Lassa fever killed 725 in five years

NO fewer than 725 persons have been killed by Lassa fever out of the 3132 infected by the viral disease in Nigeria between January 2017 and August 2021. The breakdown, according to Nigerian Tribune findings, shows that out of the 298 confirmed cases in 2017, 79 died. Out of the conformed 528 Lassa fever cases in 2018, 171 died. Of the 796 Lassa fever cases in 2019, 158 died and from the 1189 cases in 2020, there were 244 fatalities. Between January and August 2021, there were 321 confirmed cases out of which there were 73 fatalities. 

According to experts who spoke with Nigerian Tribune, although the outbreak of Lassa fever is predictable, poor preparation and weak response system have made some Nigerians vulnerable. Although the disease has spread to about 22 of the 36 states of the federation, it is prevalent in Edo, Ondo and Ebonyi states. 

Lassa fever, an acute viral hemorrhagic zoonotic disease, is difficult to differentiate from other febrile illnesses, which is why it is not often properly managed. This is responsible for its high fatality rate. The number of Lassa virus infections per year in West Africa is estimated at 100,000 to 300,000, with approximately 5,000 deaths. 

Unfortunately, such estimates are crude, because surveillance for cases of the disease is not uniformly performed. It is spread by contact with infected rodent’s faeces or urine, inhaling contaminated dust, eating contaminated food or by contact with the fluids of an infected person dead or alive. In Nigeria, a countrywide study puts Lassa fever prevalence at 21.3 per cent. 

It exhibited seasonal variation, with most cases occurring during the late rainy and early dry seasons when rodents increasingly enter into homes in search of food. Nigeria Centre for Disease Control (NCDC)’s update on the Lassa fever outbreak in Nigeria indicated that from week one to week 36, 2021, 76 deaths have been reported with a case fatality rate (CFR) of 20.6 per cent which is lower than the CFR for the same period in 2020 (20.9 per cent). In total for 2021, 14 states have recorded at least one confirmed case across 62 local government areas. 

Of all confirmed cases, 84 per cent are from Edo (45 per cent), Ondo (34 per cent) and Taraba (5 per cent) states. The predominant age group affected is 21 to 30 years. Also, more males than females contracted the infection. Also, the number of suspected cases has decreased compared to that reported for the same period in 2020 But researchers, in a study of the Lassa fever outbreak in the northern senatorial district of Ondo State, found the incidence of the disease had increased over three years, except in 2015 where the rate of those infected and confirmed cases reduced by 62.5 per cent. 

The study reported that the rate of confirmed Lassa fever cases increased by 533.3 per cent in 2016 compared to 2015, 300 per cent in 2017 compared to 2016 and 19.7 per cent increase in 2018 compared to 2017, although, deaths recorded reduced from 50 per cent in 2014 to 25.3 per cent in 2018. 

It was in the 2020 edition of the Medical Journal of DY Patil Vidyapeeth. Lassa fever infection in newborns is highly fatal and can mimic neonatal sepsis. The worrying part is the low index of suspicion particularly for children with fever in Lassa fever endemic areas, especially in hospitals. 

In 2017, researchers found that at least six per cent of children with fever tested positive for Lassa Virus Disease (LVD), likewise, 3.9 per cent of children had fever and convulsions. In fact, 5.4 per cent of children with fever which could have resulted from infection by any virus were linked to the virus. The study had involved 913 children between ages one month and 15 years admitted to the Children’s Emergency Room of Irrua Specialist Teaching Hospital, over a period of one year for LVD. 

Many of the children were brought into the hospital during the rainy season months of May to October and some had severe anaemia (low blood level) and protein in their urine. It was in the July edition of the journal, PLoS Neglected Tropical Diseases. The resurgence of the Lassa virus offers insights not only into Nigeria’s health system but also its epidemic preparedness given the limited availability of evidence-based medical care, delayed diagnosis and out- break response and the state of the national laboratory systems. Professor Kenneth Ozoilo, the past president, Medical and Dental Consultants’ Association of Nigeria (MDCAN), stated Nigeria is woefully unprepared in case there is an epidemic.

