Commiserating with families of Nigerians who died during the current outbreak, the NMA said two Nigerian doctors have lost their lives in Kano.
Lassa fever, an acute viral hemorrhagic fever, has continued to rage like bush fire, spreading into many communities across the country. According to the Nigerian Centre for Diseases Control, NCDC, Lassa fever Situation Report Epi Week 04: January 20 to 26, 2020, a total of 19 states and 60 local governments have been affected. Many Nigerians, including medical doctors and other health workers, have lost their lives while trying to attend to victims of the ailment. Sunday Vanguard takes a look at the spread of the fever in affected states and efforts to contain it.
The Epi week 04 report released by NCDC revealed that the number of new confirmed cases has increased from 81 cases in week 03, 2020 to 95 cases. They were reported from 19 states (Ondo, Edo, Ebonyi, Enugu, Kano, Borno, Nasarawa, Kogi, Rivers, Abia, Adamawa, Benue, Kaduna, Delta, Taraba, Plateau, Bauchi, Osun and Ogun. As of the time of filing this report, a total of 41 deaths, 258 confirmed cases and 689 suspected cases have been recorded. Experts fear the situation may worsen in the coming days.
Although, the overall case fatality rate (CFR) for 2020 is lower (15.9 percent) than the same period in 2019 (19.7 percent), health watchers say it is worrisome that, in just four weeks, 60 local government areas, 19 states and Abuja have recorded at least one confirmed case.
Findings by Sunday Vanguard showed that over 141 persons are currently receiving treatment at health facilities across the states. The predominant age-group affected is 11- 40 years. Ondo recorded the highest cases and followed by Edo.
In Ondo, although the NCDC Weekly report dated 20 to 26, 2020 showed that the state has the highest record of 98 cases, the latest report from the state government showed that the death toll has risen from 16 deaths to 20 and 100 to 112 cases as of the time of filing this report.
The cases were said to have been recorded in five local government areas namely Akoko South-West, Ose, Owo, Akure South and Ondo West while the victims were transferred to the Federal Medical Centre Owo and a treatment centre in Akure.
Confirming the latest development in a report, the state Commissioner for Health, Dr Wahab Adegbenro, said the number of victims rose as a result of the influx of people from neighbouring states.
“We are having higher figures because Ondo is the only state where the treatment of Lassa fever is free of charge. I think we are having people coming from other areas to assess free treatment”, Adegbenro said.
Governor Rotimi Akeredolu had blamed the continued Lassa fever scourge in Ondo on harmful practices by some people despite efforts to contain the disease.
He maintained that for efforts to rid Lassa to be effective, rats must be eliminated from homes.
In Edo, the NCDC Week 4 report revealed that the state has recorded 92 confirmed cases but the state government last week announced eight deaths out of 175 cases of Lassa fever since the current outbreak of the epidemic in the state.
The Chief Press Secretary to the Deputy Governor, Musa Ebomhiana, said, “A total of 175 cases of Lassa fever have been recorded in the state with eight persons dead since the current outbreak of the epidemic.”
According to Ebomhiana, the figure remained the highest the state has recorded in history.
For prompt response, the state government dedicated an ambulance strictly for Lassa fever cases in Edo.
Affected local government areas as of the time of filing this report include Esan West, Esan Central, Esan North East, Esan South East, Igueben and Etsako West.
According to NCDC Weekly report, Ebonyi State recorded 52 cases and rated 38 percent of confirmed cases.
According to statistics from the NCDC, Taraba has recorded 10 confirmed cases. But the most recent report from the state government revealed that four persons have been confirmed dead in Taraba. According to the state Commissioner for Health, Dr. Innocent Vakkai, 15 suspected cases of Lassa fever were recorded with only five found to be positive.
“Four out of these five people that tested positive to Lassa fever have died as most of the cases came from six local government areas of Bali, Gashaka, Gassol, Ardo-Kola, Jalingo and Ibi.
He assured that the state government had activated its surveillance system for more case detection and proper treatment. The commissioner, who blamed some of the deaths on challenges such as late reporting of patients to hospitals and difficult terrains, said these have remained the major problem in the management of the disease in the state.
Plateau has only seven confirmed cases out of the 21 suspected cases, according to the state Commissioner for Health, Dr Ndam Lar.
Lar also explained that eight persons tested negative while the results of the other six cases were being awaited. The Commissioner, however, said the state had not recorded any mortality from the outbreak. He called for high level of hygiene by ensuring that environments are kept clean to discourage rats from entering homes.
