Why Lassa fever remains yearly nightmare, 51 years on

Since 1969 when Lassa fever was first reported in Lassa village, Borno State, the disease has remained endemic in Nigeria. Every year, the country battles to contain the spread of the disease, which occurs mainly in the dry season between the months of November and May. No vaccine has been developed to tackle the disease, 51 years on. What the country has achieved so far is the creation of three main treatment centres at Irrua Specialist Teaching Hospital, Edo; Federal Medical Centre, Owo and Alex Ekwueme Federal Teaching Hospital, Abakaliki. This has resulted in near knee-jerk approach towards curbing the transmission of the infection at the turn of each year, but without the desirable outcome most times.

Records show that in 2018, the country experienced a huge outbreak in 23 states involving 3,498 suspects. Six hundred and thirty-three cases were confirmed among whom were 45 health workers. In 2019, the World Health Organisation (WHO) reported 327 cases of the disease (324 confirmed cases and three probable cases) across 20 states of the federation and the FCT. The disease killed 72 people in that year.

This year, the disease has already claimed 43 lives. The Minister of Health, Dr. Osagie Ehanire, confirmed this while addressing a press conference in Abuja last Tuesday. According to him, “as of January 28, 2020, a total of 258 confirmed cases, 41 deaths have been reported in 19 states with a majority of the cases being Ebonyi, Edo and Ondo states.”

Ehanire explained that despite the increase in the number of confirmed cases, “the overall case fertility rate for 2020 is 15 per cent compared with 2019 which was 20 per cent.” The Minister’s submission appears to suggest that the country is doing better this year than in previous years in managing the disease but that would be determined with time, as the country is still in the middle of the dry season.

However, in a recent interview with The Guardian, the Director-General of the Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu, explained that Lassa fever is endemic in Nigeria, adding: “We currently do not have a vaccine to protect against Lassa fever. Therefore, we rely on strengthening measures such as ensuring proper sanitation, good personal hygiene; standard care precautions by health workers etc. to prevent the spread of Lassa fever. These measures also depend on personal responsibility as we all have a role to play in preventing the spread of Lassa fever.”

He went ahead to disclose that the Federal government through the National Lassa fever Consortium was working closely with the WHO and the Coalition for Epidemic Preparedness Innovations (CEPI) to develop a Lassa fever vaccine, adding that Two-Phase 1 trials for a new Lassa fever vaccine have begun.

“Before the end of the first quarter of 2020, NCDC and the three main treatment centres in the country will begin Lassa fever epidemiological studies. This will contribute greatly to our understanding of the efficacy of vaccine candidates,” he noted. While Nigerians wait to see the outcome of this initiative, they look forward to seeing a more aggressive approach towards equipping the masses with information needed to combat the disease at the personal level as Ihekweazu pointed out. There is no gainsaying the fact that such awareness has been lacking all these years. What obtains mainly is a spontaneous reaction by the various stakeholders the moment the disease is diagnosed each year. The reports below show the efforts of the state governments towards curbing the current outbreak. They also aggregate views of various stakeholders and experts on the way forward.

Don’t Eat Foods Not Properly Stored, Kebbi Govt. Warns Residents
From Ahmadu Baba Idris, Birnin Kebbi

Following the outbreak of Lassa fever in the country, the Kebbi State government has started to create awareness on the prevention of the disease in the state.Addressing journalists in his office, the Director of Public Health in the Ministry of Health, Mohammed Abdullahi Bubuche, said that the government has established a treatment centre in case of the outbreak of the disease.Bubuche further explained that the ministry has met with personnel of the Federal Medical Centre and other stakeholders to intensify their surveillance in identifying suspected cases in the state.

“We have communicated to our health facilities in order to strength any case search while government has put all the necessary machineries to curtail the menace,” he added.He then admonished parents to caution all their children against eating foods that were not properly stored, saying they could be contaminated.

