Why you should care Nigeria is having its worst outbreak in 49 years

Ambe is the 102nd casualty of Lassa fever in the country since January 2018 when the Nigeria Centre for Disease Control (NCDC) reported the first confirmed case of the virus in Bauchi.

In that first situation report, the outbreak, an overflow from December 2017, was only active in five states: Bauchi, Plateau, Edo, Ondo and Nasarawa. Four months later in April, the outbreak of Lassa fever has already killed 102 people with suspected cases spread across 21 states in the country.

Across more than 57 local government areas, there are currently confirmed cases of Lassa fever in Abia, Abuja, Adamawa, Anambra, Bauchi, Benue, Delta, Ebonyi, Edo, Ekiti, Gombe, Imo, Kaduna, Kogi, Lagos, Nasarawa, Ondo, Osun, Plateau, Rivers and Taraba.

Five months ago, the NCDC's situation report indicated that only 92 people were confirmed killed by Lassa fever in 2016, which makes this year's return Nigeria's worst outbreak since 1969 when the virus was first identified from a case in the town of Lassa in Borno state.

What's the deal with Lassa fever anyway?

According to the World Health Organisation (WHO), Lassa fever is an acute viral haemorrhagic illness caused by rodents of the genus Mastomys, commonly known as the 'multimammate rat'. Multimammate rats are commonly found in grasslands or forests, urban areas and even inside houses throughout sub-Saharan Africa, which is why it's a problem endemic in West African countries such Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria.

According to a 2015 report by the United States' Centers for Disease Control and Prevention (CDC), the number of Lassa virus infections per year in West Africa is crudely estimated at 100,000 to 300,000, with approximately 5,000 deaths.

WHO says, "The incubation period of Lassa fever ranges from 6-21 days. The onset of the disease, when it is symptomatic, is usually gradual, starting with fever, general weakness, and malaise.

"After a few days, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and abdominal pain may follow.

"In severe cases, facial swelling, fluid in the lung cavity, bleeding from the mouth, nose, vagina or gastrointestinal tract and low blood pressure may develop."

Mastomys rodents are commonly found in and around homes, feasting on leftover human food items or poorly stored food, which makes direct contact transmission fairly easy. They are also consumed as food by certain communities.

The virus can also be transmitted from one person to another through body fluids such as blood and sperm.

Since the virus presents no unique symptoms, clinical diagnosis is often difficult especially at the early onset of infection.

The best way to prevent infection is by practising decent personal hygiene and avoiding contact with the carrier rodents, disposing of garbage far from the home, and banishing the urge to snack on rodents. (If you're not sure it's not a Mastomys rodent, it's probably best to not eat it just to be safe.)

Avoiding contact with the secretions of a contaminated person is also a safe way to not get infected. This is why health workers are advised to use the proper protective equipment to examine patients, isolate victims, and track down everyone they might have been in contact with to contain an outbreak.

There is no known vaccine yet for Lassa fever, but if caught early, it can successfully be treated with Ribavirin.

Government's culpability for outbreak

In January 2018, the Minister of Health, ProfessorIsaac Adewole, blamed healthcare workers for getting infected with Lassa fever due to their refusal to take necessary precautions while treating patients.

When he made this statement, three health workers had just died in Ebonyi state. Since then, three more health workers (one each in Ebonyi, Kogi and Abia) have died, with a total of 27 health workers infected since the onset of the outbreak.

After the death of the first two health workers in January, other doctors in Ebonyi took to the streets of Abakaliki to protest the non-functionality of the South East Virology Centre in the state capital.

In 2016, the Ebonyi state government had built and 'equipped' the N350 million ultra-modern virology centre within the premises of the Federal Teaching Hospital, Abakaliki, and handed it over to the federal government who promised to instil effective management in the running of the health facility.

At the commissioning of the facility in 2016, Prof Adewole expressed hope that the centre would help curb the menace of Lassa fever ravaging the zone and assured that the purpose of the centre would never be defeated.

Two years later, he returned to the state in January to blame the government's failure to fully equip the centre on the outbreak of other deadly diseases across the country.

"It's quite unfortunate that you (Ebonyi government) handed the centre over to us but because of a few other things we could not respond immediately with the operationalisation of the lab.

"As we moved to operationalise the lab we had other challenges, we had monkeypox, we had meningitis and it appeared as if in trying to prioritise we thought Lassa has calmed down a bit, we decided to quickly address these diseases and also the yellow fever outbreak," he said.

The minister's embarrassing excuse is an indication of the federal government's culpability in the troublesome outbreak that the country has faced this year.

Despite battling Lassa fever outbreaks for 49 years, the Institute of Lassa Fever Research and Control, in Irrua Specialist Teaching Hospital (ISTH), Edo state, is the only specialist facility for the treatment of the disease in Nigeria.

What this means is that victims of Lassa fever from other regions usually have to make unnecessarily long road trips, in poorly equipped ambulances, to Edo state for the best care possible. The facility's Lassa fever isolation ward was overflowing with victims in late January so much that a makeshift tent had to be erected outside the ward to accommodate the growing number of cases.

While speaking about the outbreak this year, Chairman, Medical Advisory Committee and Consultant Family Physician University of Abuja Teaching Hospital, Dr Nicholas Baamlong, blamed it on the lack of government funding of facilities and enforcement of environmental laws.

