He and his team used antibiotics to stabilize the patient, sent samples off to the Lassa virus fever centre at Irrua Specialist Hospital in Edo state, one of two premier centres for Lassa diagnosis in Nigeria. “It came out negative. Likely it was some severe infection [the patient] had,” he recalls. It was a narrow miss, but not so for many health workers across the country.

In Anambra, Delta and Rivers, many health workers have died in the 2016 Lassa season from caring for patients they didn’t know had Lassa fever. Lassa fever killed more people between 2015 and 2016, the highest death toll from the disease on record since it was discovered more than 40 years ago, says the Nigeria Centre for Disease Control, NCDC.

Across 23 states, a total 273 infections were recorded and 149 people died from contracting Lassa fever, NCDC said in a statement. “Of these, 165 cases and 89 deaths have been confirmed through laboratory testing,” the NCDC said. It is case fatality ratio of 53.9%, meaning 54 in 100 people who contracted the disease died.

The latest death from Lassa fever was a female nurse at Federal Medical Centre, Abeokuta, who died “before the laboratory result revealed she was positive for Lassa,” according to the NCDC. “This case highlights the risk Lassa fever still poses to the lives of Nigerians, particularly at this time of the year,” it said.

The Centre issued a warning about increasing cases of Lassa fever. Seven states have reported at least one case of the disease since December last year, when the dry season started. Nineteen confirmed cases and six deaths have been reported in the seven states-Ogun, Taraba, Nasarawa, Edo, Ondo, Rives and Plateau.

Ebola virus disease, which broke out in West Africa for the first time in 2014, is considered more lethal, but Lassa killed more people in the same period. Many of those killed have been healthworkers. And the killing hasn’t stopped year on year since the virus was first identified in the Lassa area of Borno, where it was first identified since 1969.

Caregivers and laboratory workers are at risk, the World Health Organisation has warned. “Health-care workers caring for patients with suspected or confirmed Lassa fever should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding,” it said. “When in close contact (within 1 metre) of patients with Lassa fever, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

“Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Lassa virus infection should be handled by trained staff and processed in suitably equipped laboratories under maximum biological containment conditions.”

Microbiologists dealing with body samples taken from patients for investigation look for virus in blood samples, said Kaduna-based microbiologist Felix Eleojo. The virus behind Lassa is of the family Arenaviridae,  carried in the rodent Mastomys, commonly known as the “multimammate rat”-for the many breasts on the female.

The rats themselves do not become ill, but they shed the virus in their urine and faeces when in contact with food they share with humans. Humans eat the contaminated food or inhale the virus. once infected, humans infect other humans through contact. That’s why health workers and caregivers are most at risk.

Eighty percent of people infected with Lassa will not show any symptoms, another reason health workers and caregivers are at risk. Only around one in five infections will result in severe disease, where the virus affects several organs such as liver, spleen and kidneys, according to the WHO.

And the symptoms are as varied as those found with any other disease, lasting anywhere from six to 21 days. It begins with fever, general weakness and malaise. Headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough and abdominal pain may follow in a few days, WHO says.

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. “Shock, seizures, tremor, disorientation, and coma may be seen in the later stages. Deafness occurs in 25% of patients who survive the disease. In half of these cases, hearing returns partially after 1-3 months. Transient hair loss and gait disturbance may occur during recovery,” it adds. “Death usually occurs within 14 days of onset in fatal cases,” it adds.

Lassa fever is especially severe late in pregnancy: in more than 80% of cases, mothers may die or lose their babies or both if Lassa infection occurs in the last three months of pregnancy. A definite diagnosis for Lassa has been difficult because the symptoms are so varied and non-specific. Lassa fever is difficult to distinguish from other fevers that cause bleeding, including Ebola, and others which cause fever such as malaria, typhoid and yellow fevers.

Two reference laboratories in Edo and Lagos are pushing diagnosis in Nigeria, but results take days to return.

NCDC says it is working with them to increase their diagnostic capacities, while planning for a larger lab network nationwide.

It has also mapped all states based on their risk of Lassa fever, and teams from the centre have travelled to distribute prevention and response materials and medicines to every state.

Its response has been to position drugs, kits and guidelines with state epidemiologists, says Lawal Bakare, technical assistant for communications at NCDC. He ran the @ebolaalert handle for Ebola awareness, now @epidalert for any outbreak.

“Distribution has been done, completed in all states,” he says. State epidemiologists either place equipment and drugs in their stores and disburse as relevant or position them at strategic centres. They have autonomy to do so.

At present, no vaccine exists against Lassa fever. But the drug Ribavirin has been shown to be effective in treating Lassa fever, if given early. It has no preventive effects, warns the WHO.

Response in Nigeria is three pronged: states need to be prepared, healthworkers and communities must prevent spread once and even before Lassa is suspected, and treatment must start as early as possible.

“The key messages to Nigerians are the same as last year,” said NCDC.

“Firstly protect your food items from access to rats using whatever means that you can afford-refrigerate, cover, store properly. Secondly if you do have a fever, insist on getting tested for malaria using a rapid diagnostic test  – remembering that not every fever is malaria,” it added.

“Finally and critically, health care workers must remember that healthcare settings are particularly risky, and staff should always apply standard infection prevention and control precautions when caring for patients, regardless of their presumed diagnosis.

“These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.”

Baamlong and his team were able to scale through the scare because his hospital had a stock of Ribavirin and personnel protective equipment before his patient came through the door.

“But you know drugs will expire. And then you start rushing to the ministry and they start telling you to apply, and before you do all of that, something may have happened,” he says.

Talk of distributing prevention and treatment kits is one thing. Getting them on the ground is another.

“Most of the time, they talk, but the real thing on the ground is not done,” he worries.

“The way Nigerians are, we are not proactive. We are reactive, in the sense that the things are not really there to manage these cases. It is when we see one case, we start running up and down, looking for what to do. all these personnel protective equipment, drugs and isolation units are not readily available.

Before you identify [the disease], a lot of people would have been in contact with the patient, so you see a lot of people getting infected. That’s my worry.”

Source: Swankpharm