Abia Records Two Deaths, Steps Up Sensitisation
From Gordi Udeajah, Umuahia 

From 2018 to date, five persons have died of Lassa fever in Abia State. The first victim was a female medical Doctor in Umuahia in 2018. This was followed by two deaths in 2019 when the disease broke out in Arochukwu and Umuahia North local councils of the state between October and November.This year, the disease has claimed the lives of two persons, a 28-year-old man from Avonkwu Olokoro community who died at the Federal Medical Centre (FMC), Umuahia on January 1, and another victim who died at Ozuitem on January 24.

The Permanent Secretary in the state Ministry of Health, Chief Emole Egbulefu, confirmed the death of the 28-year-old, saying he died on the same day he was taken to the hospital.Presently, the state government through the Ministry of Health has embarked on sustained public enlightenment through the electronic media to prevent the spread of the disease.The measures the ministry has been announcing include closing all rat holes, covering cooked and raw food containers, fumigating the environment against rats, trapping rats and appropriately disposing dead ones.Others include washing hands with running water, cooking foods well and avoiding contaminated areas, among others.

‘Avoid Bush Meat For Now’
From Eric Meya, Sokoto
Although there has been no reported case of Lassa fever in Sokoto State, the Commissioner for Health, Dr. Mohammed Ali Inname, said his ministry was taking proactive measures such as informing the general populace about the disease. Inname said the government was putting in place the necessary measures for prevention and early detection of possible cases in order to prevent the spread in case of an outbreak.

According to him, the state was closely monitoring the situation, adding that everybody should go about his/her normal daily activities without panic.He disclosed that steps being taken by the state government to curb the situation include activation of the state Emergency Preparation and Response Team (EPR), activation of the Rapid Response Team (RRT), procurement of drugs and other consumables and intensification of surveillance activities.

Others are the prepositioning of ambulance for patient’s transportation, engagement of all relevant stakeholders and the media.The ministry has also embarked on the production and airing of jingles, sensitisation of health workers, production and distribution of IEC materials and the establishment of burial protocol committee. He stated that the measures to be taken at the individual level for maximum protection included the need by health workers to strictly observe universal precaution as stipulated, saying they should consider every patient as potential risk.

Apart from personal hygiene, the ministry advised members of the public to clear their surroundings to get rid of rodents, secure food store to prevent access by rodents, secure cooked foods and water sources, follow the advice of health workers as well as early visit to the hospital once any of the symptoms or unusual condition is observed.The ministry also advised residents to stop eating and trading in bush meat especially rat, limit contact with animals unless necessary and to verify all rumours.

Government Has Capacity To Curtail Lasser Fever Spread, Says Plateau Commissioner
From Isa Abdulsalami Ahovi, Jos
Last week, the Plateau State government confirmed that five persons had been diagnosed with Lassa fever in the state.The Commissioner for Health, Dr. Nimkong Ndam Lar, who disclosed this said two of the victims were undergoing treatment at the Bingham University Teaching Hospital while the remaining three were admitted at the Jos University Teaching Hospital (JUTH).

He said the state government in conjunction with the Federal Government has the capacity to curtail the spread, adding that there was also adequate drug to treat those on admission.“The five of them on admission are doing well, they would soon be discharged. Apart from drugs, the government has also purchased personal protective equipment to take care of those that would treat the victims,” Lar said.He implored residents of the state to always cover their foods and ensure that their environments are clean and free of rodents especially rats.

He further implored them not to engage in self-medication but report any suspected case of Lassa fever in their neighbourhoods to the appropriate medical centres.Despite the awareness campaign, the state government has confirmed seven more cases of Lassa fever. Lar, however, said the state had not recorded any mortality yet. He advised residents to maintain a high degree of personal hygiene and ensure that their environment is always clean and without rodents.

The health commissioner also urged residents to ensure that foodstuffs and grains are stored in rodent-proof containers while stored water should be covered to prevent contamination.ar also called on clinicians to ensure that they observe standard infection prevention and control measures when handling suspected cases of the virus to prevent nosocomial (clinical) infection.

