Nigeria: endemic Lassa fever is a major public health problem

Text by: François Hume-Ferkatadji

Since the start of 2020, 258 people have been infected with the Lassa virus in 19 of the 36 states in Nigeria. At least 41 people have died from this acute hemorrhagic fever. In Ondo, one of the provinces most affected by this new epidemic, healthcare workers have to cope with the influx of patients with limited means.

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Crouching in the shade of a tree, hands folded towards the sky, eyes closed, Ade Djolo marmots of prayers. Her mother has been hospitalized for six days a few steps away, at the Owo infectious disease treatment center. The old lady suffers from headaches, fever and empties of her blood. Like 47 other patients tested positive for Lassa fever, she was placed in quarantine and under medical supervision, in this small innocuous pavilion of the large hospital complex in Ondo State. The sick are confined to "the high-risk area": ​​a space inaccessible to relatives, who wait long hours, often several days, helpless, outside the building.

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From the same family as Ebola, Lassa fever is contagious , transmissible from human to human by bodily fluids: sweat, blood, mucus. A heavy and restrictive system is necessary to ensure the protection of nursing staff. Before entering the "red zone", nurses and doctors must spend 20 to 25 minutes putting on a large white coveralls, putting on plastic boots previously cleaned with chlorine, two pairs of gloves, a mask and a protective visor. This equipment, the “PPE”, is tiring and painful, but necessary while taking care of patients involves delicate medical acts: infusions, injections, dialysis. Especially since the most suffering patients, sometimes affected at the neurological level, convulse, gesture and sometimes tear off their infusions. “ It's hard to work in these conditions , recognizes Alabi Josephine Furimilolla, the head nurse of the Owo center, swaddling in her PEP, it's hot, we can't hear anything, we can't see well. But it is necessary ”. In late January, two doctors died in the northern state of Kano after taking care of a pregnant woman. A few days later, another doctor was infected in the neighboring state of Jigawa. Among the 41 victims of Lassa this year, at least five are from the medical profession.

Lassa is an endemic disease in Nigeria, but also in Niger, Liberia, Guinea, and Sierra Leone. Each year it experiences an epidemic crisis, during a period which runs from November to May. The multi-udder rat, the main host of the killer virus, approaches houses and spreads its droppings on cassava which dries in the sun. " During the dry season, people prepare their fields, and start to burn their bush, so the rats flee to the villages to be safe from bush fires ", details doctor Issaley Abdel-Kader, director of the 'NGO Alima for Nigeria. This year, the epidemic places medical teams in difficulty, particularly in the poor and rural Ondo State, which accounts for almost 40% of the 258 confirmed cases. Faced with the influx of patients, the head nurse admits to being overwhelmed: “ We are currently experiencing a shortage of health personnel, the workforce is too low, compared to the number of patients we have to treat. We need support: nurses, doctors, hygienists, to cope with the influx of patients . ”

More confirmed cases

Just a stone's throw from the Infectious Disease Control Center, in one of the country's five analysis laboratories capable of detecting the Lassa virus, Johnson Etafo, in charge of controlling blood samples, shares his concerns: " The scale of the epidemic is unprecedented , he alarms himself in front of his screen linked to the PCR, it is very serious. For each analysis, I have 10 to 20 positive cases. I hope that action will be taken quickly because we are all part of the community, we are going to the market, the problem must be taken seriously. "

In late January, Oyewale Tomori, epidemiologist and expert from Lassa, also accused the federal government of negligence in its management of the response to the epidemic. " Until the Lassa Fever takes the life of an important Nigerian personality, nothing tangible will happen ," he denounced in a Premium Times column .

In Abuja, the director of the Nigerian center for disease control (NCDC), doctor Chikwe Iihekweazu, defends himself: " Newspaper headlines will always announce : " Every year, there are more and more cases of Lassa in Nigeria " , but I think it should rather be emphasized that we have put more effort into diagnosing the sick, so naturally the cases are increasing. The good news is that we have been able to reduce the hospital mortality rate from 25-26 % to 18-20 % ”.

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