Lassa fever: The lightning striking more than once
This January, a seven-month old baby died in Kogi State, and a doctor who treated the infant tested positive to Lassa fever. The doctor went into hospitalization at Irrua Specialist Teaching Hospital in Edo State, which has become a reference laboratory for Lassa confirmation. All who had come into contact with him were put under surveillance.
The outbreak season returned in December, and it is striking twice in the zones as before.
Four weeks into the latest epidemic, a total 297 cases suspected to be Lassa fever have been reported in 13 states. By February, the states affected have jumped to 15. Laboratory tests confirmed 77 of the cases positive for Lassa, and 21 people have died from the infection.
Health facilities have been at the centre of the outbreak. In one week, three health workers at a federal hospital in Ebonyi died. Ten health workers were infected in four states in January alone.
The Nigeria Centre for Disease Control has sent epidemiology teams into affected states. It has also ramped up infection prevention and control (IPC) measures at health facilities. The measures call for health workers to maintain universal precaution, hygiene and a high index of suspicion for any fever. It requires health workers to treat every fever as if it were from an infectious disease.
“Lassa fever is no respecter of persons. Health worker or no health worker, it is a dangerous disease,” said Chiedozie Achonwa, chairman of the Nigerian Medical Association Abuja chapter.
A critical aspect of managing Lassa fever outbreak is identifying the first case in any locality, determining it was transmitted and putting measures to break the transmission cycle while managing patients confirmed positive for the virus, the centre said in an advisory it issued this January.
“During case management of cases, strict infection and prevention control measures should be carried out at all times, most especially when final diagnosis of cases is being awaited,” said NCDC.
In January 139 people in Ebonyi were placed under surveillance and authorities shut down schools and evacuated patients from hospitals risk of infection was considered likely.
Some 40 health workers in Ebonyi alone have died from contracting Lassa in 13 different seasons of the outbreak. Doctors there believe their colleagues died because a virology centre of the Federal Teaching Hospital, where patients were first hospitalized for what was thought to be Lassa fever, was not functional. It hasn’t gone into full operation since the state handed the centre over to the federal government.
The Irrua Specialist Hospital is central to confirming whether a suspicious case of haemorrhagic fever is Lassa or something else. The time it takes to transport samples from any part of the country to the lab and get a result back is time to maintain universal precaution in how patients and loved ones are handled.
It is the different between containing spread of Lassa fever and encouraging further transmission. That’s how Nigeria has battled Lassa in nearly 50 years since the disease was first observed.
The ongoing outbreak is active in 15 states of Bauchi, Plateau, Taraba, Nasarawa, Benue, Kogi, Ebonyi, Rivers, Imo, Anambra, Edo, Delta, Ondo, Osun and Lagos.
The year 2018, in short bursts, is rivalling 2017’s season of Lassa fever. By the third week into the 2018 outbreak, authorities found 53 suspected cases of Lassa, 21 of them laboratory confirmed and eight deaths in 27 council areas.
For the same period in 2017, only nine suspected cases, two laboratory confirmations and two deaths were reported. And this outbreak is yet to peter out.