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Lassa fever should be prevented!

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Lassa fever is known to be endemic in Benin Republic, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria. There have been indications that it exists in other West African countries as well.

In 2017, Benin, Burkina Faso, Sierra Leone, and Togo experienced outbreaks that were reportedly controlled.

Although, Nigeria is one of several West African countries in which Lassa fever is endemic, with seasonal outbreaks occurring annually between December and June, the current outbreak of the disease in Nigeria is continuing beyond the normal season and it is killing people.

2016, the country reported 273 suspected cases and 149 deaths (case fatality rate 55 per cent) from 23 states. According to Nigeria Centre for Disease Control (NCDC), during the 2017 outbreak, nineteen (19) States (Ogun, Bauchi, Plateau, Ebonyi, Ondo, Edo, Taraba, Nasarawa, Rivers, Kaduna, Gombe, Cross-River, Borno, Kano, Kogi, Enugu, Anambra, Lagos and Kwara) reported at least one confirmed case. As at November 2017, the outbreak was active in five states: Ondo, Edo, Plateau Bauchi and Kaduna.

On January 14, this year, four cases of Lassa fever among health-care workers in Ebonyi State were reported at the NCDC. Three of the four cases – two medical doctors and a nurse have subsequently passed away, despite efforts to save their lives.

According to the University Graduates of Nursing Science Association (UGONSA), at the latest count, more than 40 health workers have died as a result of Lassa fever in Ebonyi alone in the past 13 years.

As at March, 2018, the NCDC said that Lassa fever had claimed 43 lives in Nigeria with a total of 615 cases reported across 17 states since the beginning of the year (2018).

This year’s outbreak is said to be unprecedented due to the high number of confirmed cases and deaths. As a result, Lassa fever, a disease graded as Neglected Tropical Disease (NTD), became a Grade Two Emergency on the World Health Organisation (WHO) Emergency Response Framework in the country due to the high infection and death rate.

So, the issue of Lassa fever has become a recurring decimal in the Nigerian health ‘scene’; and has thrown up different issues just as viral diseases have different strains.

Some of the issues range from poor access to preventive care and management, to prohibitive cost of treatment, which engender high mortality.

According to experts, the high cost of managing Lassa fever, as well as, late presentation, slow identification and poor management of cases, range top among reasons for the high mortality rate being recorded this year.

Although, the NCDC has ensured that every state in Nigeria has an emergency stock of Ribavirin and other response commodities available to manage cases; the treatment of Lassa fever is expensive, as it costs at least N500,000 to treat a patient of Lassa fever with the drug-of-choice, Ribavirin.

While the debate of who bears the cost of treatment between the patient and government rages, preventive health care will reduce the debate and controversy on who picks the bill of treatment.

So, there is the compelling need for critical efforts in managing the deadly ailment through prevention.

In looking at the source, WHO states that the reservoir or host of the Lassa virus is the “multimammate rat” called mastomys natalensis, which has many breasts and lives in the bush and around residential areas.

So, it is spread by rats. The virus is shed in the urine and faeces of the rats, hence can be transmitted to humans via direct contact, touching objects or eating food contaminated with these materials or through cuts or sores.

Person-to-person infections and laboratory transmission can also occur, particularly in hospitals lacking adequate infection prevention and control measures.

Persons at greatest risk are those living in rural areas where mastomys are usually found and especially in communities in cities with poor sanitation as well as crowded living conditions.

Therefore, its prevention relies on scientific interventions. All told, societal and individual behavioural changes hinge on good hygiene and sanitation.

Individuals should adopt preventive practices by storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, and maintaining clean households and environments.

Health workers should maintain a high level of alert in the wake of this new outbreak and observe universal precautions in handling all suspected cases of this viral haemorrhagic fever.

The scientific intervention requires a connect between town and gown. The Federal Ministry of Health, Centre for Disease Control (CDC) in Nigeria, Nigerian Institute of Medical Research, Institute of Human Virology, Nigerian research and development units of health-related organisations such as pharmaceutical companies and universities should collaborate and engage in a well-coordinated manner to search for solutions through research on the specie of rat that hosts the Lassa virus and how to make them de-zoonotic in order to render them impotent as carriers.

They should also lead a vaccine and treatment research, particularly now that the federal government recently said that Nigeria is set to resume local production of vaccines after 27 years.

In addition, any institution or individual who has done any useful research should make it public.

Meanwhile, relevant ministries, departments and agencies of government at all levels should map the pattern of the outbreak with a view to preventing future occurrences.

Finally, the South-East virology centre built by Ebonyi Government two years ago should be made fully functional, to reduce the unnecessary and arduous ferrying of victims of Lassa fever from the east, by road to Irrua in Edo.

The referral often leads to death from exhaustion of some of them in the course of such a long-distance journey on bad roads.

In addition, because of the high incidence of the disease recorded this year, national authorities and international partners should scale-up preventive and curative interventions in order to prevent further spread.


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