He lamented that the high infection rate of health practitioners is most notably due to a lack of necessary health equipment as well as appropriate treatment centres.

A virologist, Prof Simeon Agwale, also recently accused the government of lacking the political will to commit to producing vaccines for the disease. He urged the government to not look to the West for a vaccine solution since they don't suffer from the disease.

Another virologist, Oyewale Tomori, said the country should hang its head in shame as it is still chasing its tail over Lassa fever nearly 50 years after the first confirmed infection.

He said, "We should all hang our heads in shame for the unacceptable occurrence of Lassa fever in Nigeria. I say all of us, because we all know what to do - the government, the medical profession, the media, and the citizens. But we will not do what we know is right.

"When Ebola came visiting, the government immediately declared a national emergency, provided adequate resources and continually provided correct information to the people. As soon as we overcame Ebola, we went back to sleep."

Reaction to 2018 outbreak

A national Lassa fever multi-partner multi-agency Emergency Operations Centre (EOC) was activated in Abuja in January and has been responsible for coordinating response activities at all levels.

By March 2018, a 24-hour Lassa fever case management call line had been established with enhanced surveillance in states with active outbreaks. A team of NCDC staff and Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) residents had also been deployed to respond to the Ebonyi, Ondo, and Edo outbreaks. Bauchi and Taraba had been added to this list by April.

These states have also been equipped with dedicated Lassa fever treatment units and Ribavirin for treatment of confirmed cases.

In March, the NCDC deployed teams to four Benin Republic border states (Kebbi, Kwara, Niger and Oyo) for enhanced surveillance activities.

WHO has been working with the NCDC and other partners to control Lassa fever by deploying teams to hotspots, identifying and treating patients, strengthening infection, prevention and control measures in health facilities, and engaging with communities.

Researchers at the Irrua Specialist Teaching Hospital - in collaboration with the Bernhard-Nocht Institute for Tropical Medicine, Germany, WHO, NCDC and others - have also conducted genome sequencing of the Lassa virus.

A cause for relief and concern

In the NCDC's final situation report for March, WHO noted that the number of confirmed and probable cases had been falling for five consecutive weeks, indicating that public health measures were proving effective, even though more infections were expected until the end of the dry season.

WHO Representative to Nigeria, Wondimagegnehu Alemu, was cautiously optimistic when he talked about the decline.

"We should interpret the recent declining trend in new cases with caution. The Lassa fever season is not yet over. We need to maintain vigilance and response operations, and ensure continued engagement with communities to help curb the further spread of Lassa fever," he said.

While the decline in reported cases might ease some nerves, there are still troubling concerns to address.

According to the National Coordinator and Chief Executive Officer of the NCDC, Dr Chikwe Ihekweazu, Lassa fever is difficult to overcome because it has multiple chains of infections that cannot all be broken unlike other infections like, say, Ebola.

He said, "Unlike Ebola, there is no magic bullet for Lassa fever. It is endemic in our environment and as long as there is rat, we will always have cases of Lassa."

Even though he assured that the NCDC is doing its best to fashion out a vaccine for the Lassa scourge, he also grimly admitted that it has "come to stay for now."

These are dismal words coming from the head of the agency that's the first and last line of defence against what is a yearly epidemic. So where do we go from here?

Practical solutions against future Lassa fever outbreaks

Lassa fever is basically a yearly event in Nigeria as it is, so there's really no reason why the federal government has not made moves to establish fully functional virology centres in the six geopolitical zones of the country.

In 2018, healthcare workers still regularly complain of the lack of basic Personal Protective Equipment such as gloves, even in Federal Teaching Hospitals.

As has been suggested several times by experts, the federal government needs to commit to a more comprehensive and coordinated control program and build capacity to adequately respond to the outbreaks such as this.

It goes without saying that there should be an active surveillance of Lassa fever cases in health facilities and communities.

There should also be increased focus on areas of training, research and service delivery for healthcare workers while enlightenment campaigns, especially in high-risk areas, should be at deafening levels.

If the government can splurge on a relentless campaign to compel Nigerians to pay tax, then it can afford to embark on campaigns that are instrumental to saving their lives.

It also isn't too much to ask that relevant government agencies, across all levels, should design a plan based on years of outbreaks and find ways to absolutely limit future outbreaks.

Legislators might also want to look into making proper laws on waste disposal, environmental sanitation, and food storage that'll significantly limit outbreaks.

Why you should care about Lassa fever outbreak

With the virus already in 21 states of the country's total of 36, Nigerians should realise that caution is of utmost importance here. Since there is currently no vaccine that protects against Lassa fever, prevention should be the watchword.

Until such a time comes when Lassa fever becomes a thing of the past, Nigerians, especially people in affected states, can best steer clear of infection by blocking all the rat outlets in their homes, cooking all foods thoroughly, covering all foods and water properly, keeping the house and environment clean and storing foodstuffs out of the reach of rodents.

Health workers should also consistently implement all standard infection prevention and control measures possible to cater to patients regardless of what their symptoms appear at first.

The current outbreak in the country is a major cause for concern and more needs to be done to ensure Nigerians, like Ambe, don't wind up as ordinary statistics used to explore our annual helplessness against such a malevolent yet easily-tamed virus.