Panic Grips Benue Residents As State Records One Case
From Joseph Wantu, Makurdi 

There is palpable panic among the people of Benue State following the confirmation of one case of Lassa fever infection in the state.The Guardian gathered that the victim, a 40-year-old woman, was quarantined at the Emergency Operation Centre (EOC) of the Benue State University Teaching Hospital (BSUTH), Makurdi, since last week.Benue State Commissioner for Health and Human Services, Dr. Sunday Ongbabo, who confirmed the development, however, advised the people not to panic, noting that necessary measures had been put in place to curb the spread of the disease.Ongbabo said the patience was being giving proper attention to survive the infection. 

The Chairman, Medical Advisory Committee, Benue State University Teaching Hospital (BSUTH), Dr. Olusaya O. Alao told The Guardian that samples from the patient were taken last Friday and sent to Abuja for analysis, where it was confirmed positive.According to the Chairman, Medical Advisory Committee of BSUTH, the hospital has since embarked on tracing of persons that may have come in contact with the patient, stressing that the exercise was still ongoing.“As we speak, this hospital has achieved 82 per cent management of the Lassa fever virus. And we are sure of the cure of the patient,” he said.

While stating that stringent measures have been put in place to check the spread of the disease, Alao underscored the need for dedicated power supply at the isolation ward of the hospital as well as running water for efficiency. He said the state government was doing its best in the area of equipment and anti viral drugs, advising households to always cover their foods well to stop rats and rodents from urinating or defecating on their food. 

Imo On Red Alert But No Confirmed Case Yet
From Charles Ogugbuaja, Owerri

Apprehensive of the outbreak of Lassa fever in neighbouring states of Abia, Rivers and Enugu, the Imo State government has put in place mechanism to ensure detection and prevention.The Director of Public Health, Dr. Austin Ukeje Chidiebere, while speaking in a radio programme in Owerri, recently, said Personal Protective Equipment (PPP) has been provided for health workers and care givers, adding that samples from suspected patients were sent to Abakaliki and results produced within 48 hours.

He said: “We have not recorded any case. We have started positioning PPP. These equipment are being positioned at Specialist Hospitals at Umuguma; Imo State University Teaching Hospital, Orlu; the Federal Medical Centre, Owerri and some others. The aim is to ensure that there is enough protection for health workers who may have been attending to a patient. Timely report of suspected cases is important. If reported on time, the chance of survival is very high.”

He decried the rate of misinformation and rumours in the issue concerning the disease in the state. He added: “By the time the case in Abia was confirmed, we moved on. We had to engage in creating awareness, sensitising the population to know that there is outbreak of Lassa fever because whoever is moving to that place will have contact with the people there.

“We need to tell people what causes Lassa fever. Every rat in the environment is suspect. Reporting suspected case/s with symptoms like high fever of 38 degree centigrade, body pains, fever, vomiting, weakness, muscle pains, soar throat, viral haemhoragic fever and bleeding through nostrils, eyes is encouraged. “We have a surveillance network on ground in the state. We use social mobilisation officers. We are engaging the traditional rulers. We have what we call the monthly surveillance review meeting. During the last monthly meeting, we used the opportunity to put the surveillance network in the state on red alert.”

Cross River State Commissioner for Health, Dr. Betta Edu, has disclosed that the state government has intensified emergency preparations in collaboration with partners in the health sector to prevent the disease from spreading in the state.A suspected case was reported at the University of Calabar Teaching Hospital (UCTH) where the management swung into action by taking the sample to Irrua Specialist Hospital in Edo, where it was confirmed negative.She said the ministry has embarked on sensitisation campaign across the state, adding that so far, it has covered four local council areas, comprising Yakurr, Abi, Ikom and Odukpani.

