Lassa Fever: we are better prepared but there is no magic bullet
On 20th December 2016, the Nigeria Centre for Disease Control (NCDC) confirmed a case of Lassa fever in a healthcare worker who had died at the Federal Medical Centre, Abeokuta. The female nurse died before the laboratory result revealed she was positive for Lassa. NCDC has dispatched a team of epidemiologists, to support Ogun State to respond to the outbreak. An Emergency Operations Centre has been setup and is now monitoring all contacts of the case, disinfecting contaminated areas and coordinating all response activities.
This case highlights the risk Lassa fever still poses to the lives of Nigerians, particularly at this time of the year. Although this case has attracted media attention, especially given the involvement of a healthcare worker, in reality it is not unique as there has been a trickle of cases from many states in Nigeria, throughout the year. The Nigeria Centre for Disease Control (NCDC) as directed by the Honorable Minister of Health, has been working hard behind the scenes towards preventing the recurrence of the scale of outbreak recorded last year.
Between 2015 and 2016, Nigeria recorded one of the largest outbreaks of Lassa fever in its history- reporting 273 cases, including 149 deaths. Of these, 165 cases and 89 deaths have been confirmed through laboratory testing (CFR: 53.9%). The cases were reported from 23 states in Nigeria. In response to this, the Honorable Minister of Health inaugurated a Lassa Fever Eradication Committee, under the leadership of Prof. Oyewale Tomori, to look into the situation and proffer solutions to the Nigeria Centre for Disease Control (NCDC) towards preventing future outbreaks and reducing the deaths from Lassa fever in Nigeria.
To prevent a large outbreak this year, the Honorable Minister of Health instructed the leadership of NCDC to commence preparations early in the year towards implementing a Lassa Fever Prevention Strategy. The core of this strategy is to prevent another large Lassa fever outbreak and ensure that all the states in Nigeria are able to respond to any case.
After reviewing past experiences, the NCDC developed an approach that focused on preparing the States to lead on prevention and response to cases should they occur. This approach focuses on strengthening the capacities and capabilities of states to prevent, detect and respond to Lassa while the NCDC coordinates these efforts.
To enable states know what to do, new guidelines describing all the necessary actions were developed, and is always available for downloading from the NCDC website (http://www.ncdc.gov.ng/diseases/guidelines). These guidelines describe systems, activities, and resources at National, State and Local Government Area levels required to respond to suspected cases of Lassa fever. It builds on lessons from previous outbreaks. A copy of the guidelines was also sent to all State Ministries of Health across the country.
In addition, NCDC mapped out all the States of the country based on their risk of Lassa fever. A team from NCDC then travelled across the country to deliver prevention and response materials and medicines to every state in Nigeria. During these efforts, the NCDC team reached every capital of every state in Nigeria, to the welcome of State Epidemiologists, who received the supplies on behalf of the States. The prepositioning of commodities has now ensured that all 36 states and the Federal Capital Territory in Nigeria has a full compliment of emergency materials comprising of Personal Protection Equipment, Ribavirin, Disinfection sprayers, hand sanitizers, hypochlorite (bleach), case definition posters, hard copies of IDSR technical guidelines and safety boxes.
One critical aspects of responding to Lassa fever is the ability to verify the disease. The NCDC commenced activities towards strengthening Lassa fever reference laboratories in the country to ensure faster turnaround of laboratory samples result collected across the country. The diagnosis of Lassa fever requires specific capabilities in laboratories. The NCDC is working with the two laboratories in Nigeria that currently has capacity to diagnose Lassa fever in Lagos and Irrua to increase their diagnostic capacities, while planning for a larger laboratory network to serve the country.
A nationwide risk communications plan has also been developed. Throughout the dry season, a new communications plan will address priority antecedents of Lassa Fever outbreak to ensure prevention is guaranteed. The communication targets all key stakeholders; from presidency to households in Nigeria and will emphasize the ways to prevent Lassa fever infection.
The Lassa virus is transmitted to humans via contact with food or household items contaminated with infected rodent urine or faeces. Lassa can also be transmitted from human to human through contact with the body fluids of an infected person. The key messages to Nigerians are the same as last year; firstly protect your food items from access to rats using whatever means that you can afford- refrigerate, cover, store properly. Secondly if you do have a fever, insist on getting tested for malaria using a rapid diagnostic test (RDT) – remembering that not every fever is malaria. No healthcare worker can diagnose malaria without a test, and it is the right of every Nigerian to demand a test.
Finally and critically, health care workers must remember that healthcare settings are particularly risky, and staff should always apply standard infection prevention and control precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.
For more information call the NCDC helpline through the following channels.
- Toll Free: 080097000010
- SMS: +234809 955 5577
- Whatsapp: +2347087110839
- Facebook: @NCDCgov
- Twitter: @NCDCgov