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A fact sheet on Lassa fever

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Sir: Since Lassa fever was first reported in Nigeria in Lassa town in Borno State in 1969, several thousands of Nigerians especially medical and health workers have paid the ultimate price in the process of caring for patients who contract the disease through contact with blood, urine, vomitus, or aerosol droplets from the patients. Lassa fever is an acute viral haemorrhagic fever illness and can be transmitted to humans via contact with food or household items contaminated with rodent urine or faeces. Person-to-person infections and laboratory transmission can also occur.

The high virulence of the virus and fatality rate of the disease is further worsened by the non-specific nature of the presenting symptoms which mimics some other conditions prevalent in our environment such as malaria. Therefore, early diagnosis is usually not feasible except where there is a high index of suspicion. The absence of reliable laboratory diagnostic facilities (except the ones in Irrua Hospital in Edo State, LUTH Idi Araba and Gaduwa Abuja), some cultural practices displayed by relatives of the Lassa Fever patients such as unsafe corpse handling and poor personal and environmental hygiene are strong factors promoting the spread of the disease. The general poor sanitation and poor waste management across the cities and rural Nigeria encourages the multiplication of the vector rats, and their contact with human beings and food. Housing conditions, water supply, food safety and (primary) health care services in general have not improved from their appalling status for most citizens even as there is yet no vaccine for the VHFs (except Yellow fever).

During the outbreak in 2017, several states including Anambra, Bauchi, Borno, Cross-River, Ebonyi, Edo, Enugu, Gombe, Kaduna, Kano, Kogi, Nasarawa, Ogun, Ondo, Plateau, Rivers, and Taraba were reported to have at least one confirmed case. Tragically, during the current epidemic in 2018 many doctors and other health workers have died in the course of duty!

The NMA welcomes the following response measures that are being carried out:

Enhanced surveillance in all affected states and Lassa fever cases reported to the federal level and contact tracing carried out in affected states with an active outbreak through the state surveillance teams; The line listing of cases reported across all the states and data uploaded in the VHF database; Lassa fever treatment centers being established in the affected states to support case management; and Promotion of infection prevention and control (IPC) activities and supplies distributed by the Nigeria-CDC though grossly inadequate.

The NMA notes the commencement of the National Public Health Reference Laboratory (NPHRL) in Gaduwa, Abuja in 2017 with the capacity to confirm Monkey pox, Meningitis, Avian Influenza, Cholera, Lassa fever, Yellow fever diagnosis, and is pleased with the role being played by the N-CDC in coordinating disease outbreak response activities with the establishment of an Incident Coordination Centre.

In view of these contemporary and re-emerging challenges and the reality of poor preparedness to respond to them, NMA wishes to remind the nation that prevention of Lassa fever relies on promoting good “community hygiene” to discourage rodents from entering homes, yellow fever on prevention of mosquito bites, cholera on drinking and eating safe water and uncontaminated food accordingly. Therefore, improved hygiene especially hand hygiene and food safety are key to staying healthy and alive.

In health-care settings, staff should always apply standard infection prevention and control precautions (universal protection) when caring for patients, regardless of their presumed diagnosis. Appropriate authorities of Government and Management of health institutions must ensure that Personal Protection Equipments including microbicides for routine cleaning, alcohol scrubs and chlorine based hand sanitiser pots are placed at appropriate positions, refilled timely, and strict compliance to their usage enforced at all times.

As travellers from other countries where VHFs are also endemic could import the disease to Nigeria, there should be a high index of suspicion among febrile individuals returning from any country, especially if they have had exposures in rural areas or hospitals in countries where Lassa fever is known to be endemic. In this instance, Health care workers seeing a patient suspected to have Lassa fever should immediately contact local and national experts using the contact numbers of the NCDC Incident Centres for advice and to arrange for laboratory testing.

The NMA calls on the National Assembly to pass the Bill establishing the Nigerian Centre for Disease Control (NCDC) as a matter of urgency to position the agency for optimum performance and ensure its funding for results.

The Association considers it unacceptable that every suspected case of Lassa fever is transferred to the Irrua specialist centre in Edo state by road in poorly equipped ambulance. The NMA calls on the federal government to ensure that the long overdue Virology Centres to be supported with Public Health Reference Laboratories are commissioned in the six geo-political zones of the country without further delay. The Association also tasks the pharmaceutical and laboratory reagent companies to develop rapid test kits that would assist in early detection of these highly fatal diseases to curb the outbreaks.

NMA offers to institute massive nation-wide public health campaigns to reawaken the consciousness of good personal and environmental hygiene to sensitize the people while appealing to Local Governmental authorities to revitalise environmental health activities aimed eradicating rodents and other vectors of human diseases in our country.

Finally, NMA holds the belief that effective implementation of evidence based infection prevention and control measures through adequate funding of institutions and programs, supportive supervision, effective oversight and leadership, Nigeria would celebrate the death of Lassa fever and other NHFs as it did for Ebola this year before the diamond anniversary of the discovery of Lassa fever in Lassa town by 2019.

Prof. Mike O. Ogirima, president of the Nigeria Medical Association.



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