In an interview with The Guardian in Calabar, Edu said Lassa fever reoccurs every year in the country because of lack of proper sensitisation of the people.The Commissioner explained that Lassa fever is prevalent in the dry season when most agricultural activities are taking place like the burning of bushings to prepare farms for planting

According to her, the media have a part to play in sensitising the public on the preventive measures and importance of keeping their environment clean.“It is usually highly prevalent within the dry season, so whenever there is dry season between November and May, you have a lot of cases of Lassa fever and most of our own cultural activities are responsible for this. When you see people trying to prepare their farms for the next farming season and they begin to burn bushes, you dislodge these rats from their hidings and they come into town and enter into people’s houses and then it becomes a huge problem.

“Secondly, people are not aware of the preventive methods and what they should be doing from the little things like environmental hygiene, washing their hands well and avoiding being contaminated with the urine or blood of the infected rat. So, all these preventive measures are thing people should know. It is reoccurring because the information is not out there and we hope that the media can help get this information to the public on how people can prevent Lassa fever. It is very important,” Edu said.

He added: “Cross River does not have any case of Lassa fever now. The final lab results got into the state last Tuesday night; it was negative. So, we do not have any case. In fact, right now, we do not e where clean, avoid rats and do not dry food like garri, rice, crayfish, pepper and others on the ground to avoid contamination with the saliva, feaces or urine of the infected rats. And very importantly, foodstuff should be stored in very tight containers that should be kept closed always. “Dust bins should be closed always and refuse should be properly disposed so as not to serve as breathing grounds for rats that will turn around to infect people.”

Ondo Rallies Stakeholders As 113 Residents Get Infected
From Oluwaseun Akingboye, Akure 

DESPITE all efforts by the Ondo State government to curtail the recurring menace of Lassa fever in the state, the state is among those currently battling the spread of the disease.The Guardian learnt that a total of 113 people have been infected with Lassa fever in the state while about 28 people are reportedly feared dead. Between Sunday, January 26 and last Tuesday, 16 new cases were recorded.

According to the state epidemiologist, Dr. Stephen Fagbemi, who confirmed the new figure, the new victims were admitted at the Akure Centre, which was recently opened and is being used as holding centre.He further disclosed that 50 people were undergoing treatment while 46 had been treated and discharged. “So far, 18 people have died just as the state government continues to intensify efforts in its campaign at enlightening the people on the need to prevent the spread of the disease.” He said that once the patients are confirmed at the holding centre, they would be moved to the Federal Medical Centre, Owo, for proper treatment and control.

The first outbreak this year, which was confirmed two Mondays ago, caused a lot of stir as many residents began to panic. The outbreak has been recorded in four councils namely, Owo, Akoko South West, Akure South and Ondo West.In the last five years, the North District of the state, particularly Owo town and neighbouring communities have suffered recurring outbreak of Lassa fever almost on a yearly basis. 

Meanwhile, it is no longer a myth why there would always be Lassa fever outbreak in that part of the state. Investigations showed that the methods of processing cassava to garri in that area like spreading cassava flour on the ground and pathways expose the people to constant incidents of Lassa outbreak. 

Nonetheless, Governor Rotimi Akeredolu, in a statewide broadcast, assured the people that there was no cause for panic, while appealing to them to change their poor hygienic habits. In a bid to curtail the spread of the disease, the governor has met with traditional rulers in Owo and its environs, affirming his resolve to halt the spread.He lamented that the incident was not peculiar to the state alone, saying “this is a highly serious infectious disease that has been with us in Nigeria for some years. It is a disease that is caused by an organism and spread to man by rats. 

“This outbreak has been occurring fairly regularly over many decades. Unfortunately, in the past few years, it has increased in magnitude. Sadly, within the few weeks of this year, scores have been affected and some had died from the disease.”He commiserated with families of those who lost their lives in the outbreak and patients still receiving treatment, assuring that the state government would not relent in efforts to proffer lasting solution. 

