Breaking Cycle Of Lassa Fever Resurgence In Nigeria

By January 28, 2020, Lassa fever resurgence has spread to 11 states of the federation with the Federal Government confirming 29 deaths and 195 cases. The fear that this instrument of finality would spread to more states and record more deaths have put both the federal and state governments on their toes in search of a solution.

A recent report from Nigeria Centre for Disease Control (NCDC) released January 25 indicates that the states affected so far are Edo, Ondo, Ebonyi, Delta, Taraba, Plateau, Bauchi, Ogun, Abia, Kano and Enugu. The report also said 89 per cent of the confirmed causalities are from Ondo, Edo and Ebonyi.

The Lassa fever virus is commonly transmitted by rodents such as rats, rabbits, mice, squirrel and marmot prevalent in the environment including homes, offices, motor parks, churches, mosques and other places of human habitation.
It takes Lassa fever a period of 6–21 days to incubate. Thereafter, it starts gradually with fever, general weakness, and malaise.
Then after a few days, it graduates to headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough and bleeding from body openings in extreme cases.

Medical experts advise that if a patient does not respond to treatment for malaria or other febrile illnesses after 48 hours, he or she needs to be tested immediately for Lassa fever. The disease was first identified in 1969 in a Lassa village in Borno State; hence it was named Lassa fever.

Dr Solomon Avidime, Chairman, Nigerian Medical Association (NMA) Committee on Inter-Professional Relations and professor of Obstetrics and Gynecology in Ahmadu Bello University, Zaria, speaking on why the Lassa fever is recurring in the country said the causative virus which has rodents as a vector are ever prevalent in our environments.

He said that Nigeria has a high burden of the disease which occurs majorly during the dry season.

Poor Hygiene, Ignorance, Poverty
Collaborating, Prof Mojisola Adeyeye, Director General, National Agency for Food Drug Administration Control (NAFDAC), has blamed the resurgence of Lassa fever in the country on poor hygiene, ignorance and poverty.

Adeyeye said, “This is all about hygiene when I was growing up as the daughter of a farmer, we want to dry our food on a stone surface in the farm, we don’t leave them overnight and we wash often washed them well.

“Now I see people putting cassava and Garri by the roadside for one or even two days, you know how many rats that would be running around the place overnight. So, Lassa fever can be traced to the interaction of rodents with our foods.”

Other reasons Lassa fever recurs, he said, are some socio-cultural practices that promote the transmission of the disease such as bush burning, eating of the rat as a delicacy, poor personal and environmental hygiene. These coupled with the fact that Lassa fever has no cure at the moment, but can only be prevented.

Education And Sensitisation
Dr Avidime also believes that other things that account for the recurrence is poor community sensitisation, stressing, “Community education and sensitisation is poor, Nigeria’s response to the outbreak again leaves much to be desired.”

Contributing, Lawal Bakare, Founder, EpidAlert and Risk Communication Expert regretted that Lassa fever would continue to recur so long as the State, Federal and local governments do not live up to their responsibilities.

Bakare said, “Sanitation in Nigeria needs to improve. Where I live here in Germany, I drink my water from my tap, I don’t even buy water. It was the same story when I was growing up in Lagos, Surulere, we used to drink water from the tap, but all of that has now changed.

Bakare also berated the sanitation situation in Nigeria. “We talk about routine environmental sanitation, we talk about sewage and there is a lot that needs to happen in the safety space, which has to do with the Ministry of Agriculture and controlling of the food chain/product that goes into the market.

“Some of our food items are not able to go into the international market. It is because we are not able to produce those crops and products (foods) which are good for basic human consumption.

We are not yet hygienic enough, we don’t even take care of our crops, and we just grow crops. Some people, if you see the way they process some of the crops they produce, you will ask yourself if this is for human beings.

“But, the truth is somebody is being paid in every Local Government and at the Federal level for this product inspection. Where are these people? Who is monitoring them and are they getting the jobs done? When they don’t get the job done, is anybody getting punished? Or is it when they hear of Lassa fever outbreak?”

He warned, “We cannot just be pushing doctors to the line and say doctors should be taking care of people that have Lassa fever. Lassa fever cannot survive in modern American or Europe, because they have good sanitation.”

Commenting, Dr Mohammad Mahmood Abubakar, Minister of Environment, noted that in 2019 his ministry created Sanitation Desks in 36 states of the federation to coordinate the programme and activities, liaise with the Local Government Area environment departments and to report back to the ministry.

“We are responding to the increasing number of Lassa fever cases across the country by sensitising the public on preventive and control measures to avert further outbreak and spread,” the minister said.

He added that in 2019, they worked with World Health Organisation(WHO) and NCDC to carry out environmental sanitation response activities in Edo and Ondo states by distributing equipment and chemicals.

Contributing, Adeyeye said, “Part of what we are trying to do in NAFDAC is to continue to enlighten our people about other means of drying foods than putting them on the ground by the roadside.

