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Return of Lassa fever: The vital signs

By Sola Ogundipe

Sometime around 25th of July 2017, a pregnant woman was rushed to the Lagos University Teaching Hospital, LUTH, with bleeding complication of pregnancy.  She had been earlier managed in private hospital from where she was referred to LUTH. Bleeding in pregnancy is not uncommon and the woman was managed normally. But doctors were worried with what they saw, and requested for post examination.

The result showed she had Lassa fever. The woman died three days after admission. She was the first case of Lassa fever death in LUTH.

Regrettably, before the result was obtained, hospital workers including a female Resident doctor had been exposed to the disease. All those exposed were put under observation and three others later tested positive to the Lassa virus.

At about the same time, a known sickle cell anaemia patient identified as Mr O. was admitted in LUTH. He was said to have travelled to a neighbouring state and came down with the disease on arrival. However, he presented very late and died within 24 hours of admission. He was the second case.

Both victims have since been buried according to international health guidelines. Both cases were earlier managed at private hospitals before being referred to LUTH, increasing the risk of exposure.

On the 4th of August 2017, the Nigeria Centre for Disease Control (NCDC) was notified of the outbreak of Lassa fever in Lagos State. As at 9th of August 2017, the State had reported five confirmed cases and two deaths.

Public health response commenced immediately led by the Lagos State Ministry of Health with support from the NCDC. Contact identification and tracing was initiated, and case management has begun for other confirmed cases.

The Federal Ministry of Health through the NCDC has provided resources including medical supplies to support case management in the State.

Currently the situation is under control and the outbreak has almost been completely contained.

What it is

Lassa fever is a viral haemorrhagic illness, caused by contact with food or household items contaminated with rodent urine or faeces. It is an epidemic prone disease. Just a single case is already an epidemic. The Lassa virus can be spread between humans through direct contact with blood, urine, faeces, or other bodily secretions of a person infected with Lassa fever.

Symptoms

The illness is characterized by sudden onset of fever, and general weakness. Other symptoms including headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and abdominal pain may follow. In the most severe cases, individuals may bleed from the mouth, nose, eyes or other parts of the body.

Treatment/observation

Confirmed patients are managed with the drug Rivabirin and good hospital care. Once there is a case, history is taken to find out if the person has been out of the state or not. Such information is crucial in assisting epidemiologists about notification of the disease outbreak. All persons that have had contact with the Lassa fever patients are traced and placed under observation.

Each contact is given a thermometer to monitor his/her body temperature and can go about normal business. Anyone that presents with high temperature is moved to the isolation ward. The virus becomes infective as soon as fever develops.

Prevention

Although there is no vaccine currently available for Lassa fever, the disease can be prevented and is treatable. Adopt the following measures:

Survival tips

Get the facts: Get the factual and correct information on Lassa Fever from social media, radio, television and newspapers. Be knowledgeable about how to respond to outbreaks. This helps minimise fear.

Hand hygiene: Hand washing should be practiced frequently. A good preventive habit against Lassa fever to embrace is healthy living. Lassa Fever is strongly linked to poor hygiene and sanitation.

Outbreaks often emphasise the essence of hand hygiene in the prevention of diseases. Proper and regular hand washing is essential for everybody.  While it may not be possible to eradicate Lassa fever, it is important to keep it under control.

Rat control: Rats breed in filthy and untidy environment, so a clean environment is not conducive for breeding of rats. Discourage presence of rats and rodents from to the household as much as possible. Store food in rodent-proof containers and use dustbins and refuse containers with covers. Garbage should be disposed properly and far from the home.

Food hygiene & storage: Avoid consuming raw grains. Cook all grains well before consumption. Safer methods should be adopted for food processing and storage. Farmers in rural communities need to avoid sun-drying farm produces on bare ground and/or road sides as these are opportunities for rodents to perch on these products that will eventually be processed into food.

Early reporting: Familiarity with the structure of public health facilities is advised. Be in possession of the contact numbers of Primary Healthcare officers and their locations. If you encounter or observe fevers that are not responding to anti-malarial and antibiotics, or fever associated with sore throats or bleeding, report promptly to the local government health officers.

Notification: It is very important to report to a health facility for early initiation of treatment. Lassa fever should be suspected where common causes of fever, like malaria have been ruled out. Health care workers are advised to practice universal care precautions while handling patients at all times, not just when Lassa is suspected.  Every health worker should think about Lassa fever and have a high index of suspicion.

For more information, contact NCDC toll-free number: 0800-970000-10, sms 08099555577. WhatsApp 07087110839. Twitter/Facebook: @NCDCgov

 


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