“Although we have been faced with this challenge for several years, yet we have not relented on adopting necessary measures to address it. Specifically, our administration over the past one year has taken several steps to curtail this outbreak. In spite of all these efforts, the state still finds itself once again at the throes of another serious outbreak,” he said. He attributed the development to lack of proper hygienic living. “Currently, our government has stepped up efforts to sensitise the populace about the disease through massive community awareness creation. In addition, government has continued to provide free treatment to all patients that present with this disease in our treatment centres.”

Stressing that the disease is treatable, he urged health workers, traditional rulers and other stakeholders to cooperate with the government in the bid to eradicate Lassa fever from the state. “On our part, government is determined that the yearly occurrence of this outbreak is finally brought to end. In order to achieve this, the state government has already taken certain important steps.“We are aware that, in order to succeed, we need the cooperation of the entire citizenry to ensure that we rid our homes and communities of dirt and the rats that now threaten our health,” he stressed.

Rivers Confirms Three Deaths, Trains 150 Doctors
From Ann Godwin, Port Harcourt

In a move to control the spread of deadly Lassa fever virus in Rivers State, the Ministry of Health in conjunction with the state Primary Health Care Management Board has trained over 150 medical doctors across the 23 local council areas. According to the Director, Disease Control Services of the Primary Health Care Management Board, Dr. Obed White, the training became necessary for infection control.

The Guardian gathered that some health experts have also begun decontamination of facilities, presumptive prophylaxis and surveillance to ensure public health safety.As at last Thursday, three persons were confirmed dead of Lassa fever virus in the state.The Director, Planning and Statistics, State Ministry of Health, Dr. Chinwe Atata, confirmed the deaths while giving updates on the deadly virus.

She said: “We received reports of about four Lassa fever cases in the state few weeks ago and we collated samples and went into investigations. Presently, we have received preliminary confirmation that three of the samples tested positive to Lassa virus.” Atata said the deceased persons had since been buried according to health standard, adding that the Public Health Emergency Operation Centre in the state has intensified efforts towards containing the outbreak of the disease.

Atata said close relatives of those who died have been put under surveillance.She said: “Presently, there is no spread of the virus in the state. The 57 persons are still under surveillance; they are going through the routine procedure and decontamination of the facilities has been done.”

The Guardian further gathered that the state government has procured Lassa fever drugs and distributed them across some health facilities in the state including the University of Port Harcourt Teaching Hospital and the Rivers State University Teaching Hospital.A top management staff of UPTH who craved anonymity confirmed that there are available drugs for the virus in the hospital, adding that trained personnel were on standby.

Speaking further, Attata said a holding centre was also being prepared to render services.She added: “The Rivers State Public Health Emergency Operation Centre (EOC) had earlier commenced proactive effort for containment of the outbreak. So far, all hands are on deck for facility decontamination, line-listing, presumptive prophylaxis and surveillance to ensure Public health safety and security.”

Findings across the state shows that residents were beginning to heed to health safety advises as none was seen patronising uncovered fruits and food items in some markets visited.In public places, people now hardly shake hands while some schools have installed hand washing posts and made it compulsory for students to wash their hands before entering into classes.

Meanwhile, some medical and environmental experts have also blamed the yearly outbreak of the virus to ignorance and lack of sustained public awareness on proper environmental hygiene.Speaking with The Guardian, a medical expert and Chief Medical Director of Mount Hermon Hospital, Port Harcourt, Dr. Cyril Ekhaeyemhe, stressed the need for steady awareness on keeping the environment clean.

He said: “Ignorance kills; people tend to forget easily the need to keep their environments clean to avoid attracting rodents which is the cause of Lassa fever to their houses and shops and there is no sustained effort to keep this awareness going.

