Health: LASSA FEVER – When Prevention Is Better Than Cure – By Dr. Popoola Margaret O.

 

“According to the CDC, 100000 to 300000 cases occur annually with about 5000 deaths”

PEGASUS REPORTERS, LAGOS | JANUARY 14, 2021

Benson looked up from the file in front of him and was eternally grateful for coming to the end of the day’s work. It had been a hectic week of continuous call being the only house officer in the infectious disease unit of the hospital. The week long work marathon was beginning to take it’s toll on him as he felt unusually weak. He actually had a slight fever in the morning when he woke up but didn’t think much of it. With his last patient for the day gone, he was sure he would get better soon. That however was not the case as he went through the rest of the day having a non specific feeling of being generally unwell.

Three days later, his condition worsened and he complained of headache, sore throat, muscle pain and chest pain which necessitated a visit to the staff clinic. He was placed on the treatment for malaria and sent home however, when nausea, vomiting, diarrhea and abdominal pain set in a few days later, he was admitted in the hospital. Blood samples were then taken for routine investigations and he was commenced on treatment for enteric (typhoid)fever. Yet, no improvement

.

When the results for the routine investigations all returned negative, there was a palpable fear because at that point all thoughts turned towards Lassa fever. Benson’s thoughts went over the lists of patients he had come in contact with during his week long call and he was able to narrow down to a specific patient who came in with diarrhea and vomiting. Other background histories surrounding her illness seemed to tally very well with the condition. He remembered he took samples from her perfontarily to do the ELISA test for Lassa but didn’t follow up with the results because the patient died. He couldn’t say at this point if he observed universal precautions while interacting with her or not. He just couldn’t think. The details were no longer clear to him. The fear of death increased his anxiety and the mucous in his throat seemed to increase and thicken simultaneously clogging his throat and blocking his airways making it difficult for him to breathe.

Even as the nasal prongs for oxygen was fitted unto him to improve oxygenation, he was visibly shaken and terrified. He thought of his widowed aged mother and how she sold all she had to send him to school. He thought of his fiancee who stood by him all through the many years of lack as he toiled to get the golden fleece called medicine. Their wedding has been set for three months after his completion of housemanship. He thought of the opportunities ahead that a career in medicine promised him and all he could see was emptiness. For the very first time, he came to a full understanding of what is meant by ‘the hazards of the profession’. He feared greatly for his life because he came to a sudden understanding that with Lassa Fever, prevention is better than cure.

WHAT EXACTLY IS LASSA FEVER

Lassa Fever is an acute viral heamorrhagic illness caused by the Lassa virus, a member of the arena virus family of viruses.

HISTORY
First discovered in a town called Lassa in Borno State, Nigeria, in 1969, when two missionary nurses died from the illness.

MODE OF TRANSMISSION
Humans usually become infected with Lassa virus through exposure to food or household items contaminated with urine or feaces of infected multimammate rats ( Mastomys natalensis) It could also be transmitted from human to human through contact with infected body fluids.

INCUBATION PERIOD
6 – 21 days

SURVIVAL OUTSIDE HOST:
The virus is stable as an aerosol, particularly at low relative humidity (30 % RH). The biological half-live at both 24°C and 32°C ranges from 10.1 to 54.6 minutes.

ENDEMICITY
West African region, mainly Sierra Leone, Liberia, Guinea and Nigeria. Individuals who live or visit these endemic areas and have exposure to the multimammate rats are likely to be susceptible to the infection.

EPIDEMIOLOGY
According to the CDC, 100000 to 300000 cases occur annually with about 5000 deaths.

Between 2018 and 2020, Nigeria recorded it’s highest annual incidences of Lassa Fever to date ( 633 confirmed cases in 2018, 810 in 2019 and 1189 in 2020, across 29 states), prompting national and international healthcare mobilisation and raising concerns about an ongoing, systematic emergence of Lassa Fever nationally. Very recently, about 4 doctors lost their lives to Lassa Fever in a very small space of time.