Although the NCDC Weekly report revealed that a total of seven cases were confirmed in Bauchi, a report from the state government said it had discovered about 15 new cases of Lassa out of which three had been confirmed and receiving treatment at the infectious diseases isolation centre of the Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi.
The Executive Secretary of the Bauchi State Primary Healthcare Development Agency (BASPHCDA), Dr. Rilwanu Mohammed, said the remaining 12 suspects of the infection were under surveillance by officials of the agency and other health care agencies in the state.
According to NCDC report, Delta has recorded five confirmed cases. Meanwhile, there has been unconfirmed death of a single mother in Asaba, the state capital.
Enugu State has recorded two confirmed cases, according to the NCDC. Meanwhile, the state has also confirmed one death from Lassa fever. According to the Permanent Secretary in the state Ministry of Health, Dr Ifeanyi Agujiobi, all hands were on deck to contain the problem.
“We advise all persons to observe universal health precautions especially washing of hands with soap at all times, avoid eating rats or the likes, as well as avoid drinking raw garri because of the vector that transmits the disease”, Agujiobi said.
The Epi report of NCDC showed that Kano has recorded three confirmed cases of Lassa fever. The state government also confirmed that the fever has so far claimed three lives.
The state Commissioner for Health, Aminu Tsanyawa, said a pregnant woman and two medical doctors who diagnosed her died of the fever.
Tsanyawa said, as of the time of filing this report, there were a total of 292 persons who had had contact with the victims and were under watch. This, it said, would help to quickly quarantine anyone who showed any symptoms of the disease to avoid further spread.
The first victim was a 28-year-old pregnant woman from Gwale local government area of Kano who took ill two weeks after the death of her mother.
The state government, according to the commissioner, was working assiduously to curtail the spread of the viral disease in Kano and that the isolation centre at Year Gaya had been activated.
“Other measures taken include activation of the rapid response team, prepositioning of drugs and other consumables, contact tracing as well as daily coordination meeting at the state’s emergency operation centre amongst others,” the commissioner said.
Only two confirmed cases have been recorded in Osun. Corroborating NCDC figures, the state government said the two persons affected were responding to treatment.
The state government said proactive measures had been put in place to curtail Lassa fever spread, adding that necessary drugs had been sent to the hospitals where the cases were reported.
The Osun government said they were taking campaigns on preventive measures against the disease to public places including mosques, churches and markets.
According to NCDC Report, Kogi has recorded four confirmed cases. Also, a report from the Federal Medical Centre, Lokoja confirmed one death in the last one week.
Head of Clinical Services of the Federal Medical Centre, Dr. Bernard Ododo, said five suspected cases were reported out of which three were positive while one person died. “Treatment is more effective if detected early and commences immediately. Lassa fever is highly infectious and contagious, everyone must beware,” Ododo said.
According to NCDC, Adamawa has recorded one confirmed case of Lassa fever while the state government confirmed four suspected cases and one death.
The state Director of Public Health said the victims were admitted at the state treatment centre located at Federal Medical Centre, Yola. The samples of suspected cases, according to him, have been taken and referred to the laboratory in Abuja for diagnosis. He said the state government had taken preventive measures against the disease.
Other states affected include Ogun with just one case. The state Commissioner for Health, Dr. Tomi Coker, said that contrary to reports that the victim transferred to the FMC Abeokuta had died of Lassa fever, he was moved to the Federal Specialist Hospital, Irrua, Edo State.
Coker stated that the Rapid Response Team commenced line listing of all contacts with the patient for surveillance purposes, including her relatives and hospital staff that managed the case.
Nassarawa also confirmed one case, Rivers three, Benue one and Abia two.
Meanwhile, the Nigeria Medical Association, NMA, has described the current epidemic of Lassa fever as a reflection of the state of the country’s health sector.
In a press statement, the President, Dr Francis Faduyile, and Secretary, Dr Olumiyiwa Odusote, recalled that the Lassa fever virus, which is endemic in Nigeria and other parts of Africa, was discovered in Nigeria in 1969 and has caused devastation to families including healthcare professionals whose deaths are most times the pointer to the beginning of an outbreak.
The doctors maintained that the current epidemic, like other outbreaks, was a reflection of the abysmally low level of preparedness in handling infectious diseases especially viral hemorrhagic fever at all levels of healthcare delivery.
They said the frequency of the outbreaks also gives credence to the deplorable state of healthcare delivery in Nigeria.
They called on government and all stakeholders to join hands to ensure the speedy and full implementation of the National Health Act 2014, and increase budgetary allocation to the health sector to 15 percent of the annual budget in line with the minimum benchmark recommended by the Abuja Declaration of 2001.
