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‘Our Surveillance System Is Too Weak To Curb Lassa Fever’

By Joseph Okoghenun
09 January 2016   |   12:31 am
Nigeria has been battling Lassa fever for almost a decade now. Why has the country not been able to eradicate the disease? First, we expect it in every dry season, but our surveillance system is not really good enough.
Prof Oyewale Tomori

Prof Oyewale Tomori

Nigeria has been battling the resurgence of Lassa Fever for over six weeks now. Even as Nigerians seek ways out of the current quagmire, the disease has already claimed 35 lives in eight states of the federation. While many are confused on how Nigeria got into this mess, President of the Nigerian Academy of Science (NAS) and former Vice Chancellor of Redeemer’s University, Prof Oyewale Tomori, said the country’s surveillance system has become too weak to detect and pick up Lassa Fever early enough.

Nigeria has been battling Lassa fever for almost a decade now. Why has the country not been able to eradicate the disease?
First, we expect it in every dry season, but our surveillance system is not really good enough. Although it happens every year, in February and March, we forget what happened. Then it comes back again.

The awareness is not there. We should create the awareness since we tend to have it more during the dry season.
It is so easy to explain why it happens. Special types of rodents harbour the virus. During the rainy season, there are lots of foods in the farm, so these rodents do not need the food in the house. They are rodents and which means they are found around houses.

But during the dry season, especially in the North, where we have foods stored in silos, if you do not cover your food properly, the rodents will contaminate your food.

It is a yearly occurrence. It is just for us to change our attitudes in the way we store our food and doctors should be alert of the virus during the dry season.

Aside creating awareness, what else should be done to reduce the scourge?
This is a disease that has an intermediate host. Except you want to clear the host, there is nothing else you can do. The rodent will always remain with us, just like malaria. You cannot eradicate malaria as you can eradicate polio, because there is another vector between man and the disease.

But polio is transmitted from man to man; there is no intermediate vector. For yellow fever and malaria, you need the mosquitoes. Where there are mosquitoes and people, there will always be malaria.
We should reduce the number of cases of Lassa Fever that occur to curb the mortality. When you are aware of the details of the disease and mode of transmission and take care of those things, you can reduce the number.

Do you know why we have a big problem? When you get to our hospitals and doctors and nurses are not aware of the virus, then they get affected. Once two of three nurses are dying of Lassa Fever, they will close down the hospital and that creates more problems.

So, what we need is a lot of awareness, especially among people in the rural areas, to store their foods properly to protect them from contaminated virus. Once you do that, you can limit the number of cases that you have.

You said our surveillance system is bad. What is wrong with it?
Surveillance is like insurance. If you do not pay your insurance premium, you will pay for it when the trouble comes. What happens is that most people think they do not need insurance. Because they have driven for three or four years without an accident, they begin to think,

what am I paying insurance for?
Like insurance, surveillance enables you to monitor what is going, like when you have more febrile cases coming into your hospitals.
If you look at the documents of Nigeria 10 years back, you will observe when we usually see the peak of Lassa Fever. Then two or three months before time, you begin to alert people.

One of the problems with Lassa Fever is that it presents like malaria or any other disease, so that you do not know that you have it until you get to the hospital. Surveillance is a continuous thing; it is not something you do this year and forget it next year.

And most of the problems we have with the Federal Ministry of Health are that surveillance is a stop-and-search kind of a thing. They do it only when there is a big epidemic. But once that is over, they forget about it.

Go and look at our Epidemiology department. They actually have little or no funding. If they are funded this year, they would not get any funds next year. The following year, they would not get any funds.

Now we have abandoned surveillance, the story I am hearing is that a lot of states are experiencing Lassa Fever, but good surveillance system should have picked it up a long time ago. But if you do not keep records of the past, you will not know when you have an upsurge. That is what is killing us in this country.

Reports from the Federal Ministry of Health show that Lassa Fever has already hit Oyo State. Is that not a warning to Lagos State?
Most of the cases had been in the Northern part of the country, but we had it in Ekpoma, Edo State in 1989. So, we do have it a bit in the South.
Ekpoma is another place where we regularly get it every year. It mainly occurs in the North, but we have had cases in Enugu, Owerri and Mbaise. Oyo State should not be a strange thing.

Are the fatalities not well beyond what we used to have?
Yes! The fact that we have that kind of huge number is abnormal, but it could be that we need to improve on our surveillance.
By surveillance, I mean that people are reporting cases. If our surveillance were good as at the first time we noticed it last year, we would not have been where we are now.

Imagine if Ebola had raged on for three months, I do not think anybody will still be living in Nigeria.
Is it not time to start building treatment centres for viral diseases?
Definitely! We need two things: proper diagnosis and good surveillance system. Then, we can easily filter out what is not. Most of these diseases look very much alike. So, we need a good laboratory to tell us that this fever with this symptom is this one and not that one, so that we do not keep on wasting money treating the wrong disease.

Most of the cases that occurred must have been treated for malaria and we began to suspect viral disease when the malaria treatment did not work.
But if from the onset, we had good laboratories, it will be a different scenario. Remember that the first Ebola case that came to Nigeria was tested for malaria before a laboratory confirmed that it was Ebola virus.