Ebonyi’s duel with Lassa fever

May 27, 2014

Martin Elechi

In Ebonyi State many health workers are at the mercy of Lassa fever, writes IHUOMA CHIEDOZIE, who visited the state

Ebonyi State is used to intermittent outbreaks of Lassa fever but the latest episode caught everyone, including highly experienced medical practitioners in the state, napping.

Lassa fever normally appears during the dry season, when farmers burn their farmlands to prepare for the next farming season. The flames drive a particular specie of rat, which hosts the disease, out of the burning bushes and into human habitations where they interact with food items and eventually infect people. But that was not the case this time around.

The latest outbreak came in the middle of the rainy season, a development which Dr. Emma Okeke of the Federal Teaching Hospital, Abakaliki 1, described as “amazing.”

Nobody suspected that Lassa fever was around when a pregnant woman was taken to the theatre for surgery at the Federal Teaching Hospital, Abakaliki 1. But the manner in which she died after giving birth to a baby, who also died later, raised suspicions of Lassa fever.

Tests carried out later confirmed their fears. But by then, the doctors and other health workers who attended to her had already contacted the disease.

A total of 19 health workers, including eight doctors, four nurses and about five others were infected as a result of their participation in the operation.

The medical practitioners were promptly taken to the Specialist Hospital, Irma, in Edo State, for diagnosis and immediate medical attention.

Okeke, in a chat with our correspondent, disclosed that no other case of Lassa fever infection has been discovered besides that of the late pregnant woman and the medical practitioners who operated on her.

“The amazing thing is that, this is not the season we do expect the outbreak of Lassa fever — it is usually during the dry season.

“The major carrier is a specie of rat and usually when the farmers burn the bushes, they escape into people’s houses,” he said.

The Ebonyi State Chairman of the Nigerian Medical Association, Dr.ChidiEsike, who spoke to our correspondent after returning from a visit to the affected health workers at the Specialist Hospital in Irua, Edo State, on Tuesday night, stated that some of the patients had been discharged.

“Those who are yet to be discharged are being treated for various forms of complications, but they are responding to treatment,’’ he said.

Like Okeke, Esike noted that the latest outbreak of Lassa fever came as a surprise. “Initially, people thought it (Lassa fever) is seasonal, mostly occurring between November and December, but this one is coming in the rainy season,” he said.

The unexpected outbreak has made the disease even more dangerous, as people, who were accustomed to taking certain precautions during the dry season, when the fever is known to appear, have to be extra cautious.

To Esike, the outbreak has further underscored the need for the Federal Government to establish a virology diagnostic centre in the South-East, for quick diagnosis of cases and urgent treatment.

Currently, the nearest virology diagnostic centre is at the Specialist Hospital in Irua, Edo State, where the health workers that were infected with Lassa fever in Ebonyi are being treated.

Esike spoke of challenges posed by the absence of a virology diagnostic centre in the South-East. “Driving to Irua is five hours non-stop and we have to transport patients in critical condition that far.The Federal Government should, as a matter of urgency, establish a virology diagnostic centre in the South-East. These ones are health workers, what of other persons? Who will take them to Irua? Will they have the money and means to go that distance?

“It is time the government realised that this disease is here with us. It is killing people. The figures we have are from those who report at the hospital. “What of those in the rural villages who cannot come to the hospital? People are dying. There is need to have a virology diagnostic centre here because when you discover these things early, you can easily contain them,” Esike said.

The deceptive nature of Lassa fever, which initially appears with symptoms associated with common fever or malaria, further exposes people, including health workers and other patients, to possible infection.

In the face of the risks which the outbreak has exposed them to, are the health workers still committed to their job?

“It is a pathetic situation when 16 health workers are affected. It is a hazardous work, there are risks involved but it is our calling. We cannot run away from it,” Esike answered.

He admitted that there was little that health workers could do to protect themselves from possible infection.

He said, “It is difficult to know what to do because Lassa fever comes like just any other fever. Unless you say you will not touch any patient. “That is why there is need for a virology diagnostic centre so that patients can be tested and diagnosed upfront before we start treatment. There is a limit to the precaution you can take. If you are a patient and when I come close to you I cover my nose you will think I am discriminating against you. The worst thing is that, as a doctor, if you have it, you can also infect a patient.”

Although no fresh infection has been recorded, tests are being carried out to ascertain if there are other cases.

Interestingly, health workers have borne the major brunt of the scourge of Lassa fever in Ebonyi State over the years.

Figures released by the Ebonyi State Chapter of the NMA revealed that no fewer than 25 people have died from Lassa fever in the state since 2005, most of them medical personnel who were infected in the course of their duty.

NMA said, “In 2005, we lost five nurses who died of Lassa fever contracted in the cause of their duty.

“In 2008, we had six cases and two doctors died in the cause of treating them. “In 2011, we had seven cases and two deaths. In 2012, there were 20 cases with six deaths.

“In 2013, there were 21 cases with eight deaths. In 2014, we have, so far, 18 cases and two deaths.”

Esike added that the number of fatalities could indeed be higher, since the absence of a virology diagnostic centre in the area meant that incidents of deaths in the interior villages were not recorded.

“The figure is understated; there might have been more of such cases that are not recorded.

“The fact that we do not have the virology centre puts the doctors, indeed everybody at greater risk, because, you would need to travel to another geo-political zone in Nigeria to text for Lassa fever” .

While the NMA waits for the government to establish a virology diagnostic centre in the South-East, the association urged the media to assist it in educating the people about ways to prevent possible infection.

The preventive measures include covering food items properly to avoid contact with rats, preventing rats from entering the home, and avoiding the consumption of rat meat, among other routine domestic processes.

In the midst of the concern over the dangers posed by the latest outbreak, the Ebonyi State Commissioner of Health, Dr. Sunday Nwangele, has said most cases of Lassa fever in the state were “imported.”

He said the pregnant woman, through whom the health workers contracted the disease, was not from Ebonyi State.

The commissioner equally declared that the Ebonyi State Government would not accept the status of an endemic state and as a result, has designated a land for the construction of a virology laboratory in Abakaliki.

Nwangele disclosed that a joint committee set up by the state Ministry of Health and the Federal Teaching Hospital, Abakaliki, on Lassa fever had evolved a two-way approach, comprising short and long-term control measures, for the treatment of infections.

In the short-term approach, the suspected patient is administered with prophylactic tablets, while on the long-term; the patient is administered with injectable drugs.

Experts say Lassa fever or Lassa haemorrhagic fever is an acute viral haemorrhagic fever caused by the Lassa virus, which was first discovered in 1969 in Lassa, a town in Borno State, Nigeria.

The infection is endemic in West African countries, where about 300,000 and 500,000 cases are recorded yearly, with approximately 5,000 deaths.

The primary animal host of the Lassa virus is the Natal Multimammate Mouse, an animal indigenous to most of Sub-Saharan Africa, and the virus is believed to be transmitted by contact with the faeces or urine of the animal.