PATHOPHYSIOLOGY
Following transmission, the Lassa virus infects the endothelium and replicates intracellularly using an L-polymerase enzyme and nucleocapsid protein NP, which synthesize ribonucleoprotein (RNP) that produces mRNA and antigenomic RNA required for transcription. NP protein helps the virus evade the host immune system.

SYMPTOMS
Symptoms may be early or late.
At the onset, it is usually gradual, starting with a fever, generalised body weakness and malaise. After a few days, additional symptoms appear like headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhea, cough and even abdominal pain.

RISK FACTORS IN THE DEVELOPMENT OF LASSA FEVER

1. Travel to endemic region (West Africa)

2. Exposure to infected individuals.

3. Exposure to rodents (Mastomys natalensis rat/mouse) or

4. Contaminated household items (including food)

5. Occupational exposure in healthcare settings.

DIAGNOSIS
Lassa fever is most often diagnosed using the Enzyme – Linked Immunosorbent Serologic Assays ( ELISA) which detect IgM and IgG antibodies as well as Lassa antigen.
Reverse Transcription-Polymerase Chain Reaction (RT – PCR) can also be used in the early stage of the disease.
A high index of suspicion on the part of the physician is also very key in making timely diagnosis. This is very important as most of the symptoms may be non specific and mimic those of malaria.

TREATMENT
Though very deadly, it can be treated and many successes have been recorded despite the mortalities that usually follow in it’s wake.
The anti viral drug Ribavirin given intravenously and early in the course of the illness is an effective treatment however may not be readily available when needed.
In addition, there’s also supportive therapy of fluids and electrolytes, oxygenation etc.

VACCINES
No licenced vaccines presently however, some are in the pipeline.

HOW CAN WE CONTROL LASSA FEVER?
The best control is Prevention.
PREVENTIVE MEASURES
Primary Prevention
Secondary prevention.

Primary Prevention of the Lassa virus from it’s host to humans can be achieved by:
1. Avoiding contact with the Mastomys rodents especially in the geographic regions where outbreaks occur. In fact, all rats are suspects. Keep them away from your home.

2. Storing food in rodent proof containers

3. Keeping the home and it’s environs clean to discourage rodents (rats) from entering homes.

4. Regular cleaning of exposed surfaces in the home.

5. Maintaining a good hand hygiene through regular washing of the hands.

6. Avoid direct handling of dead rats. Burn or properly dispose of them away from the house

7. Avoid dumping refuse close to the house and properly cover the dust pin in the house.

Secondary Prevention

1. High index of suspicion by the attending physician (doctor)

2. Observing universal precautions at all times in relating to patients.

3. Avoid burning of bushes and avoid eating of rats

4. Keep a cat

CONCLUSION
Though the outbreak of Lassa fever occurs annually, we have the responsibility to work actively towards it’s prevention and reduce mortality.

REFERENCES

1.https://www.researchgate.net

2. https://www.wikidoc.com

3. https://www.academic.oup.org

4. https://www.nature.ng

5. WHO

6. https://www.cdc.gov

Dr. Popoola Margaret Owoloyi, also known as Dr. Meg, is an Orthopedic Surgeon in training at the Ahmadu Bello University Teaching Hospital, Zaria. She’s a Reverse Medical Tourism advocate and a champion of the call for a better health system for Nigeria and Nigerians.

She is the ED, C-HELP Nigeria, Coordinator, Irawo Book club and the Chief Navigator at WOW Consult, a Patient Navigation outfit that seeks to connect patients to the appropriate health facility for their medical condition locally, thereby encouraging Reversal of Medical Tourism.

She is the author of the financial bestseller NAIRA BOSS and the amazing medical text, EVERY PREGNANT WOMAN ( with Hausa translation) amongst others.

Dr. Popoola Margaret is the Convener of the C-HELP’s HEALTH SUMMIT and ANNUAL CANCER AWARENESS ROAD WALK. She is also the Convener of the HEROES of HEALTH AWARDS. JMBSR – a medical and basic science journal, is also floated by her organisation, C-HELP.

She is married to Dr. Popoola Olayinka Benjamin, an Oncologist, with whom she has 5 lovely kids. Dr. Popoola writes in from Zaria, Nigeria.

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