He stated: “These processes should be prepared well ahead of time for any outbreak. But usually, it is when the event has happened that we start responding. In peacetime, everybody goes to sleep. “We’re supposed to walk out protocols; if this happens, this should be our response. This is the Disaster Response protocol. Imagine, something like the personal protective gear is locked up in a store even in the few hospitals that have it. It is after the problem has started that you even begin to talk about the isolation area. 

“It takes money quite alright, and that is why it should be done in peacetime. When you do it as an emergency, it takes even more money. If you remember last year, a packet of gloves went for as high as N50,000 something that is sold for N3,500. 

“It is not just about pumping funds. You have to decide and agree on the processes. Let the process be established and understood by everybody so that you don’t even need to be there. Once it happens, the process is triggered and it takes on a life of its own. What we’re doing now is cost-inefficient, we pump in so much money and a lot of it does not really trickle down to where it is needed.” 

But, Incident Manager, Oyo State COVID-19 Emergency Operation Centre, Dr Taiwo Ladipo, said an Emergency Preparedness Response Team is always on standby to contain whatever outbreaks or any epidemics like Lassa fever through a multidisciplinary approach. He added, “Oyo is ready to respond or tackle an epidemic in case it comes. Yes, it might not be funds that are dedicated to Lassa fever, but the funds that are available for COVID-19, if something else comes up, we will be able to utilise it. 

“Manpower is a major issue, most of the people, including the health care workers that you see in the EOC today, are volunteers; they volunteer their time and expertise towards trying to rid the state of any emergencies.” 

Dr Pelumi Adebiyi, a public health expert at the College of Medicine, University of Ibadan, declared that funding is a challenge to Nigeria’s epidemic preparedness given that less than four per cent of the national budget goes to health. Although Nigeria is a signatory to the Abuja declaration that 15 per cent of the national budget should be given to health, he stated that controlling the epidemic in Nigeria needs more domestic funding and increased community involvement in planning, implementation and evaluation to ensure health systems resilience. 

He said, “There is a budget for disease control generally, but the funding is not enough. It is expected that the basic health care provision fund would solve some of the problems that we are looking at, but be that as it is may, we still need multiple sources of funding to be able to cater for some other needs like community engagement processes, logistics to support supervision and evaluation.” 

Dr Adebiyi stated that a lot of money is going to COVID-19, while a lot of money is being taken away from other programmes, forgetting that all these diseases like Lassa fever are with us and they will continue to be with us. 

He added, “The records that we had from the Call Center during the COVID-19 lockdown shows that the community’s concerns also go beyond COVID-19. About 25.4 per cent of the calls that were received between March and September last year were non-covid related. They had to do with issues of palliatives, getting immunisation services and how to get other services.” 

Dr Adebiyi said although Nigeria is doing well generally speaking on surveillance compared to many other African countries, its preparedness to respond to an epidemic is a major problem in terms of resources, who does what, contingency plans, manpower and funding. 

He added, “The pocket of funding that we can quickly mobilise to respond in case of an epidemic is not available. The 2020 midterm joint external evaluation shows that we had improved, but we are not ready for the next epidemic. 

“It shows that we do not have a multi-hazard plan; that is a plan that can anticipate any kind of disease outbreak including Lassa fever and be able to respond very well without the healthcare services be- ing affected and with minimal loss of life.” 

Currently, no medical countermeasures exist for Lassa fever and a series of preparedness and response activities of government organisations, public health agencies and health care centres to control the epidemic have not been very successful in preventing the recurrence of outbreaks of Lassa fever. 

Professor Oyewole Tomori, a foremost Lassa fever researcher, however, said Nigeria needs to take Lassa fever more seriously and prioritise the health and welfare of the common man. 

He said, “We must never let our leaders rest until they provide funds and create an enabling environment for improved disease surveillance, detection, diagnosis, and control, with an appropriate response. 

“In addition, Nigeria must stop depending on foreign assistance and provide adequate funding to support – and provide sufficient funds for the conduct of research into the drugs for the treatment of Lassa fever, and vaccines for the control of the disease.” 

Certainly, Lassa fever is a very serious case. Over the years, attention has been given to its fight and awareness in the country. But enough preparation should include allocated funds put in place before an outbreak commences. State-level funding for epidemics must be emphasised and all this backed up by a reformed legal framework to ensure countless lives were saved.

 

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