AN UNPRECEDENTED OUTBREAK

Lassa fever hits Nigeria

By ALIMA

March 28^th, 2018

Nigeria is facing its largest-ever recorded outbreak of Lassa fever. according to the World Health Organization. The Nigeria Centre for Disease Control (NCDC) says that 1,613 suspected cases have been reported throughout 19 of the country's 36 States, between January 1 and March 25. Among these, 394 cases have been confirmed by laboratory testing, and 95 people have died.

The number of cases reported during the first two months of the year was more than double the normal annual average.

A morgue attendant and a porter wheel out the body of a young man who died of Lassa fever at the Irrua Specialist Teaching Hospital.

SUPPORTING THE RESPONSE

Following the launch of a public health response on January 19th by the Nigeria Centre for Disease Control (NCDC), ALIMA launched an emergency response to support local health authorities in the two most-affected States - Ondo and Edo - on January 22, 2018.

This includes working alongside Nigerian health authorities to improve patient triage and support case management, protecting and training hospital staff, facilitating laboratory diagnostics, and supporting actions within the community to control the transmission of Lassa fever.

A nurse, dressed in PPE, accompanies a patient suspected of having Lassa fever, as he is transported to the isolation ward in Owo.

SUpporting the response

ALIMA and its partners provides all its patients with treatment free of charge, and has also donated medications (including the recommended treatment, Ribavirin), personal protective equipment and other hygiene materials to local health centers.

“The priority is to diagnose cases early on and improve the chances of survival for those who become infected, while protecting health workers and families.”

- Dr. Bernard Gaüzère, ALIMA's Medical Advisor for Lassa fever

A nurse accompanies a patient suspected of having Lassa fever into the isolation ward at the Federal Medical Center in Owo.

The disease

Lassa fever is an acute viral hemorrhagic and deadly fever, endemic to West Africa, which is usually transmitted to humans from the infected urine or feces of the Mastomys rat. Human-to-human transmission is also possible, via contact with the bodily fluids of an infected person, putting health workers and families at an especially increased risk of infection. Seventeen health care workers have been affected since the onset of the outbreak, in six states; 4 of them died.

Symptoms of the disease include fever, diarrhea, vomiting, abdominal pain, sore throat and hemorrhaging. Without proper diagnosis and treatment, Lassa fever mortality rate can reach 50% during outbreaks. There is no vaccine to prevent Lassa fever, but symptomatic treatment improves a patient’s chance of survival. The WHO says the antiviral drug Ribavirin has been shown to be an effective treatment if given early on in the course of the illness.

Various species of carriers of the Lassa Virus are put on display at the Lassa Ward in the Irrua Specialist Teaching Hospital, Edo state.

Caring for PAtients

Given the unusually high number of suspected cases being reported during the early weeks of the outbreak, many health centers, at times, simply did not have enough room, health workers, Ribavirin or PPEs to treat patients.

To help increase the bed capacity of treatment centers, ALIMA helped construct 2 treatment tents at the Irrua Specialist Teaching Hospital in Edo State, and supported the rehabilitation of a 35-bed treatment center at the Federal Medical Center in Owo, in Ondo State.

ALIMA’s response team sets up an inpatient treatment tent, which will be used as an extension of the Lassa ward at the hospital in Irrua.

To help reduce patient overflow at the Lassa ward in Irrua, ALIMA constructed two, 8-bed isolation tents, along with sanitation facilities.

ALIMA supports the rehabilitation of a building at the Federal Medical Centre in Owo, to increase bed capacity.

When a patient suspected of having Lassa fever arrives at a health clinic or hospital, they first must go through a triage process. Health staff take their vital signs and then draw their blood to send the sample to a highly-specialized laboratory, at the Irrua Specialist Teaching Hospital, for testing.

While waiting for the results, the patient suspected of having Lassa fever, if already at the hospital, is temporarily transferred to the isolation ward. If the patient is at a health clinic, he or she is accompanied by a nurse, wearing full protective equipment, via ambulance, to the nearest isolation unit.

Once the results come back, if the case is confirmed as positive, the patient is transferred to the infectious disease ward, where they continue treatment for Lassa fever. If the results are negative, the patient will receive treatment for their symptoms within the hospital. In either case, the isolation room where they stayed is completely disinfected to avoid risk of further contamination.

Prisca's Story

Prisca first started feeling sick in early February. A few weeks earlier, the husband of a close friend of hers, died after a short illness. Prisca made regular visits to their home to check in on her friend. Not long after her friend became sick as well, and Prisca helped care for her.

“I did not know the cause of his death, and then a few weeks later my friend died too,” she said. “After her death, I fell ill and when I was taken to the hospital, I was diagnosed with Lassa fever.”

Prisca spent 3 weeks at the Infection Control Center in Owo, where she received free care. Today, she is fully recovered.

Prisca waits to be discharged from the treatment unit in Owo.

Protecting Health Workers

If not properly protected, doctors and nurses are at an increased risk of infection when caring for patients with Lassa fever. At health centers in both Owo and Irrua, ALIMA helps train health workers how to protect themselves when treating suspected cases, as well as reinforcing good hygiene measures.

ALIMA’s medical team leader, Dr. Dally, reinforces best hygiene practices with staff from the waste management unit.

A waste management staff member dries protective gear, which has twice been carefully disinfected, washed and rinsed.

Prevention Measures

There are a number of prevention measures that people living in or visiting areas where Lassa fever is endemic can take to protect themselves.

This includes: practicing good hygiene measures, such as regularly washing hands, cleaning and cooking food thoroughly, and controlling local rodent populations.

During an outbreak, it is important to avoid contact with the blood or other bodily fluids, including vomit, diarrhea and urine, of sick people, especially those exhibiting symptoms of Lassa fever. Within health facilities, staff should always apply standard Infection Prevention and Control measures.

A woman disinfects her hands using chlorinated water before entering the Federal Medical Centre in Owo, Ondo State.

Nigerians are being warned against eating uncooked food, including Garri, a popular powdered grain, which risks contamination from rats.

Some health officials encourage people to control local rat populations by using rat poison or keeping a cat.

Nathaniel's story

"It started with headache, and after a while, sore throat and chest pain. When my family members realized I wasn't responding to treatment, they took me to a traditional herbal home. I didn't get any better so my brother-in-law brought me here. He saved my life! I've just being discharged three weeks after been treated for Lassa fever. I'm so happy to be alive."

-Nathaniel, a 26-year-old driver from Plateau State, who was treated in Irrua

Nathaniel poses outside the Lassa treatment ward in Irrua, moments after he was discharged.

*ALIMA's emergency response support to the Lassa fever outbreak is made possible thanks to funding from the ELMA Relief Foundation, the Start Fund and the World Health Organization.