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Lassa fever: What makes Lagos a bad case

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NCDC confirms 70 deaths from Lassa fever
Lassa fever

By Sola Ogundipe

Nigerians were greeted at the crack of dawn on Wednesday February 19, 2020 by the news that one case of the dreaded Lassa fever had been confirmed in Lagos State.

Saturday Vanguard gathered that the index case is a Law student from Eboyin state diagnosed at the Lagos University Teaching Hospital, LUTH, on February 17 and is currently in isolation at the hospital.

The development was confirmed by the Lagos  State Commissioner for Health Prof, Akin Abayomi. He said health authorities from the Lagos State Ministry of Health had traced 63 persons that had close contact with the index case and they were being monitored.

The news sent chills down the spines of millions of Lagosians and several residents of the populous megapolis went into panic mode. Many persons have been running helter skelter in anticipation of the worst.

Lassa fever is a viral haemorrhagic illness, caused by contact with food or household items contaminated with rodent urine or faeces. Human to human transmission is also possible. 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. It is highly contagious and can be fatal although is treatable and preventable.

Outbreak of Lassa fever is an annual ritual that has killed over 1, 050 people since it was first diagnosed five decades ago. The number of cases usually climbs around the start of the year linked to the dry season.

Prior to the Lagos incident, outbreaks of Lassa in Nigeria had already killed 103 people within the first seven weeks of 2020. The Nigeria Centre for Disease Control (NCDC) in its latest statistics on the virus said the overall number of confirmed cases rose by 115 last week to a total of 586 across the country.

All these combined to put fear of an impending Lassa fever epidemic is palpable among the residents.   Within hours of the report, the demand for hand sanitizers, household disinfectants, rat traps and rat poison in and around the city went up and the prices increased appreciably.

This response was not unexpected given that it wasn’t the first time that Lassa fever would hit Lagos. In several respects the disease was only making a return to the megacity.

Lagos has it’s share of the disease in recent times. In July 2017, a number of health workers including a resident doctor at the LUTH were quarantined after they were exposed to a pregnant woman who was later diagnosed to have Lassa fever. Three others later tested positive to the disease.

A known sickle cell anaemia patient  also died in the same hospital within 24 hours of admission.

Both victims  were earlier managed at private hospitals before being referred to LUTH, increasing the risk of exposure. In August 2017, the NCDC was officially notified of the outbreak of Lassa fever in Lagos State.

Worse still, Lassa fever has been on the prowl in several parts of Nigeria since the onset of the dry season in 2019, with several cases and a number of deaths reported. Suspected cases have been recorded in at least 28 states of the federation out of which 20 states have established more than 550 confirmed cases and 103 deaths.

The annual outbreak of the disease in the country is seasonal with occurrence peaking in the dry season, and all this is understood by the  residents. Lagos is highly prone due to the high population of rats and people.

Paula James, a Lagos housewife is not taking chances. “I am not at all surprised that Lassa fever is in Lagos because this is the hub of the Nigerian economy. People come here everyday from other parts of the country and from all over the world. Before the announcement, I has started preparing for the disease by purchasing hand sanitizers for my home and office.”

Daniel Ugochukwu, a trader at the Ladipo spare parts market told Saturday Vanguard that he believes Lassa fever has been in Lagos long before the hospital diagnosis of the index case.

“Lagos is a busy place and there are too many people here so let’s not deceive ourselves that it’s only one case. There must be thousands that are undiagnosed so it is already an epidemic.

“Lagos is very dirty and many of the people have dirty habits. My shop is close to a canal which is a breeding ground for rats because it is full of debris and garbage. I kill rats in my shop everyday I have also bought enough rat poison to kill as many rats as I can.”

Ayo Adewale, a medical doctor in a private hospital in Ikeja said he has already out his staff on notice. “Lassa fever is highly contagious and many health workers have been infected and some even died. They are instructed to utizr the necessary protection protocol and also to have a high index of suspicion when attending to patients with the typical symptoms of fever, headaches, and body pain. We know that just one reported case of Lassa fever is an epidemic so Lagos already has an epidemic from the look of things.”

The  dread for Lassa fever in Lagos may be understandable. Lagos has a huge population of rats. Rats breed in filthy surroundings and  Lagos is overwhelmed by filth. Heaps of stinking refuse and mountains of refuse are the hallmark. The streets and roads are dirty and no one appears bothered by the unsanitary conditions and improper waste disposal.

A trip around the city is a revelation. A visit to the slums in Ajegunle and Ijora Badiya, for instance is confirmation and leaves no doubt that another Lassa fever epidemic is inevitable in Lagos. Dirty roads,unsightly and massive piles of stinking garbage, coupled with abysmal sanitation and unconventional waste disposal tell the story graphically.

Most of the main roads and side streets are certified dump sites and rats breed freely therein.  The dirt is so rancid and overflowing even in some of the highbrow places such as Ikeja GRA, Apapa GRA, Ikoyi, Surulere, Yaba, etc. Almost every street, junction, major road and even market place is a dumpsite, with heaps and piles of dirt littering the landscape.

The situation is as bad or even worse in places like Akowonjo, Isheri, Mushin, Shomolu, Ojota, etc., particularly as the Lagos State Waste Management Authority, LAWMA, has practically gone to sleep. These dumpsites are hotspots for rapid breeding of rodents and other vermin that promote transmission of diseases such as Lassa fever.

Lassa fever is a viral infection carried by the multimammate rat Mastomys natalensis a common rodent in equatorial Africa, found across much of sub-Saharan Africa. It 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.

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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.

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

Survival tips for Lassa fever include getting the factual and correct information,and being knowledgeable about how to respond to an outbreak to minimize fear.

A good preventive habit against Lassa fever to embrace is healthy living because the disease is strongly linked to poor hygiene and sanitation. Hand hygiene is non-negotiable. Proper and regular hand washing is essential for everybody and should be practiced frequently. While it may not be possible to eradicate Lassa fever, it is important to keep it under control.

Rat control is overdue in Lagos. Rats breed in filthy and untidy environment, and the current level of filth in Lagos presents an ideal place for the breeding of rats. Lagos is overrun by refuse and the residents are having a a huge problem discouraging rats and rodents from their households. Improper disposal of garbage remains a big issue.

Among effective control methods is safer food hygiene and storage. Measures like avoiding consumption of  raw grains, cooking all grains well before consumption. Safer methods should also be adopted for food processing and storage. Farmers in rural communities need to avoid sun-drying farm produce such as gari 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.

Vanguard

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