• 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.
Guardian reported that 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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