Nigeria intensifies surveillance as Lassa fever epidemic spreads

• Lagos reports three suspected cases at Mainland Hospital, Mushin General Hospital • Medical experts challenge govt on virus containment
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Despite increase in surveillance, the recent Lassa fever epidemic continues to spread but with reduced fatality even as three suspected cases of Lassa fever has been reported in Lagos by Mainland Hospital and General Hospital, Mushin.

Also, the former Vice-chancellor of Ambrose Alli University, Ekpoma (AAU), Edo State, and Professor of Microbiology, Dennis Agbonlahor has called on the federal government to synergize with major stakeholders in the health sector to step up aggressive advocacy to halt the spread of Lassa fever in the country.

Agbonlahor who decried the ravaging effect of Lassa fever since the resurgence of the contagious disease after the successful elimination of Ebola virus Disease also stressed the need to wage war against Lassa fever same way as in the outbreak of Ebola which was proactively curtailed.

Also, President Pharmaceutical Society of Nigeria (PSN), Ahmed Yakasai, said there is a need to re-orientate approach to public health realities.

Lagos State Commissioner for Health, Dr. Jide Idris, in a statement, yesterday, said the first suspected case is a 47year-old woman who was referred to General Hospital, Mushin from a private health facility (Alafia Tayo Maternity Home) on January 7, 2016 with three days history of sore throat; frequent watery stooling of 8hrs duration; difficulty in breathing of one hour duration and widespread petechae hemorrhages on the body.

Idris said the patient later died few minutes after reaching the hospital. Result of laboratory investigation (blood) was negative for Lassa fever.

He said the second suspected case, a 31 year-old woman from Nassarawa State, was referred from a private to Mainalnd Hospital, Yaba on account of the following symptoms she developed on January 4, 2016 : fever, sore throat, abdominal pain, discharge from the eyes, bleeding per vagina, passage of bloody urine, anal bleeding and hemoptysis. Result of laboratory investigation (blood) was negative for Lassa fever.

Idris said the third suspected case was a 24-year-old housemaid who returned from Taraba State and was brought by her relations to Mainland Hospital, Yaba on the January 8, 2016 on account of fever, vomiting and diarrhea on January 9, 2016.

The commissioner, however, said result of laboratory investigation (blood) was negative for Lassa fever. “One of the primary contacts of the confirmed case in Rivers State who resides in Lagos is presently being monitored along with her contacts (secondary contacts). All the contacts as at the time (Day 14) of this briefing are apparently healthy,” he said.

Nigeria has been experiencing Lassa fever outbreak in the past six weeks in Bauchi, Edo, Gombe, Kano, Nassarawa, Niger, Oyo, Plateau, Rivers and Taraba. The first case was reported from Bauchi State in November 2015. The total number of suspected cases so far reported by Federal Ministry of Health (FMoH) is 86 with 40 deaths, and a Case Fatality Rate of 46.5 per cent. Laboratories have confirmed 14 cases.

Lassa fever is an Acute Febrile disease caused by the Lassa virus belonging to the arenavirus group. It was first described in the 50s and the virus was isolated in 1969 in Lassa, Nigeria. Lassa Fever occurs more often in the dry season, rather than in the rainy season. The multimammate rat (Mastomys natalensis) is the reservoir host of Lassa fever.

Other interventions by the Lagos State Ministry of Health (LSMoH), according to Idris, include:

•Airing of jingles on Lassa fever on electronic media

•Distribution of factsheets on Lassa fever to the Medical Directors of Lagos State University Teaching Hospital (LASUTH) and 26 General Hospitals in Lagos State, Medical Officers of Health in all the 57 Local Government Areas (LGAs)/Local Council Development Areas (LCDAs), all other agencies of the Ministry and Association of General and Private Medical Practitioners of Nigeria (AGPMPN) for circulation to all health workers in their facilities.

•Reactivation of isolation wards in LASUTH and 26 General Hospitals in Lagos State for isolation of any suspected case.

•Prepositioning of Personal protective equipment (PPE) in all 26 General Hospitals for use by health workers with 6,750 PPEs reserve at Mainland Hospital, Yaba.

•The Disease Surveillance and Notification Officers (DSNOs) in all the LGAs in the state have been sensitized on Lassa fever to
enhance early detection and prompt reporting of cases.

•Creation of awareness on Lassa fever by the health educators in the 57 LGAs/LCDAs.

•Sensitisation on Lassa fever of Iyaloja General of Nigeria and market leaders of all the 57 LGAs/LCDAs in Lagos by the State Health Educator.

•Contact tracing of health workers and relatives of suspected case at General Hospital, Mushin, Alafia Tayo Maternity Home, Mushin and 18 Oloje Street, Papa Ajao Mushin on January 8, 2016 by Ministry and World Health Organisation, Lagos.

•Decontamination of General Hospital,Mushin, Alafia Tayo Maternity Home and residence of the deceased suspected case at 18 Oloje Street, Surulere by State Environmental Health Monitoring Unit (SEHMU).

•Collaboration with Federal Ministry of Health, Virology Reference Laboratory, College of Medicine University of Lagos and World Health Organisation, Lagos in prevention and control of the disease.

The health commissioner said members of the general public are hereby enjoined to:

•Avoid contact between rats and human beings.
•Ensure proper collection and disposal of waste.
•Cover all foods (including left-overs) and water properly.
•Wash hands properly before and after cooking of foods.
•Block all rat hideouts.
•Store food items in rodent-proof containers.

Idris advised health workers to:

•Be at alert and have high index of suspicion for Lassa fever and other viral hemorrhagic fever.
•Report any suspected case to the Primary Health Department of LGAs or the Ministry of Health.
•Observe universal safety precautions when attending to all patients.
•Wear appropriate PPEs when attending to suspected/confirmed cases.

Idris urged Lagosian to report any case with above symptoms or persistent high fever not responding to standard treatment for malaria and typhoid fever to the nearest health facility or calling the following lines: 08033065303, 08022234273, 08037170614 and 08023169485.

He said The Lagos State government remains committed to ensuring that Lagos State is Lassa fever free.

Meanwhile, Agbonlahor recalled how the dreaded Lassa fever wiped out an entire family at Ekpoma in Esan West Local council area of the state, said it took the timely intervention of a notable medical expert in the person of Prof. Adewale Tomori, a Professor of Human Virology who collaborated with himself to carry out the research aimed at getting to the root cause of the outbreak of the disease.

He noted that after the successful conduct of the research and the specimen taken to the Laboratory for confirmation, it was discovered that Lassa fever was endemic in Ekpoma and Irrua, in Esan Central Local Council Area of Edo State.

Agbonlahor, a professor of microbiology noted that the first outbreak of Lassa fever was recorded in a village called Lassa in Borno State and another in the city of Jos in Plateau State in 1969, adding that the symptoms of Lassa fever include fever, headache, vomiting, stooling, body pains, diarrohea, swollen at the neck with advanced ribavirin as the major antiviral drugs for the treatment of the dreaded disease.

According to him,” the contagious disease which is spread by mastomys rat after escaping from the bush due to persistent bush burning, settled at homes, where it deposit faeces and other deadly substances on food not properly covered and there contaminates such food.”