Scores of people including doctors were killed following the resurgence of Lassa fever in some parts of the country. Omolara Akintoye, (Lagos), Okungbowa Aiwerie (Asaba) and Ernest Nwokolo, Abeokuta examine what went wrong.
E want to assure Nigerians that Lassa fever will soon become a thing of the past. It will become history in Nigeria. Ordinarily, Lassa fever will be eradicated in April. But if we do nothing, it will come back by August. So, we will make sure that we work all-year round to make sure that there is no resurgence in August.”
These were the words of the Minister for Health, Prof. Isaac Adewole, when the dreaded disease broke out early last year, assuring Nigerians that it will be eradicated by April. Like a soothsayer, the minister predicted that if government failed to do anything, it would come back by August.
The minister’s prediction came to pass. In August, lo and behold, the disease resurged, this time with a vengeance. Could this be as a result of laxity on the part of the federal government?
The outbreak of Lassa fever in Lagos State with the confirmation of five cases has no doubt put the nation’s health authorities on red alert. It is a warning to all to be vigilant and proactive to check its spread. The five cases were reportedly placed on 21-day surveillance, while two patients, who were reportedly presented very late, died of the disease at the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, in spite of spirited efforts of the hospital’s medical team to save them.
The Chief Medical Director (CMD) of LUTH, Prof. Chris Bode, said that about 100 different hospital workers exposed to the index case are currently being monitored. The Centre for Disease Control (CDC) in Nigeria has reportedly been notified of the outbreak. He assured that there are adequate drugs and other necessary materials to contain the disease. The Lagos State Government also said that all the patients under its custody are doing very well.
Also, the Director, Lagos State Disease Control, Dr. Eniola Erinosho, has advised the public against panicking. He stressed that the state government is collaborating with LUTH, Lagos State University Teaching Hospital (LASUTH) and other relevant government health agencies to contain the disease.
Lassa fever is an acute feverish illness, with bleeding and death in severe cases, caused by the virus with an incubation period of six to 21 days. About 80 percent of human infections are without symptoms, while the remaining cases have severe multiple organ disease, where the virus affects several organs in the body, such as the liver, spleen and kidneys.
Lassa fever is a significant cause of severe illness and death. Medical experts advise that the promotion of good community hygiene and prevention of rodents from entering homes are effective measures to prevent the disease. Other measures include storing grains and other foodstuff in rodent-proof containers, disposing of garbage far from homes and maintenance of cleanliness.
They also advised standard precautions in healthcare settings, with all blood fluids considered potentially infectious. These precautions include hand hygiene, use of appropriate Personal Protective Equipment (PPE), proper waste disposal, disinfection of medical equipment, cleanliness of the environment and safe injection practices.
On its part, Lagos University Teaching Hospital (LUTH) said it has trained over 500 staff on Lassa fever, as two more doctors tested positive in the hospital as at last Monday.
According to the Chief Medical Director (CMD), Prof Chris Bode, the trained personnel were taken through various aspects of the contagious ailment.
He said various meetings have been held with doctors and other members of staff to reinforce the messages while fresh trainings have also been conducted and are ongoing for staff at the forefront of patients’ care.
Delta renew efforts at containing the scourge
in its own case, Delta State Government has grappled with the epidemic since November 2011, following its first recorded case, a patient died of the disease at the Shell Clinic Warri, Warri South West L.G.A.
Also in August last year, a medical doctor died in Asaba. Although, Delta State has not recorded any Lassa fever case, the health authorities have taken steps to contain the scourge in the case of any eventuality.
The Health Commissioner, Dr. Nicholas Azinge, in an interview observed that despite the fact that the epidemic not having occurred in the state, the Ifeanyi Okowa administration has collaborated with the World Health Organisation (WHO) /Federal Ministry of Health (FMOH)/NCDC in a bid to check any outbreak.
Dr. Azinge said sensitization campaigns have commenced through the mass media with jingles, printing and distribution of leaflets, adding that there is continuous awareness creation among health workers to take preventive measures in the event of an outbreak.
He added that the state has established a system for collection of blood samples for laboratory confirmation, while the state has issued a red alert placing health facilities on standby in a bid aimed at preventing the disease from spreading to the state from neighbouring Edo and Rivers States.
The commissioner said a team has been raised to maintain constant patrol in the seven local government areas sharing boundaries with Edo and Rivers.
The local government areas include Oshimili North, Ika South, Ika North East, Ethiope East, Ethiope West, Warri North and Aniocha North.
He said that sensitization has been intensified to enlighten residents about the disease, stressing that surveillance of the border local government areas of the state will be constant to nip any case in the bud.
He stressed that the state surveillance system through the State DNSO (Disease Surveillance and Notification Officers) in the 25 local government areas of the state.
He described the outbreak of the disease as an issue of national concern, adding that the number of patients under observation in the state has dropped to only 13 persons.
On his part, the Commissioner for Information, Mr. Patrick Ukah stated that the sensitization and advocacy to local government areas, Primary Health Care Centres, schools, market places, among others, will not just continue, but will be intensified to achieve the desired result.
