The Association of Resident Doctors (ARD), Federal Medical Center, Lokoja is deeply worried by the reemergence of Lassa fever in Nigeria after the last outbreak in 2012 which claimed many lives.
The Federal Ministry of Health has revealed that Lassa Fever has claimed 63 lives out of 212 suspected cases reported from 62 local government areas in affected states. So far, not less than 17 states have been affected over the last 8 weeks, including Bauchi, Niger, Taraba, Kano, Rivers, Oyo, Ondo, Edo, Plateau, Gombe, Nasarawa, Lagos, Delta, Ekiti, Ebonyi, Zamfara and our dear Kogi.
That an ailment which originated in the country about 47 years could resurface, despite advancement in medicine, shows that Nigeria’s healthcare system is weak in disease prevention and control.
The death rate attributed to Lassa fever is currently put at 43.2 per cent, a rate considered very high by all standards.
Fact sheets released by the United States Centre for Disease Prevention and Control (CDC) indicate that Lassa virus, the most prevalent virus-induced hemorrhagic fever in Africa, is carried by rats and spread to humans through contact with urine or droppings of infected rats, causing devastating outbreaks similar to Ebola virus. In West Africa, the virus kills an estimated 30,000 to 40,000 people every year—approximately 10 to 15 percent of those infected.
The document explains that, in rare cases, the ailment could be spread from person to person through direct contact with a sick person’s blood or body fluids, but there is no record of transmission through casual contact.
The illness reportedly was discovered in 1969 when two missionary nurses died in Nigeria. The virus is thus named after Lassa, a village in Borno State in the North East where the first cases occurred.
The first case of the current outbreak was reported from Bauchi in November, 2015. This was followed by cases reported by Kano State, and subsequently the other states mentioned previously.
Lassa fever is an acute febrile illness, with bleeding and death in severe cases, caused by the Lassa fever virus with an incubation period of 6-21 days. About 80% of human infections are asymptomatic; the remaining cases have severe multi-system disease, where the virus affects several organs of the body, such as the liver, spleen and kidneys.
The onset of the disease is usually gradual, starting with fever, general weakness, and malaise followed by headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and bleeding from mouth, nose, vagina or gastrointestinal tract, and low blood pressure.
The reservoir or host of the Lassa virus is the “multimammate rat” called Mastomys natalensis which has many breasts and lives in the bush and peri-residential areas. The virus is shed in the urine and droppings of the rats hence can be transmitted through direct contact, touching objects or eating food contaminated with these materials or through cuts or sores. Nosocomial transmission also occurs in health facilities where infection prevention and control practices are not observed. Person to person transmission also occurs most especially when a person comes in contact with the virus in the blood, tissue, secretions or excrements of an infected individual.
As we join hands with our parent body (NARD) to kick Lassa fever out of Nigeria once and for all, ARD wishes to reinstate its commitment to quality healthcare delivery in Kogi State. We also wish to assert the following:
(1) We commiserate with the families hit by Lassa fever in the country.
(2) We commend the Federal Ministry of Health for the prompt interventions to arrest further spread of the disease and for ensuring that Ribavirin, the specific antiviral drug for Lassa fever, is in good supply to most states of the federation.
(3) We urge governments at all levels, NGOs and health professionals to step up advocacy on Lassa fever to all stakeholders including market men and women, traders, food vendors and hawkers, etc such that they have sufficient knowledge on how to prevent rats from gaining access to food in stores and warehouses, especially uncooked food such as garri, groundnuts, biscuits, meat, fruits, etc which can easily be contaminated by rodents. There is an urgent need to intensify awareness creation on the signs and symptoms of the disease as well as general hygiene measures.
(4) We decry the inadequate state of facilities in FMC, Lokoja in the face of the ongoing epidemic that has ravaged neighbouring states, especially considering the fact that other institutions across the state (including health) are on temporary lock-down. This is not in tandem with the principle of universal health coverage which has to be accessible, available and affordable.
(5) We note with displeasure that our centre is not sufficiently equipped to deal with a suspected, probable or confirmed case of Lassa fever. There is no functional isolation unit, no visible personal protective apparatuses, and the entry points for patients in the hospital (GOPD, A & E, EPU) are at maximal risk.
(6) We lament the poor state of refuse disposal in the state, especially as these unhealthy sites serve as breeding grounds for the vectors (rats). Receptacles should be strategically located for ease of refuse and other waste disposal.
(7) Clinicians and relevant healthcare workers in the state need to be sensitized and mobilized in areas of patient management and care.
(8) We implore the management of FMC, Lokoja to take practical steps to ensure routine infection prevention and control measures, including provision of items noted in (5) above.
(9) Family members and health care workers are advised to always be careful to avoid contact with blood and body fluids while caring for sick persons.
(10) We call on the general public to ensure that persons presenting with any of the preliminary symptoms are taken to the nearest health facility for prompt medical attention.
(11) The public should ensure high standards of personal and environmental hygiene as well as avoid any exposure to rats.
(12) Since the Lassa Fever scourge has been linked with rats, the only logical way for residents in the state to ward off rats in their surroundings is to keep the environment clean and healthy.
We call on residents to properly maintain their soak-away and other channels which are very convenient spots for convergence by rats. Only such safe practices would guarantee a clean and healthy environment in the State as well as ward off the incursion of rats and other undesirable pets into homes and surroundings.
Long live ARD-FMC, Lokoja!
Long live NARD!
Long live Kogi State!
Long live the Federal Republic of Nigeria!
Dr. Kennedy O. Obohwemu Dr. Nnanna U. Agwu
President Public Relations Officer