The Fight Against Lassa

Prevention, treatment and research

By ALIMA

November 1^st, 2019

JANUARY 22, 2019: DECLARATION OF AN OUTBREAK OF LASSA FEVER IN 8 STATES IN NIGERIA

Lassa fever is an acute and deadly hemorrhagic fever, which is endemic in West Africa. According to the Institute Pasteur, it infects between 100,000 and 300,000 people per year. The virus is usually transmitted to humans via the urine or feces of the Mastomys rat. Human-to-human transmission is also possible through contact with the bodily fluids of an infected person, making the risk of infection higher for caregivers and patients' families.

Symptoms of the disease include fever, diarrhea, vomiting, abdominal pain, sore throat and bleeding.

For more than a year, ALIMA (The Alliance for International Medical Action) has been working in Nigeria with local health authorities in Ondo and Edo States, which are particularly affected by Lassa fever. Our NGO has funded the rehabilitation of several medical treatment centers, supports case management, and protects and trains hospital staff. Additionally, ALIMA facilitates laboratory diagnosis and supports community actions to control Lassa fever transmission.

Since january 2019, 214 suspected and confirmed Lassa fever patients received free care, thanks to ALIMA.

Each year, between January and May, the disease presents itself as an outbreak. The dry season causes rodents to move around, invading villages and even houses - potentially contaminating the inhabitants.

These outbreaks tend to worsen and their impact on local populations is disastrous:

without proper diagnosis and treatment, the mortality rate

can reach 30-50%.

To date, there is no vaccine to prevent Lassa fever. The antiviral drug Ribavirin can be an effective treatment if given early enough in the progression of the disease. The problem is that the clinical signs of the onset of the disease are similar to those observed for other common diseases, such as malaria, typhoid fever and Ebola, and do not allow Lassa fever to be detected in time.

Ribavirin is therefore not enough to fight the virus.

Lascope : A research partnership

To be more innovative in the fight against Lassa fever, ALIMA established a partnership with the French National Institute of Health and Medical Research (INSERM 1219) via the ALERRT consortium (The African coaLition for Epidemic Research, Response and Training), and in coordination with the Nigeria Centre for Disease Control and the World Health Organisation. Since 2018, a research team has been leading a cohort project, LASCOPE (Lassa fever clinical Course and Prognostic factors in an Epidemic context in Nigeria), to better understand and describe the disease, while working on the evaluation of therapeutic strategies. To achieve this ambitious project, the consortium wishes to help local health structures conduct future clinical research for better treatment of Lassa fever.

Protecting health workers

The risk of contamination is even greater for front-line medical staff. In health centers, staff must adhere to very strict measures to protect themselves from infections.

Personal Protective Equipment (PPE) must be worn during consultations: full-body clothing, mask, safety glasses and gloves are required to protect the agent.

Injections and blood tests must be carried out in a safe manner to prevent transmission of the virus. The handling of samples in the laboratory is also subject to strict rules. It is necessary to avoid contact with the patient's blood or bodily fluids, as well as contaminated surfaces or materials, such as clothing and bed linen.

At the general hospital of Idoani (Ondo State), ALIMA organizes training sessions for local health personnel. The objective is to raise awareness among workers of the risks associated with a lack of vigilance and to avoid contamination.

Le docteur Shola passe en revue les mesures de sécurité élémentaires à adopter lors de rapprochements avec les cas suspects.

Il est important pour les agents de santé de se laver les mains dans une solution chlorée.

L’hygiéniste Adekunle montre aux équipes médicales comment mettre des gants sans risque de contamination.

Monitoring patients' Families

Every week, ALIMA staff visit the families of patients in the Lassa service at the Centre for Disease Control.

To limit the spread of the outbreak, ALIMA teams monitor the vital signs of family members. They also make households aware of the danger posed by rats and the preventive measures to be practiced. These weekly checks make it possible to quickly refer people with Lassa symptoms to a care center. Prompt treatment considerably reduces the mortality risks for suspected cases.

Preventive measures include: washing hands regularly and properly, following good hygiene practices when preparing meals and monitoring the presence of rodents in the household.

M. Agu contrôle la température de ses enfants lors d’une visite d’une équipe ALIMA, dans le cadre de l'opération de contrôle hebdomadaire et de recherche active de cas.

Une volontaire relève les températures des enfants de M. Agu. Sa femme vient d'être déclarée guérie de la maladie Lassa. Elle a été soignée au Centre de Contrôle des Maladies infectieuses d’Owo.

The survivors

"Lassa fever can be very costly to communities - severely affecting families, both financially and psychologically. Thanks to the free care provided by ALIMA, patients go through a period of emotional transition throughout their care. These range from anxiety at admission, to joy at discharge and excitement at meeting former patients at follow-up meetings. Witnessing this emotional roller coaster makes us appreciate the impact of the work of the ALIMA teams."