The effect of a pandemic could be as devastating as the negative outcome of a war, despite the lesson taught amid the COVID-19, yet commitment to Lassa fever and response are a fraction of the resources Nigeria commits to epidemic preparedness. The country is yet to find a lasting solution to the scourge that has claimed live after 51 years. In this write- up, Anthonia Obokoh creates awareness on the scourge with a survivor story, while accessing the government’s efforts at tackling the virus and why funding research is critical for epidemic preparedness.
The ignorance of how deadly Lassa fever has left an unforgettable and scary experience for a 38years- old civil servant and trader Ikenna Ahaotu who resides in Abakilike, the Ebonyi State capital.
Ikenna is the first known victim of a Lassa fever patient in Alex Ekwueme Federal University Teaching Hospital Abakaliki who has been in coma for two days, unconscious for about two weeks, had convolution, bled in the nose and, doctors fear, he may not survive because he had just 20 percent survival chance.
“Some people are scared of going to the hospital because they know they will be quarantined and they have wrong information that one they are quarantined they will die at the hospital. It is not true. I was there and I came out alive” he says.
Recalling how he contracted Lassa fever, Ikenna who buys and sells rice in wholesale had chewed many grains of rice at the mill to know if it is good rice or well processed or not.
Unknown to him, one week after he had visited a rice mill in Abakilike, Ebonyi. He then started experiencing fever; he had a severe sore throat, weakness and at a point was kind of confused.
He got treated for malaria and typhoid, but he was not getting better. He sought help from a private hospital but nothing improved. He finally went to the University Teaching hospital at the Lassa Centre. The doctors originally suspected Lassa, after about 12 hours of tests- they confirmed him positive for Lassa fever.
“I thought it was stress, I felt much worse. The aches were joined by chills, a high-grade fever, vomiting, and weakness. My symptoms weren’t from stress or malaria, as it turns out but it was a Lassa fever,” says Ikenna.
While on the hospital bed, Ahaotu watched how lifeless bodies were being taken out of the ward, this frightened him.
“Lassa fever is serious; I was down and out in my bed for one month and a week straight. I saw people dying. While I was in the hospital I saw a family, the man, wife, and children all got it and they were brought to the center. Lassa is a very serious case, they don’t talk much about it there in Abakilike and it’s very prevalent,” he says.
Ikenna was cured of Lassa and happy but says he is still grappling with its after-effects.
“It’s not even Lassa that kills most people, but the complications that result from the people who have Lassa. Awareness should be created more on Lassa fever because a lot of people don’t even know the symptoms. Some people think it’s an evil projection on them by the enemy. Some feel it is a normal fever and they will die,” he explains.
“Some people are scared of going to the hospital because they know they will be quarantined and they have wrong information that one they are quarantined they will die at the hospital. It is not true. I was there and I came out alive” he says.
Truly, Lassa fever is a very serious case. Over the years, attention has been given to its fight and awareness in the country. An estimated 100,000 to 300,000 infections of Lassa fever occur annually, with approximately 5,000 deaths.
The fever is transmitted by Mastomys natalensis, a species of rats that spread the virus via their feces and urine. The fever is prevalent more in the dry season and is contagious. Considering the shattering pain it causes, the Lassa virus will go to the pancreas; kidneys, eyes, and brain. It will cause diabetes, psychosis, kidney failure.
According to medical experts, the virus comes and goes, but the complications will remain. The danger lies in the fact that people often contract Lassa fever without realizing they have it, and in some cases, it can lead to shock and even death.
The fever’s yearly outbreak and increasing death toll are distressing. Sadly, 51 years, after two sisters, became the index case of the fever acquired in the town of Lassa, Borno State in Nigeria since 1969 is still poorly understood, challenging to diagnose and treat in Nigeria.
The challenges have sustained the prevalence of fever in Nigeria.
This year, so far Nigeria has recorded the highest Lassa fever outbreak in recent times. The vicious toll is taken by the disease, according to the Nigeria Centre for Disease Control (NCDC), Lassa fever situation report in 33 weeks has no fewer than 5,527 suspected cases of Lassa fever that have been recorded in 2020, while 1,061 confirmed cases and 222 deaths.
“Lassa fever is endemic; and it is relatively common in West Africa, including the countries of Ghana, Sierra Leone, Guinea, and Liberia. In Nigeria’s case Edo, Ondo, and Ebonyi state are more prevalent with the outbreak,” says Rosemary Audu, Virologist and director of Research and Head, Microbiology Department, Nigeria Institute of Medical Research (NIMR), Lagos.
“Many of Nigeria’s population may have been exposed without getting ill because 80 percent are asymptomatic and it is only 20 percent of those infected with Lassa fever, which becomes severe and requires management,” Audu further says.
According to her, more awareness needs to be created and individuals are expected to play their roles in personal responsibility of hygiene.
“I urge Nigerians to take precautions and to protect themselves against Lassa fever, in fact even starting with COVID, for instance, we are talking about washing hands and hand hygiene and it’s important not only for COVID, even for Lassa,” she said.
For the virologist, it is very important to keep the environment clean because these rodents feed on garbage.
“If we keep waste around our home, it will attract these rodents into our homes. So, let’s dispose of our waste properly and, I also advise the health workers, to be on the infection prevention control. Don’t use your eyes, because you cannot tell with your eyes who has Lassa or who does not have. Use appropriate tools,” she counseled.