He advised all persons living in the state to keep their environment clean and cultivate good sanitary behaviour.
Ogun on red alert
On August 10, the deadly scourge crept again into Ogun State when a patient at the State General Hospital, Abeokuta, who reported there for treatment for what he thought should be taken as an outpatient matter, was eventually placed under close observation on suspicion that he was suffering from the deadly and contagious disease.
The 22-year old male patient whose identity is being kept secret, tested positive to the virus that causes Lassa fever. He was said to have returned from Badagry in Lagos with feverish symptoms and has since been moved to an isolation centre at the Federal Medical Centre, Abeokuta.
Expectedly, Ogun residents were once again, thrown into another round of panic and apprehension over the presence of the infectious disease in their midst.
Parts of state government’s initial response was to move the patient to an isolated centre, engage medical officers to begin community level mass mobilization through various local government Information Officers to educate members of the public on personal and environmental hygiene as well as the need to keep food supplies safe.
In December last year when the state recorded cases of Lassa fever, two persons – a man identified as Great Okusaga, a mortician, and Assistant Chief Nurse, Omobolanle Adesuyi, died of the disease at the FMC, Abeokuta, where they were receiving treatment.
The Nurse, until his death, was a staff of the FMC. The government quickly rolled out measures not only to contain the spread but to allay the fears of residents that the situation was under control.
Three Isolation Centres were established at the FMC, Abeokuta, Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, State Hospital, Ijaiye and Iberekodo – both in Abeokuta while residents were advised to imbibe the rules of hygiene such as regular hand washing, proper cooking or washing of food before eating and ridding of homes of rats believed to be carrier of the virus that causes Lassa fever.
Also, about 2000 people who had contacts or suspected to have had contacts with the two victims – Okusaga and Adeduyi, were identified and placed under surveillance at the time by the health officials from the health ministry.
In the latest case, the Commissioner for Health, Dr Babatunde Ipaye, told The Nation that it would be wrong to consider Lassa fever case in the state as a “re-occurrence,” saying none took root from the state.
He said the cases recorded so far were all imported into the state from other states by the victims, but added that the government has taken adequate steps to contain its spread.
He explained that last year, one of the victims returned from Kogi State with it while another got it from Ebonyi while in the current case, the patient returned from Badagry, Lagos State with symptoms of fever.
Already, 106 people who had contacts with the patient in the current case have been identified and given thermometers to monitor their temperature while health and surveillance officers have been monitoring them for 21 days.
“Initially we had 66 contacts but now, we have additional 40 contacts. So, we are monitoring the 106 contacts. All the initial 66 were care-providers in all the hospitals that he’s being treated. We also had to go to his house to decontaminate it. So, everybody that lives around there are primary contacts one way or the other; just to play safe.
“We have to monitor their temperature for 21 days. That was what we did for over 1, 800 people we followed the other time. We had to monitor their temperature minimum of twice daily – morning and evening. And the contacts must come up to tell us the reading immediately. We have given all of them thermometers and we have taught them how to measure temperature.
“So, when we call them they would tell us what the temperature was in the morning and the evening and they would do this for 21 days. If after 21 days there is no fever of any type, then that patient is discharged away from our contacts.
“But if there is fever, we would take him and put him in an isolation place and do the test quickly. So, if the test is negative we discharge him. If the test is positive, then we start treating the person.”
He, however, allayed residents’ fear saying there was no cause for alarm as none of the 106 persons being monitored had reported any feverish symptoms. “We don’t have any problem for now,” Ipaye told The Nation.
But nurses at the FMC in charge of treating the Lassa fever patients initially raised an alarm over inadequate medical protective equipment.
The Chairman of the National Association of Nigerian Nurses and Midwives (NANNM), FMC Abeokuta chapter, Mrs. Yemisi Fagoyinbo, complained that they would soon exhaust the supply of Personnel Protection Equipment (PPE) at the isolation centre and may run into crisis should the state government fail to send more PPEs to the centre.
Fagoyinbo said PPEs brought by the state government were not enough to cater for the confirmed patients.
A total of 100 PPEs were demanded from the government but it supplied 60, she said, but raised the hope that the patient who is said to be seeking admission at the Federal Polytechnic, Ilaro, before he came down with Lassa fever, is responding to treatment.
“The patient is feeling fine, the temperature is cooling down and is taking food orally. I want to commend the Management, Staff of FMC, Abeokuta, for rising up to the challenge and I equally want to thank the staff for taking the bull by the horn.”
However, the FMC’s Public Relations Officer, Mr. Segun Orisajo, told The Nation that the government and management of the FMC have taken steps to tackle the challenges being faced by nurses running the isolation centre.
“The Lassa Fever patient is with us here at the FMC Isolation centre and is receiving treatment. The state government brought him here. And just yesterday (Wednesday), the Commissioner for Health, Dr. Babatunde Ipaye was here. He and the FMC Medical Director visited the patient to see how he is faring, things needed as well as challenges as narrated by nurses.
“The nurses complained that the PPEs supplied were inadequate but the state government and FMC have now stepped in to address the shortages or inadequacies,” Orisajo said.
