The dreaded haemorrhagic disease Lassa fever, which is spread by rats, is making a comeback in Nigeria, and it is doing so in a big way, according to the Chief Medical Director of Irrua Specialist Hospital Prof. George Akpede. He said the current Lassa fever epidemic in Nigeria may be countrywide and not limited to some states.
Infection with the Lassa virus is debilitating because it causes a fever whose symptoms include vomiting blood, passing blood in the stool, body rashes, jaundice and other symptoms commonly found in typhoid and malaria fever.
According to Akpede, at least 13 states and the Federal Capital Territory have now reported the disease’s outbreak with more than 51 million Nigerians at risk of contracting the disease. Irrua Specialist Hospital is designed specifically for the treatment of Lassa fever, and its CMD estimates that at the current rate of infection, the annual number of people who will fall sick from it is expected to be around 3 million. The annual number of deaths from the fever could top 58,000, he also said.
Consultant Community Medical Doctor at Irrua Specialist Hospital Dr. A.D. Asogun said 48 Lassa fever patients were brought to the hospital in January 2012 alone, out of which 15 have died. Giving a breakdown of reported cases, he said there have so far been 22 reported cases in Edo State out of which 9 died. Taraba State recorded the second highest number of infections with 9 patients out of which 4 died, followed by Ebonyi State with 8 cases brought to the hospital out of which 3 died. Other states include Ondo, 6 patients; Plateau State, 2 patients and Rivers State, 1pateint.
“These figures only represent cases brought to the hospital in Irrua when the situation has gotten too bad to handle,” said Dr. Asogun. “Millions of Nigerians live with the Lassa fever virus without knowing it, while some have mistakenly been treating malaria or typhoid fever.”
Akpede said in 2008 Irrua Specialist Hospital treated 229 patients who were suspected of contracting the disease out of which 30 died. In 2009, in January and February alone, 161 patients were treated, of which 25 died. In January this year alone there were 48 patients referred to the hospital. “We are yet to get statistics from other states and autopsies and we are yet to get the figure for February,” he said.
Health workers are especially at risk of contracting the disease from exposure to infected patients. Since 2008, 7 doctors died from the disease, with the latest death being a medical doctor in Taraba State.
“The present patients in the hospital from Taraba and Ebonyi States are health workers,” said Dr Akogun. “I wonder what could have happened to the patients they operated on and members of their families. Last year we had three doctors from Yola hospital in Adamawa State brought here and one of them died.”
Doctors at the hospital say the available manpower and equipment at the hospital are grossly inadequate to treat the disease and the facilities are overwhelmed. Doctors also say the hospital requires more trained staff and because the virus is highly contagious, more isolation facilities and dialysis machines.
There is no vaccine or immunization for Lassa fever. Only awareness can help in prevention, doctors say. It is treatable at the early stage, say within 6 days of infection. Lassa fever is endemic in Nigeria, Sierra Leone, Guinea and Liberia. The virus is shed in the urine and droppings of rats. The virus can therefore be transmitted through direct contacts, touching objects or eating food contaminated with urine or droppings of these rats. As the rats often live in and around homes and scavenge on human food remains or poorly stored food, transmission of this sort is common. Contacts with the virus may also occur when a person inhales tiny particles or aerosols in the air contaminated with rodent excretions. Infections may also occur via direct contact when rats are caught and eaten.
Lassa fever may also spread through person to person contact. This occurs when a person comes in contact with the virus in the blood, tissue, secretion or excrements of an individual infected with Lassa virus. This can happen in rural and healthcare settings. The virus may also spread in contaminated medical equipment in health care settings when materials such as needles, syringes and scalpel blades are reused.
Dr. Ogugua Osi-Ogbu, Consultant Physician at the National Hospital, Abuja and the Coordinator of its Lassa Fever Infection Control said, “It is worthy of note that this period is the outbreak period and it is because of the fact that January to April is the period that people practice bush burning and in the process, displace rats and make them find their way into homes. So if people don’t keep their food clean and cover them, these rats that are infected with the virus can come in contact with them.”
There was an upsurge of the disease in Nigeria between December 2011 and January 2012, doctors say. Estimates from doctors say there had been a 60 percent increase in suspected cases of the disease and 80 percent increase in confirmed cases. The upsurge in infection rate, doctors say, is because Lassa fever is often confused with typhoid fever or malaria fever.
“Patients infected with the disease usually complain of fever, headache, so in most cases, when doctors meet such patients with these kind of complains the first thing that runs through their mind is malaria fever or typhoid. Doctors need to have a very high index of suspicion, especially during this epidemic period.
“Lassa is easily treated if it is diagnosed early, but most of the mortality cases occur when there is late treatment. If you can track it in the first six days of infection, treatment is easy but when it gets to a point where organs failure sets in, chances of survival become very slim.
