Lassa Fever: Maintain good community hygiene, experts warn
• Medical Personnel Should Ensure Proper Barrier Nursing, Infection Control Practices – NMA
• LASG Urges Calm, Says Situation Under Control
• Scarce Protective Devices Worry Doctors
With three medical doctors, (all from the Morbid Anatomy and Molecular Biology Department, Lagos University Teaching Hospital (LUTH)), who took part in the post-mortem examination of deceased victims of Lassa fever now under surveillance, concerns about health workers’ safety is gaining currency in the face of inadequate protective devices for their use.
The doctors are among the over 100 hospital workers exposed to the index case. They are all under surveillance.
Health workers at the Emergency Department of the hospital, revealed to The Guardian that the protective devices are not enough for them, and stressed the need for more protective devices to be made available in view of the fact that health workers were constantly being exposed to infectious diseases.
LUTH’s Chief Medical Director, Prof. Chris Bode, who confirmed the death of two persons on Tuesday, added that 100 hospital workers, who had contact with the index patients were being monitored for the symptoms of the disease.
He, however, urged patients and health workers at the facility not to panic as there are relevant drugs and resources to prevent an outbreak, or spread of the disease within the health facility.
He said the state Ministry of Health and the Federal Ministry of Health had sent personnel and experts to assist with the tracing and follow-up of contacts in addition to managing suspected cases.
But speaking on behalf of the resident doctors, Chairman, Association of Resident Doctors (ARD), LUTH Chapter, Dr. Adebayo Sekunmade, said the association has spoken to the management on the need to have all infectious disease control measures on ground.
He said: “We have told them that there should be running water at all the service points. They should ensure that gloves and other protective wears are on ground 24 hours so that health workers do not run out of it.
“Some resident doctors have volunteered to treat those 100 people under surveillance, but we want the management to handle the situation more carefully. The volunteer resident doctors and nurses should not come to the general wards or move around the premises. They should be appropriately monitored and also protected so as to prevent further casualties,” he noted.
In an interview with The Guardian, the LUTH CMD said the three doctors that are currently under admission were being effectively treated and were responding to treatment.
“The outbreak is under control. We have enough drugs and we have received enough assistance from partners. Let us please douse the panic created by unguarded statements, and if anyone needs to make enquiries, we have already provided hotlines for this,” he said.
Bode, who expressed optimism that the outbreak would be contained, explained that corpses of the deceased have been professionally managed, adding that each of the cases had been managed in other facilities before they were referred to LUTH.
On the management of the infected medical personnel, he said, “We have four beds in the isolation unit, which is completely self-contained and have rooms where nurses and doctors can change, including their own toilets and bathrooms. It has regular supply of electricity and water, fully air-conditioned and we follow international standard procedure in attending to the patients,” he said.
He urged all hospitals across the state to maintain high index of suspicion and contact LUTH on 08058019466, 08058744780, 07035521015 and 08023299445 once the need arises.
Former chair of ARD, LUTH Chapter, Dr. Omojowolo Olubunmi, who also shared the same view, said protective devices are supposed to be readily available at the Emergency Department, but doctors complain that they don’t have enough.
Olubunmi, who is also the Chairman Nigeria Medical Association (NMA) Lagos Chapter, said the current outbreak was not the fault of the hospital. “It is the nature of the disease. The patients presented late, and the hospital did everything it could to save their lives,” the former ARD chair said.
He urged government to scale up its level of preparedness, by providing personal protective devices in all hospitals across the nation. Shedding light on the disease, the medical practitioner described Lassa fever as, “an acute febrile illness, with bleeding and death in severe cases, caused by the Lassa fever virus, which has an incubation period of 6-21 days.
“The virus, a member of the virus family Arenaviridae, is zoonotic, or animal-borne. About 80 per cent of human infections are without symptoms; the remaining cases have severe multiple organ diseases, where the virus affects several organs in the body, such as the liver, spleen and kidneys. Lassa fever is a significant cause of severe illness and death,” he said.
Countries, which has the disease in endemic proportion, according to him, are Benin Republic, Guinea, Liberia, Mali, Sierra Leone, and Nigeria, with peaks in incidence closely related to seasonal patterns.
“It is an acute viral haemorrhagic illness caused by Lassa virus, first identified in 1969 in Nigeria. However, because the rat species, which carry the virus are found throughout West Africa, the actual geographic range of the disease may extend to other countries in the region.”
On the mode of transmission, he said: “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 around 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.
“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,” he said.
Although Lassa fever can occur in all age groups, he noted that persons at greatest risk are those living in rural areas, where the rats are usually found, “especially in communities with poor sanitation or crowded living conditions. Health workers are at risk if Lassa fever is not suspected or while caring for Lassa fever patients in the absence of proper barrier nursing and infection control practices,” he said.
For signs and symptoms of the disease, Olubunmi said; “The onset of the disease, when it is symptomatic, is usually gradual, starting with fever, general weakness, muscle and joint pains, prostration and malaise. After a few days, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and abdominal pains 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.”
He continued: “Protein may be noted in the urine. Shock, seizures, tremor, disorientation, and coma may be seen in the later stages. Deafness occurs in 25 per cent 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. Patients may die from shock.”
On treatment, he said the only known specific treatment for Lassa fever is Ribavirin, which may be effective if given within the first six days of illness.
“It should be given intravenously for ten (10) days. Supportive treatment should include; Paracetamol, Vitamin K (Phytamenadione), Heamacel, Ringers lactate, antimalaria and antibiotics. If patient is severely anaemic, consider transfusion,” he said.
While informing that there is currently no vaccine that protects against Lassa fever, the medical doctor said, “Prevention of Lassa fever relies on promoting good community hygiene to discourage rodents from entering homes. Effective measures include storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, and maintaining clean households.
“In healthcare settings, prevention is by standard precautions where all blood and body fluids are considered potentially infectious. Standard precautions are applied to all patients at all times and in all health care settings. These include hand hygiene, use of appropriate personal protective equipment (PPE), waste disposal, cleaning and disinfection of medical equipment and environment, safe injection practices,” he added.
Meanwhile, the Lagos State government has called for caution in order to avoid unnecessary panick over the outbreak.
Director of Disease Control, Lagos State Ministry of Health, Dr. Eniola Erinosho, said the Health Ministry had directed its Epidemiology Unit to move into LUTH immediately it was notified about the development on August 3, 2017 in order to prevent further spread of the disease.
“We are on top of the situation and there should be no panic. The index case in the outbreak was referred from Divine Grace Hospital, Imota, Ikorodu area of the state. We have been to Imota and have taken charge of the situation, but none of them has actually come down with fever.
Erinosho disclosed further that already, the state government was taking over the second corpse, which was still in LUTH’s possession, since the index case had been moved to Ilesha, where burial would be conducted according to international standards.
“In case of death through Lassa fever, we use body bags, seal the coffin and the relatives will not see the body. From there, we have special unit in the Ministry called the State Environmental Monitoring Unit that carries out the procedure.”