• Resident doctor infected, isolated in hospital’s ward
There is the fear of an outbreak of Lassa fever in the country as the Lagos University Teaching Hospital (LUTH) yesterday confirmed that two patients treated have died within a few days of admission in the past one week.
The Chief Medical Director (CMD) of LUTH, Prof. Chris Bode, told journalists that the two patients who were at the advanced stage of the infection died despite efforts to save their lives.
“The first was a 32-year-old pregnant lady with bleeding disorder who died after a stillbirth. Post-mortem examination had been conducted before her Lassa fever status was eventually suspected and confirmed. No less than 100 different hospital workers exposed to this index case are currently being monitored,” he said.
Bode, who is also a professor of paediatrics, said a resident doctor from the Department of Anatomic and Molecular Pathology who took part in the autopsy was later confirmed with the disease and is currently on admission and responding well to treatment at the Isolation Ward of LUTH.
The CMD who visited the Isolation Centre yesterday in the company of his top management staff assured doctors of the hospital’s full support.
The paediatric surgeon enjoined all LUTH workers to maintain a heightened level of alert in the wake of this new outbreak and observe universal precautions in handling all suspected cases of this viral hemorrhagic fever.
He urged Nigerians to notify the response team in LUTH in case of any suspected case of Lassa fever through the following phone numbers : 08058019466, 08058744780, 07035521015 and 08023299445.
The medical expert noted that LUTH has always worked closely with officials of the Lagos State Ministry of Health in handling a number of diseases of public importance such as rabies, cholera, Lassa fever and the recent diarrhoea disease at the Queen’s College. He said both the Lagos State Ministry of Health and the Federal Ministry of Health have responded swiftly to contain the current Lassa fever outbreak by mobilising human and material resources to trace the sources and extent of the disease, follow up on potential contacts, identify early and test suspected cases.
The LUTH boss said there were adequate materials for the containment of the disease while drugs have been made available to treat anyone confirmed to have it. The Centre for Disease Control (CDC) in Nigeria has also been contacted and two other suspected cases from Lagos State are also currently admitted and quarantined while confirmatory laboratory tests are ongoing.
According to the World Health Organisation (WHO), Lassa fever is an acute viral haemorrhagic illness of two-21 days duration that occurs in West Africa. The Lassa virus is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces. Person-to-person infections and laboratory transmission can also occur, particularly in hospitals lacking adequate infection prevention and control measures.
Lassa fever is known to be endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria, but probably exists in other West African countries as well. The overall case-fatality rate is one per cent. Observed case-fatality rate among patients hospitalised with severe cases of Lassa fever is 15 per cent.
It has been shown that early supportive care with rehydration and symptomatic treatment improves survival.
The virus is zoonotic, or animal-borne. About 80 per cent of human infections are without symptoms; the remaining cases have severe multiple organ disease, 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.
According to the WHO, 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.
A WHO fact sheet on Lassa fever noted that it occurs in all age groups and both sexes. Persons at greatest risk are those living in rural areas where mastomys 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.
According to the WHO, 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 pain 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. 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 one – three months. Transient hair loss and gait disturbance may occur during recovery. Patients may die from shock.
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- start by I.V. If patient is severely anaemic, consider transfusion.
Unfortunately, there is currently no vaccine that protects against Lassa fever.
According to the WHO, 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.
Before now and besides Lagos, active transmission of Lassa fever has been reported in five states (Bauchi, Edo, Ogun, Ondo, and Plateau) in the past three weeks. Altogether, 13 new suspected cases were reported from four states during the last week of July: Plateau (five), Ondo (five) Bauchi (two), and Ogun (one), including two deaths.
Nigeria is one of several West African countries in which Lassa fever is endemic, with seasonal outbreaks occurring annually between December and June. In 2016, the country reported 273 suspected cases and 149 deaths (case fatality rate 55 per cent) from 23 states. In 2017, Benin, Burkina Faso, Sierra Leone, and Togo experienced outbreaks that have since been controlled.
The current outbreak of Lassa fever in Nigeria, however, is continuing beyond the normal season.
This persistent Lassa fever outbreak comes against the background of a protracted humanitarian crisis in the northern part of the country, as well as outbreaks of cholera and hepatitis E.
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