“Also, our plan this year is to engage National Youth Service Corps (NYSC) members in the 774 local governments in the enlightenment programme, where the youth corper will interact more with the locals by educating them on this type of issue we are talking about.

“We are represented in 36 states, but we cannot be in each local government so we will have our state coordinator working with the local government to educate them so that the illiteracy rate in Nigeria will decrease tremendously.

“We will have to educate them not to dry by the road side, rather dry on the hill, stone base and whatever, but make sure you are there to ensure that there is no interaction with rodents.”

She insisted that ignorance, poverty are causes of recurring Lassa fever outbreak, apart from hygiene, adding, absence of government health inspectors who enforce and promote good sanitation at local the level has also contributed to compromising hygiene across the country.

She said, “When we were growing up, we had local hygiene inspectors, they would often go from house to house and inspect them even water coolers, if they see dirty water cooler in any household, they would fine them.

“The State, Federal and Local agencies are responsible, we need to join hands, we don’t have health inspectors if we do, they can`t be offered money for them to pretend like they didn’t see the uncleanliness.”

Collaborating, Prof. Babatunde Salako, Director -General, Nigerian Institute of Medical Research (NIMR), there is a need for a massive education of the people in the rural area, often in the States where the outbreak has become very frequent. Salako said.

“Beyond that, we can talk about the general process of hygiene like hand washing, ensuring that your environment is not bushy, and clearing them to hinder rodents from getting into the house and ensure that we cover some of the things we eat.

The NIMR boss also condemned the practice of drying food on the roads and bush paths, saying it is another mode of transmission.
He said, “I know many of these practices of spreading Garri, cassava and all sorts of food items on the roads and along the bush paths which in the processed urine of rodents could be sprinkled on them and can transfer the virus on those things and it is later consumed. Of course, these items are what they sell in the market and I believe this need to be eradicated. 

It is going to take time since there are no technologies for them to dry food items and even the ones available are too expensive for them to afford.

“I’m not very sure it’s the rats that stay in the house; I think it more of the ones from outside that carry Lassa fever. Another one is the practice of bush burning, these are all theories. Bush burning may send some of the rodents from the bush to come to people’s house.

This is dry season and people have started bush burning and these rodents will leave the bush and run into the human habitat making them mix with human activities, so these are all possibilities that maybe responsible for the recurrent outbreaks we are having.

Research And Funding
 “But I think more importantly, we need to go into this area research, the government need to put money for research so that we can study the population where we have the diseases and study the population where we don’t have it so as to see the differences and peculiarity between where we have and where we don’t.”

Similarly, Dr Avidime, said, “Nigeria’s response to outbreak again leaves much to be desired. More importantly, Nigeria is not investing in research. We should by now have evolved a home-grown solution via strategic research, which ultimately would produce vaccination.

“Facilities for laboratory diagnosis are few; treatment centres are similarly few. It is important to stress that health workers, particularly doctors need to have a high index of suspicion. So that early diagnosis is made and treatment commenced, with isolation and contact tracing,” he said.

Part of the measures being taken to checkmate the spread of the menace, according to Dr Abubakar is to embark on proactive measures to improve the overall general and hygiene in these environments.

Dr Avidime believes that as an infectious disease, the only way to prevent Lassa fever is to stop the transmission chain from vector to human, and from human to human.

He said efforts at breaking the chain are avoiding contact with the rat -their body fluids such as urine and faeces.

Other measures, he said, are to block the holes through which rats can penetrate our homes; avoid bush burning; improving personal and environmental hygiene; emphasising early diagnosis, and case management which involves isolation of infected persons; avoiding contact with patient’s bodily fluids and hand-washing practices.

However, according to Dr Chikwe Ihekweazu, Director -General, Nigeria Centre for Disease Control (NCDC), there had been a decline in the case fatality rate of reported Lassa fever cases from 23.4 per cent in 2019 to 14.8 per cent this year.
Ihekweazu said NCDC continues to support treatment centres across states in the country to effectively manage Lassa fever cases.
“In addition, five laboratories in Nigeria have the capacity to diagnose Lassa fever in Nigeria. These laboratories are critical to reducing turnaround time between identifying a suspected case and confirmation. This ensures prompt case management and other response activities, thereby reducing the number of deaths,” he said.

Ihekweazu also noted that Nigeria is contributing to research and other activities for the development of a Lassa fever vaccine.
He added that NCDC and the three main treatment centres in the country, Irrua Specialist Teaching Hospital, Federal Medical Centre (FMC) Owo and Alex Ekwueme Federal Teaching Hospital Abakalilki, are set to commence Lassa fever epidemiological studies that would provide data to guide research and response activities.

He assured that the NCDC was committed to protecting the health of Nigerians, but stressed the need for members of the public to practice good hygiene and take measures to protect themselves and their families.
Dr Avidime also stressed the need for availability of the drugs rivabain used in the management of the disease.