develop new diagnostic tests, vaccines, and medicines to combat the scourge.
NCDC’s counsel
NCD’Cs Dr. Ihekweazu gave a few tips that could save lives during Lassa fever emergencies. He urged members of the public to focus on prevention by practising good personal hygiene and proper environmental sanitation.
His words: “Take effective measures by storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, maintaining clean households, and other measures to discourage rodents from entering homes.
“Hand-washing should be practised frequently. The public is also advised to avoid bush burning. Health care workers are again reminded that Lassa fever presents initially like any other disease-causing febrile illness such as malaria.
“Health care providers are advised to practise standard precautions at all times, and to maintain a high index of suspicion.
“Rapid diagnostic test must be applied to all suspected cases of malaria. When the RDT is negative, other causes of febrile illness, including Lassa fever, should be considered. Accurate diagnosis and prompt treatment increase the chances of survival.
“The national guidelines for infection prevention and control, as well as Lassa fever case management, have been developed, disseminated to states and are available on the NCDC website for download.”