“Government will raise awareness now and in few months time, everything goes down. That is not the way to go, the awareness should be sustained,” he said.He also emphasised the need to boost the immune system by drinking enough water and being careful with what to eat. Also, an environment expert, Mr. Micheal Akinde, said it was necessary for residents to fumigate their homes and keep the environment clean.He warned against dirty environment, which according to him, attracts rodents into residential areas which may cause diseases like Lassa fever and others.

Enugu Records One Death, Educates Residents On Precautions
From Lawrence Njoku, Enugu

As at Wednesday, only one person was officially reported to have died of the dreaded Lassa fever in Enugu State. The victim, a 75-year-old woman died 10 days after she was brought to Enugu State University Teaching Hospital, Parklane. Following her death, however, the State Ministry of Health took blood samples of the 23 persons who had direct contact with her for hematological investigations.  As at the time of filing this report, the outcome of their investigations has not been made public.

Meanwhile, the Permanent Secretary, Ministry of Health, Dr. Ifeanyi Agujiobi, has stated that the health ministry would continue to ensure that universal health precautions are strictly observed.He disclosed that the state Ministry of Health has constituted a multi sectoral Rapid Response Team charged with the responsibility of containing and militating against the deadly Lassa fever menace.

Elaborating on the precautionary measures, the permanent secretary said: “All hospitals in the state have been told to be on the watch out and to make use of all protective and preventive measures. “Bush burning should be discouraged for now. We should avoid garbage and refuse close to the house to dispel rats and other rodents and ensure that all foodstuffs are properly covered. Canned drinks, bottled/soda water should be properly washed before drinking. All schools are encouraged to observe basic hand washing hygiene and use sanitizers,” he said.

On other measures taken after the death of the patient, he added: “The state Ministry of Health, Public Head Department with the ESUTH Parklane management has stepped up action to decontaminate all sections of the hospital that the patient was managed including the ICU unit. Contact tracing is ongoing and there will be sensitisation of all health care workers at the ESUTH Parklane so that any health worker that perhaps came in contact with the deceased will be monitored and some possibly placed on prophylactic Ribavarine therapy prophylactic”.

As it is, there is increased awareness about the disease in the state. Announcements are made in churches, market places and jingles, among others on how residents should live to avoid contracting the disease. The awareness also includes how cases of Lassa fever could be identified.

Speaking on some practices that trigger off the outbreak of the disease, a health expert, Dr Benjamin Ugwu explained that many Nigerians live carelessly, adding that they bother less about their environment and cleanliness.“They don’t care about the environment where they could stay and eat or even where they stay to make money. You will be inviting rodents and other insects when you litter your environment with food items and other edibles. You will be asking these rodents to live with you when you don’t keep your surroundings clean. People live in a place with several properties that are not in use. The next thing is that rodents will enter into them and begin to reproduce; as they reproduce, they are feeding from leftover food items, urinating on food items and property in the house. You come up and start using those things and in the process contract Lassa fever.

“That is why I will always ask people to ensure that they have access to every part of their surroundings. With that you are sure there is no uninvited animal or insect you are habouring. We should practice basic hygiene that will see us washing our hands all the time.“Our people are in the habit of eating with hands that are not washed. They are in the habit of using unwashed plates and what have you to eat. They eat food that did not pass through fire and keep things that can attract rodents. We should watch some of these things so as to contain the spear of Lassa fever,” he stated.

On her part, a staff of the Public health department of the University of Nigeria Teaching Hospital, Mrs Dorathy Orji, said: “We advice all persons to observe universal health precautions especially washing of hands with soaps at all times, avoid eating rats or the likes as well as avoiding drinking raw garri because of the vector that transmit the disease – a specie of rat.

“This Lassa Fever is caused by Lassa Virus- a hemorrhagic viral disease. The disease may be asymptomatic but can present with symptoms mimicking malaria. You know that malaria is a common thing in our environment? That is why a thorough examination is suggested to avoid branding a case of malaria as Lassa fever and that of Lassa fever as malaria. But the primary thing is for people to be mindful of their environment and live healthy,” she added.