“All must also be committed to the revamping of the primary healthcare system”, they said.
“We appeal to health authorities at all levels to prioritize the capacity building of healthcare professionals on standard infection prevention and control measures and ensure the provision of basic disinfectants and appropriate personal protective equipment in healthcare facilities, and call on corporate organizations, NGOs and religious organizations to work with government and the Nigerian Medical Association in intensifying ongoing public enlightenment campaign and ensure that all Nigerians are educated especially those at the rural communities on preventive strategies and prompt care-seeking.”
Commiserating with families of Nigerians who died during the current outbreak, the NMA said two Nigerian doctors have lost their lives in Kano.
They maintained it was necessary to strengthen institutional infection prevention and control measures and preparedness with periodic capacity building, and build more diagnostic and treatment centres across the country in order to effectively combat this dreaded virus.
What is Lassa fever?
Lassa fever is a viral hemorrhagic disease caused by the Lassa fever virus.
Rodents are the natural reservoir of the virus and transmission primarily occurs through contact with its excreta and blood and consumption of contaminated food items. Spread is through direct or indirect contact with the body fluid of infected individuals.
Symptoms include fever, headache, general body weakness, malaise, muscle pain, redness of the eyes, sore throat, nausea, vomiting, diarrhea, cough, chest pain, unexplained bleeding (from the mouth, nose, anus, other routes and into the skin), convulsion, etc.
To prevent Lassa fever, ensure proper sanitation, cover your dustbins and dispose refuse properly. Communities should setup dump sites very far from their homes to reduce contact with rodents.
Store foodstuff in containers should be well covered with tight-fitting lids.
We need properly equipped regional centres to handle Lassa fever – Sodipo
Sunday Vanguard spoke to the Chairman, Medical Guild, Dr Oluwajimi Sodipo, the umbrella body of medical doctors under the employ of Lagos, on their level of preparedness on Lassa fever.
What is the situation report on doctors killed by Lassa fever?
The specific number of doctors killed is unknown but estimated but it should be about three which occurred in Kano following exposure to a pregnant woman with Lassa fever.
Can these deaths be as a result inexperience?
We are actually experienced, especially in areas where Lassa is endemic such as Ondo, Edo and Irua where Irua Specialist Hospital is actually a reference point in Nigeria and the world. But the challenge is in areas where Lassa is not endemic and health care workers are caught off guard as the initial symptoms are similar to malaria and other common febrile illnesses.
The number of deaths so far due to Lassa fever after several years of discovery, are they necessary?
The issue of high index of suspicion, proper history taking especially on travel and exposure with ensuring proper notification of suspected cases for diagnosis will help to reduce mortality and morbidity.
Also, we need regional centres which are equipped to handle Lassa fever and its complications as the spread pattern is becoming more national due to ease of travel from one place to another.
It is difficult to comment on the number of deaths from previous years because there is now improved reporting which might make it seem that there is an increase.
How prepared are your members to handle Coronavirus if it enters Lagos?
As for Coronavirus, we are aware and getting prepared especially in having a high index of suspicion, taking a good history especially of travel and contact and ensuring proper infection control mechanisms in hospitals.
We are also educating members of the public on symptoms, proper hygiene and cough etiquette among other measures.
Don’t you think that shortage of doctors in Lagos could pose a problem?
We have the expertise in Lagos to tackle it. Already government is scaling up surveillance. And Lagos has specialists, a bio bank laboratory and is collaborating with the NCDC.
The watchword, however, has to be high index of suspicion and notification of appropriate authorities once a case is suspected.
Lagos has a number of Chinese nationals and even Nigerians and foreigners who have travelled to China and are coming back.
Proper cataloguing of their addresses, contacts and cities they have visited need to be documented. In other countries, people coming from China, especially Wuhan province, are being quarantined for up to 14 days as the problem with Coronavirus is that it can spread even without symptoms of fever which is the main screening method.
On the issue of shortage of doctors, we are happy that it is being addressed with the recent approval to employ more healthcare workers including doctors. However more needs to be done as there is a large deficit and more are still leaving.
We need to also start thinking of how to care for patients if an outbreak occurs especially in terms of bed space, extra personnel, PPE kits, etc.
That’s why we must be extra vigilant because of the resources involved if an outbreak were to occur. I mean government. The PPE involves using masks when consulting especially when the patient has cough.
Also, ensuring prompt triage of anyone with cough, we expect government to provide them as they are not expensive.
These are gloves, hand sanitizers, masks, thermometers, disposable overalls, and disposable goggles especially for those in the emergency sections and triage areas.