“Some of the major challenges in treating Lassa fever are common. Medical personnel don’t have high suspicion index at this period of the outbreak between January to April. When medical personnel treat patients for fever and it refuses to go, that personnel must think of diagnosing Lassa fever.”
While Edo State reported the worst case of the disease so far, the disease has been causing great concerns in Taraba State where the second worst case of infections has been recorded. Left with no fumigation control that would help reduce rats around their homes, residents in the state have deployed cats to help reduce the population of rats lurking around their homes. While this could prove to be an effective strategy, it could chase rats into neighbouring homes that don’t have cats.
The disease first broke out in Jalingo in early January before it spread across Taraba state, killing at least nine persons in five local government areas. As at Monday, authorities at the Federal Medical Centre, Jalingo, said at least eight persons have died at the hospital due to a disease suspected to be Lassa fever. Two of the victims were pregnant medical staff of the hospital, authorities of the tertiary health facility have said. At least 28 suspected cases of Lassa fever have been reported at the centre since early January, according Dr. Attah Dangana, Head Clinical Services of the FMC.
He said Dr. Aisha Shettima and Hajiya Aminatu Abdullahi a doctor and a nurse of the hospital, all pregnant mothers, contacted the Lassa virus while treating patients infected with it and died even before they were referred to the National Institute of Lassa Fever Research and Control at Irrua in Edo State for medical attention.
In addition, two doctors and five nurses of the hospital, who had shown symptoms of the disease have been taken to the Lassa Fever Research and Control Institute at Irrua, with the doctors and two of the nurses testing positive to the fever.
Dr. Dangana said when the first three suspected cases of the disease were presented at the centre in early January, they were treated and one of the patients got better but the other two died within 24 hours. He said the two persons that died were from Iware and Mayo Raneyo, all in Ardo-Kola local government of the state.
“And because we were suspecting, we had not actually confirmed the disease, we took samples immediately to be sent to the proper laboratory. We don’t run the test here. We gave it to the Epidemiology Unit. Unfortunately the samples were not sent and we did not receive any further report until about two weeks ago when one of the doctors that attended to one of the patients started developing symptoms of the disease,” he said.
Doctors that have treated Lassa fever patients at the Jalingo FMC have been kept on surveillance such that once they develop the symptoms they are rushed to Irrua for confirmation and treatment. However, the two medical staff the centre has lost to the disease presented the symptoms and died within a very short time because they were pregnant. “Usually the disease is more severe in pregnancy,” he said.
The head of clinical services said more deaths due to Lassa fever could have occurred as some two patients with suspected symptoms of the fever signed against medical advice and left the hospital, with the likelihood that they may not survive the deadly disease.
Dr Osi-Ogbu, the Lassa fever coordinator at the National Hospital, Abuja identified some of the challenges faced in treating the disease and protecting the health of medical workers who come in contact with it. She said there is “the inadequacy of centers where the diagnosis of Lassa fever is done. At the moment, the available centers in the country are just in Edo and Lagos State. Whenever, there is any suspicious case anywhere, even in Abuja, samples must be taken to those centers to be tested, so you can imagine the logistic challenge involved, the timing etc. Meanwhile this disease needs quick treatment, so it’s a big challenge.
“Another challenge is the availability of the drug of choice. The drug is expensive, though at the moment it is provided by the government, through the Federal Ministry of Health. Again, we don’t have it in drug form. It comes in form of injections. The last challenge is the unavailability of adequate protective wears at work for health workers. The way Lassa fever infection is, workers taking care of patients are supposed to be highly protected from head to toe in the hospital.”
The Yola Federal Medical Centre has been forced to close its accident and emergency unit and the male medical ward as a measure of containing the disease from spreading. Dr Dangana lamented that it is a public health problem that has taken a toll on the hospital. He said the shut down units have been fumigated and will only be opened when it is safe to do so.
He said though the FMC has competent personnel to treat the disease, logistics and equipment to carry out the test in Jalingo, and how to protect medical staff from getting infected was a serious challenge to the hospital.
“It takes 48 hours to get laboratory investigation results from Irrua,” he said. “It is a whole day’s journey from here and I think that is not the best way to tackle a medical emergency.”
He said they had enough medication to manage the disease but lacked drugs to prevent health workers handling the cases from contracting the disease. “Ribavirin which all medical staff treating the patients should take can only be found in one pharmacy in Lagos and our supply of protective masks and other safety facilities are in short supply,” he said.
Dr Dangana said a particular species of rat with many breasts and a hairless short tail is the main vector of the Lassa virus.
He advised members of the public not to panic but take protective measures of covering their food since the easiest way to contact the disease is by allowing the rat to urinate, excrete or spit saliva on food.
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