Accessing government’s efforts
The re-emerging of the Lassa virus counsels insights not only into Nigerians hygiene level and precautions but political health of the state of her health security — particularly as it concerns epidemic preparedness.
In response to the increasing number of Lassa fever cases across states in the country, the Nigeria Centre for Disease Control (NCDC) activated a National Emergency Operations Centre (EOC) and besides, five laboratories in Nigeria can diagnose the disease.
Irrua Specialist Teaching Hospital, Federal Medical Centre Owo, and Alex Ekwueme Federal Teaching Hospital Abakalilki-are three main treatment centers for Lassa fever epidemiological studies that will provide data to guide research and response activities.
Meanwhile, the UK Department for International Development (opens in a new tab) initiated funding two projects to help with future Lassa fever outbreaks in Nigeria with about £500,000 over three years to WHO to support the Nigerian government to lead the research response.
This funding support projects on creating a mechanism for coordinating research efforts related to Lassa fever, also ensuring that standardised lab tests are available to support response and research efforts and to enhance oversight capacity for research in Nigeria through the National Regulatory Authority and the Ethical Research Committee.
Also, the African Coalition for Epidemic Research, Response, and Training (ALERRT) set up a clinical research response in Nigeria with the £90,000 to strengthen case management of Lassa fever patients by supporting Nigerian clinicians in standardised collection of clinical assessment, outcome, and laboratory data across multiple health centres.
Funding requirements and search for Lassa fever vaccine
Experts say the way and manner Africa’s largest economy is responding in tackling and ending the ailment with the collective inconsistency of health and economic development is worrisome.
They say Nigeria cannot afford to relegate diagnostics in epidemic due to low preparedness level, adding that inadequate funding has stalled epidemic research in the country.
“We need funds. The kit is very expensive and there is not much support for necessary research within Nigeria,” Audu says.
“Here, the government does not invest too much in research; there is little that could have been done before now. The outbreak resurfacing is our problem if we do not bring money to do the research, then the fever remains with us,” he states.
The virologist expressed concern, thus “There are no clinical trials, yet for a Lassa fever vaccine in Nigeria. We are still trying to develop vaccines and the virus is also very difficult sequencing it, because of its genetic pattern. So it is difficult to get the strain and there are about seven main strains. The ones that they have even worked on are not even the ones that are common in our environment.”
“What we have are strains in Senegal, those are the ones that they have even developed one candidate vaccine for which is still even being tried and it has not yet to reach clinical trial level yet,” she pointed out that, because of the biosafety issues involved, it’s been very challenging.
“The drug (Ribavirin) being used for Lassa fever is just being repurposed for it. So it is not as if it’s specifically the drug. This was not even developed specifically for treating Lassa fever but it’s just being repurposed, and the drug is only effective if treatment starts early.
“The drug must be used in the first six days, or thereabout. Due to late presentation by infected people, the drugs are being used late and that’s why we see high mortality even in the hospital,” Audu said.
Omomoh Emmanuel, a former senior scientific officer in Irrua Specialist Teaching hospital and presently working with NCDC said, “We are not at the stage of getting a vaccine yet. Even in other countries, there is no vaccine for Lassa fever.
“The government has allowed international collaborators to come in to help develop or find a search in developing vaccines and make it ready. A lot of these collaborators are also collaborating with other countries like Liberia, Senegal.
“They bring their work of experience and also lessons learned from other countries to Nigeria and also, lessons from Nigeria to other countries to implement and see how it will work there,” Emmanuel further said.
Audu thinks partnerships and collaboration can help “For us in Nigeria Institute of Medical Research (NIRM), we are working with Institute Pasteur Senegal in Dakar.
Last year, some of our staff were at Dakar to do some research with them, but somehow because of this COVID- 19, we were not able to complete it, but we have a Memorandum of Understanding of a research partnership with them,” she said.
Epidemic preparedness: Need for political will
Health science-related research capacity and funding are inadequate to cater to current pandemics in Nigeria.
Trial steps should be taken towards finding an effective treatment for Lassa fever and there should be efforts in the research of possible treatment in the context of an infectious disease outbreak.
This year, the federal government allocated N1, 673, 486, 127 to the NCDC for epidemic preparedness, detection, and response to infectious disease outbreaks and public health emergencies for over 200 million Nigerians.
The government, policymakers, and the public often fail to understand that epidemic preparedness is crucial for maintaining a disease-free nation but is also cost-effective for the Nigerian economy.
Chikwe Ihekweazu, director-general, Nigeria Centre for Disease Control (NCDC), has constantly advocated for attention on national health security as well as increased funding. This implies that one area of healthcare in Nigeria most flopped by this absence of a political will is epidemic preparedness.
“Government needs to increase funding for epidemic preparedness and awareness. States in Nigeria need to demonstrate the serious impact of the disease and the governors should also provide adequate funds for a sensitive disease surveillance and response system,” said Oladoyin Dubanjo former chairman, Association of Public Health Physicians of Nigeria (APHPN), Lagos Chapter.
However, preparedness for pandemics and health emergencies has a high return on investment, estimated at $2‒7 for every $1 committed. As it stands, Nigeria’s epidemic preparedness is a very risk that has greater potential for catastrophic economic impact.
Therefore, it is crucial to put measures in place and early enough to avoid another financial crisis for disease outbreak as experienced in Lassa fever and even COVID -19 this year.
