Emerging and re-emerging diseases: Call for timely public health response in Nigeria

At present, the World Health Organisation (WHO) is monitoring a couple of infectious diseases, including: Ebola, Lassa fever, Severe Acute Respiratory Syndrome (SARS), Acquired Immune Deficiency Syndrome (AIDS), Haemorrhagic fever, West Nile Virus, and Lyme disease. The rate of re-emergence of infectious disease has been on the increase. Diseases such as cholera, tuberculosis, Influenza (flu), hepatitis and staphylococcus infections thought to have been controlled are re-emerging. A majority of the agents causing these diseases have either mutated or genetically recombined to become more dangerous and often drug-resistant.

The rapid spread of these diseases across continents has shown that the ease of international travel and cross border trades put countries at risk of mass infection. The WHO and the wider scientific and general medical community share the thought that the world may be as close to pandemic as it has ever been.

The emergence and re-emergence of these diseases are warning signs and countries have responded with various levels of intensity to protect their populations. While some countries have been proactive (anticipated dangers and designed quick response mechanisms), others are just being reactive. In any case, many of these diseases are resident in Africa.
Public health management and response – Review of the Ebola outbreak and a case for Lassa fever re-emergence
The Ebola outbreak in 2014 (notably in West Africa – Liberia, Sierra Leone, Senegal, Guinea and Nigeria) was supposed to be a warning of greater dangers to come, especially for countries that do not have sound healthcare systems. But was it really? For the swift effort of the first responders (the physicians at First Consultant Hospital in Lagos, who risked their lives to halt the first known Ebola case in Nigeria, the effect of Ebola may have been fatal than experienced.

More importantly, the public health breakdown and mass death due to the Ebola disease in Liberia and Sierra Leone should be enough to remind the appropriate health management authority that danger yet looms and necessitate the need for a rather proactive rapid response to disease outbreaks.

Nigeria has four documented episodes of Lassa fever occurrences. The first emerged in 1969 in Lassa village (Borno State, North East Nigeria) but was isolated from the blood sample of a missionary nurse who had sought treatment in Jos, Plateau State (North Central region of Nigeria). Then Lassa outbreak occurred in Jos in 1970, 28 persons were reportedly infected, of which 13 died. A third episode in 2012 infected over six hundred persons and killed over 70 in 19 of the 36 states. All these episodes also had Nosocomial transmissions (infection of healthcare workers). Barely four years later, Nigeria has witnessed a re-emergence of the same epidemic- prone disease (since December 2015).

Lassa fever is endemic to West Africa – with confirmed cases in Sierra Leone, Liberia, Guinea, Nigeria and Mali – all which were also affected by the Ebola outbreak. Estimates of annual incidences of Lassa fever across this region could reach as high as 300,000 infections and 5,000 deaths. Ebola and Lassa are haemorrhagic in nature and are also occurring within similar region. Is there a link between geography and these diseases or just a coincidence? Public health knowledge suggests that these should be vital information for the Nigerian health authority and the insights gained can be useful to inform proactive responses, perhaps in anticipation of future outbreaks.
A rather slow initial approach
Since the re-emergence of Lassa fever in Nigeria in 2015, the spread has shown no sign of slowing down. About 50 people have been confirmed dead of the disease and many are being infected across different states. Given the population size of Nigeria, behavioural, nutritional and hygiene practices, cultural beliefs, poor environmental practices and massive inter/intra centre movement, it is only a matter of time before thousands, if not millions of people are affected. Thus, more proactive and adequate health initiatives must be implemented to manage this emerging episode.

The response from the Ministry of Health, especially at the federal level has been poor. Mass awareness and grassroots sensitisations on Lassa fever have been incoherent. More unhappily, the Ministry of Health has not maximised the potentials of technology and social media platforms to educate and raise awareness among the citizenry on the epidemic-prone diseases. Ditto other major official health management agencies at both state and local levels.
Integrated public health response
One of the basic tenets of public health and a functional health system practice is to have disease control and prevention programmes at all levels – national, state and local government level. The default practice is that there must be emergency notification of any case or death to any of the following nine priority diseases: AIDs, Lassa fever, Yellow fever, Anthrax, Cerebrospinal meningitis, Cholera, Plague, Human rabies, Typhoid and paratyphoid.

Disease notification must be fully entrenched and practised – this includes routine surveillance and identification of disease, which must be promptly reported via disease notification forms, telephone, telex, and other innovative means.

Disease control and prevention objectives are successfully met when resources are dedicated to improving the ability of health workers to detect targeted diseases, obtain laboratory confirmation of the identified disease(s) and use thresholds to initiate action at least at the local level.

The WHO and related health agencies propose Integrated Disease Surveillance and Response (IDSR) strategy for improving communicable disease surveillance and response linking community, health facility, local and national levels. The local government should be the focus for integrating surveillance functions, and then scaled up to other top levels.

Similar to the Ebola outbreak, the on-going Lassa outbreak in Nigeria is exposing the incapacity of the health system to deal with emerging and recurring disease outbreaks in this increasingly interconnected world, where diseases can quickly spread from remote villages to cities.

Falade, a Senior Research Associate at the Centre for Public Policy Alternatives (CPPA), lives in Lagos
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E-mail: mikkyfarad@yahoo.com; Michael.falade@cpparesearch.org