Why Lassa fever is spreading —Tomori

In this interview with SADE OGUNTOLA, Professor Oyewale Tomori, a Professor of Virology, educational administrator, and former Vice-Chancellor of Redeemer’s University, Ogun State, speaks on the resurgence of Lassa fever in the country with the attendant loss of lives in a number of states. EXCERPTS:

 

GOVERNOR Rochas Okorocha of Imo State warns against handshaking and drinking garri to prevent Lassa fever. Is there any justification for such seeming panicky measure?

If I need advice on building a wooden scaffold, I will go to a carpenter, and not an electrician. We all say that half a word is enough for the wise. Better to say half a word from the wise is enough. We should endeavor to make specific statement on a particular issue, instead of giving off the cuff general statements on issues we are not really conversant with. The distinguished Governor’s statement is likely to cause more confusion than provide solution to the problem of preventing Lass fever transmission. Lassa fever, like many other diseases can be transmitted when we are careless about our hygiene, such as not washing our hands, It would have been more useful if the Governor had focused more on hand washing than hand shaking. On the garri issue, when you protect your garri from being contaminated with rodent urine and droppings- all the time from initial preparation through to storage at home- then you can drink as much garri as you want.  The same goes for the advice by charlatans, that you should not eat bush meat. This is a general advice that does not address the real issue. Yes, some rodents are natural hosts of Lassa fever virus, and the virus may be present in their blood and body fluids. The danger of exposure comes when we have contact with live rodents – the hunter who traps the rodents may be contaminated with virus shed in the discharge of the rodents on his trap or hunting instruments, the person who prepares the (raw) rodent for cooking may also get contaminated. However, after the rodent meat is thoroughly and well cooked, the meat is safe for eating. But note that he or she who gets contaminated and infected with the virus from the raw meat, becomes a source of infection to others, especially when we abandon the basic issues of hygiene. I think the most painful fact of Lassa fever is the annual reports of health workers dying from the disease. This should not happen.  It is a reflection of the poor state of our health delivery system. Our hospitals are ill equipped with the facilities and material – gloves, masks, coats, and other protective equipment – needed to ensure acceptable infection control in our health system. We also have health workers, who for unimaginable reasons, and what I call, suicidal tendencies, go around cutting corners, while attending to undiagnosed infectious disease patients admitted into their hospitals. This is happening in a country where Lassa fever has been an annual occurrence for at least the last twenty years.  Finally on the protection of our health workers from exposure to and possible infection by infectious diseases, our government, especially at state level, must provide adequate and sufficient quantities of protective materials in our hospitals. It is essential to provide adequate advice, so our people and our governments will know what appropriate action to take, instead of advising us to avoid hand shaking and garri drinking.

 

About 80 per cent of people who become infected with Lassa virus have no symptoms. One in five infections results in severe disease, where the virus affects several organs such as the liver, spleen and kidneys. Why is this the case?

This is the characteristic of the virus, just as the virus responsible for cold infection affects the cells of the respiratory tract, and hepatitis virus shows preference for liver cells, so you have viruses, such as Lassa fever and yellow fever affecting cells of many organs, which define the signs and symptoms of the disease.

 

Do you think that Health workers taking care of Lassa fever patients in Nigeria observe proper barrier nursing and infection prevention and control practices?

I tried to answer that above. Yes indeed, they can observe proper and ideal infection control measures, provided they are provided with adequate protective equipment- simple things as gloves, mask etc. There is a serious need for our health workers to, in addition, increase their awareness about these infectious diseases. I think the level of awareness of these diseases is not at the expected level. To me, the most important issue is government providing enough resources, supplies, facilities and basic requirements to protect health workers. I was most pleased by a report that survivors of the Ebola virus disease outbreak took the government of Sierra Leone to the ECOWAS court, accusing the government of negligence by not providing enough resources for health workers during the 2014-2015 outbreaks. The survivors contend that many more health workers died than expected as a result of government negligence. I think it is high time we take consider taking our government to court over the unnecessary and preventable deaths of Nigerian citizens from years of Lassa fever, yellow fever, and CSM outbreaks.

 

Although malaria, typhoid fever, and many other tropical infections are much more common, can we say that the diagnosis of Lassa fever should be considered in febrile patients now in Nigeria

We certainly need to improve the level of our laboratory services, given that the early symptoms of all these diseases- malaria, typhoid fever, Lassa fever and even Lassa and Ebola fevers are very similar and indistinguishable.

 

Why the resurgence of Lassa fever in Nigeria

Indeed, it is not resurgence, it is an endemic situation with seasonal peaks. Available records indicate that we report between 20-30 cases of Lassa fever EVERY WEEK. Come the dry season, the number of suspected cases goes up. We neglect the weekly slaughter of our people by Lassa fever and only cry out loud, when the deaths of doctors, nurses and other health workers heralds the beginning of Lassa fever season. We forget that the health workers get their infection from the weekly cases we of Lassa fever that we neglect, discountenance and accept as normal. As I mentioned earlier, our health workers at the battle front of combating disease seem to easily forget the deaths of their colleagues a few months after and the relapse into utter unawareness and disdain of the disease….at their own peril!

 

Are panic measures and fire brigade approach working for control of this disease such as Lassa fever and meningitis?

Panic measures only create more panic. We should have known in this country, almost 50 years after Lassa fever was first reported, that panic measures only create more alarm, more anxiety, more terror, more confusion and more wastage of resources, not to mention more human deaths.

 

Do people need to avoid eating bush meat now that Lassa fever is epidemic?

Please refer to my comment under 1 above.

 

 Some experts say some states fall into the Lassa fever belt, does this explain why the problem is more prevalent is some states than the other?

Nigeria as a whole is Lassa fever belt. Anywhere you find the Lassa fever host rodents and where poor hygiene is the norm; there you will find Lassa fever cases. Tell me which part of Nigeria is outside such a belt of rodent infestation and environmental filth muck. You remember, once rodents invaded the office of our President, more like when the cat is out, the rodents become president

 

What some of the salient precautionary measures for Lassa?

These have been very well stated by the Nigerian Center for Disease Control – I will quote from WHO documents on prevention and control of Lassa fever:

To prevent Lassa fever, promote good “community hygiene” to discourage rodents from entering homes. Store grain and other foodstuffs in rodent-proof containers,  dispose of garbage far from the home, maintain clean households and keep cats.  Avoid contact with blood and body fluids while caring for sick persons. In health-care settings, when caring for patients, regardless of their presumed diagnosis apply standard infection prevention and control precautions – basic hand hygiene, respiratory hygiene, use of personal protective equipment, safe injection practices. In the laboratory, samples taken from humans and animals for investigation of Lassa virus infection should be handled by trained staff and processed in suitably equipped laboratories. At home, ensure safe practices for burying dead people. Finally, I am tired of answering these same questions year in year out and seeing people dying of preventable Lassa fever disease from our national disgraceful neglect and palpable inaction. It is as if our country is deaf. My hope is that the public hearing exercise for enacting the National Centre for Disease Control (NCDC) held by the Senate Committee under the leadership of Senator Mao Ohuanbunwa, last Monday 22 January 2018, will not be another exercise in the continuous futility of finding solutions to the problems of endemic and perennial outbreaks of preventable diseases.