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Health Corner with Krystal: LASSA FEVER

Lassa Fever has been rampant lately in Nigeria and it’s only fair I do my part as a healthcare professional to educate on the treatment, prevention and control of this deadly disease. This new year alone, it has claimed 16 lives with 4 of them being health care workers. It’s a very scary thing just like the Ebola virus that gave us quite a lot of cause for concern. Health workers like me are usually the secondary victims as they get infected while treating patients with the disease. I know some of us will flee from the hospitals and health centers, but if no one attends to the primary patients we’d have an even bigger public health problem on our hands.

The Nigeria Centre for Disease Control (NCDC) stated recently it has recorded a total number of 107 suspected cases in ten states across the country – Ondo, Bauchi, Anambra, Imo, Benue, Lagos, Edo, Ebonyi, Kogi and Nasarawa states. Just a few days ago I got word there was a suspected case around Asokoro District in Abuja (not sure this has been confirmed). So let’s try to understand this disease better.

Lassa fever is an acute viral hemorrhagic illness; a zoonotic disease as it is transmitted from animal to humans. Like the Ebola virus gotten from wild animals like the fruit bats, Lassa fever virus has its host as the multimammate rat (Mastomys). These rats infected with the virus do not become ill but they can shed the virus in their urine and faeces. Detection of the disease in humans is quite difficult due to the variability of its clinical course. Person to person transmission occurs in both community and healthcare settings where the virus may be spread by contaminated medical equipment such as needles. It can also be contacted sexually.

Incubation period of the virus ranges from 6-21 days. The symptoms begin gradually with fever, body weakness and a general feeling of restlessness (malaise). Headaches may then follow after a few days with sore throat, muscle pain, cough, chest pain, nausea and diarrhea. Severe cases show facial swelling, bleeding from cavities such as the mouth, nose and vagina with development of low blood pressure as well. At first most health care personnel assume the disease is malaria and treat patient as such while awaiting results. This disposes them to contacting the virus very easily as no proper protection is employed. Besides all these, deafness occurs in 25% of patients who manage to survive the disease with partial hearing returning after 1-3 months in half these cases.  Death will usually occur within 14 days of onset in fatal case and is severe when patient is pregnant (third trimester).

At the moment, no vaccine can protect against lassa fever. An antiviral drug, Ribavirin, has proven to be effective against the disease if given early on in the course of clinical illness. However, there has been no benefit of its use as a post exposure prophylactic (PEP) treatment for Lassa fever.
How can we bring this under control? How do we prevent contacting the disease? It’s imperative that good community hygiene be promoted nationwide especially in those very remote areas. Encouraging hygiene will discourage rodents from entering homes. Measures like storing foodstuffs in containers that are rodent-proof, keeping cats around, maintaining clean households and disposing your garbage far from the house would be very effective in completely eliminating the rats from your surroundings. Now if you discover a family member is showing signs of the disease, please avoid contact with blood and body fluids while caring for the sick persons. Also, hand washing should be practiced as frequently as possible. The use of hand sanitizers as well is very much encouraged.

In the hospitals and other health care settings, extra care and infection control measures should be applied with any suspected or confirmed case of Lassa fever. Every fever case must be investigated properly and treated accordingly. Don’t just begin treating for malaria with no proper tests or diagnosis. You’re setting yourself up for exposure. A high index of suspicion while treating patients who present with malaria symptoms should be maintained because Lassa fever appears initially like any other disease, causing a febrile illness like malaria. The first thing to do is perform a Rapid Diagnostic Test for malaria. If the test proves negative, other causes of febrile illness should now be considered, including Lassa fever. Health staff should apply standard infection prevention and control precautions when caring for their patients regardless of the presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (PPE), safe injection practices and also safe burial practices. When in close contact of patients with Lassa fever, health workers should wear face protection, a clean non-sterile long-sleeved gown and gloves. Laboratory workers who take samples from humans and animals for investigation of the infection should do so in suitably equipped laboratories under maximum biological containment conditions.

As a country, we should tighten our borders and carry out necessary investigations at the airport to prevent more cases of the disease from being imported from other endemic countries like Benin, Ghana, Guinea, Sierra Leon, Liberia and Mali.

Please once you begin to notice you or any one you know has any of the symptoms, don't try to hide it or wait till it's worse. You have a better chance of survival once treatment is started early. Early supportive care with rehydration and symptomatic treatment improves survival. Don't run away from the hospital for fear of quarantine or isolation and then go on to infect other people......don't kill others due to your ignorance, fear or just plain malicious intent because you feel mad at the world for getting the virus. And dear doctors and healthcare practitioners, don't flee the hospitals once you hear there is a case of Lassa fever, stay and protect yourself while you help the patient. Remember the oaths you took. 

Peace and love, Krystal

Excerpts from WHO facts on Lassa fever