Lassa fever is the not-so-new super bug

This is the transcript for a post written for The ScoopNG. Read the original post here.

Tuesday morning, December 23, 2008, was like any other morning. Ezeugo* was preparing to have breakfast before heading out to work. He had heated some water and made tea. He planned to take it with the bread he’d brought with him the previous day from Owerri, Imo State, his home town, to Afikpo, Ebonyi state where he resided and ran a shop.

On observation, he discovered that the seal of the bread had been broken and it seemed like some rodent had managed to pilfer some crumbs off of the loaf. He did what the average Nigerian would do: he chopped off the parts nearest to the area the rodent had bitten off and proceeded to have his breakfast. After that he went out to work. It was holiday season and business was good.

At dusk on Christmas day, after sufficient partying and merry making, he headed home to rest. That’s when he noticed his body temperature had started to rise and that he felt rather exhausted. He figured it could be either one of two things: he either was fatigued from all the ensuing stress of the holiday season or he was coming up with malaria fever. The fever was more likely, he thought. He proceeded to purchase Paracetamol from the Pharmacy down the street to help relieve him. He wasn’t better by the next morning; he was weaker and hotter. That’s when he proceeded to the nearby clinic. Two nurses tended to him and, when his condition continued to deteriorate quickly, they referred him to the General Hospital, Afikpo. The General Hospital was being manned at the time by a doctor undergoing his National Youth Service.

The moment Ezeugo entered the General Hospital and the doctor took one quick look at him, he knew whatever it was that ailed this patient, the hospital didn’t have the required personnel and/or equipments to handle it. He had a hunch it was something more sinister than malaria fever and thus dispatched him to the General Hospital, Abakaliki, where he was certain the patient would get better care.

At the General Hospital, Abakaliki, Ezeugo was admitted and his attending physician administered treatments to help keep him stable. Nobody knew what it was exactly that ailed him. Some very bad strain of fever was at the top of the guess list though.

A few days later, while Ezeugo was fighting to cling on to life, his doctor started to get sick. Another doctor had to pitch in to watch over them both. Not long after that, the second doctor got sick too. Because the patient was the priority (and probably because doctors are wont to delay their own treatment when they get sick), he got more attention and thus, better treatment. It was after the first attending suddenly died and the second was in the throes of death that it became clear that there was an epidemic in the hospital. Whatever Ezeugo had, it was not a fever they’d handled before. They filed a report to the Federal Ministry of Health (F.M.O.H.), Abuja and asked for help.

When the FMOH team arrived from Abuja, they quickly checked the patient’s charts and proceeded to get an accurate history by doing a back trace through every stop the patient had made enroute to Abakaliki. Shocking discoveries were made during the investigations. The two nurses at the clinic and the Pharmacist Ezeugo had initially contacted at Afikpo had mysteriously passed away.

Meanwhile, Ezeugo had been transferred to The Irrua Specialist Teaching Hospital, Irrua, Edo State, where they had a Human Virology centre. Tests revealed that he had Lassa fever and after a series of questioning, the patient revealed the story about the bread he’d eaten. The connection was made: Lassa fever from rat pee. It was a cool diagnosis but one made after two doctors, two nurses and a local pharmacist had paid a steep price.

Lassa fever was first observed in 1969 in the Nigerian town of Lassa in Borno State. Its primary [animal] host is the Natal Multimammate Mouse (Mastomys natalensis), which exists in abundance in most of Sub-Saharan Africa. The rodents are usually hunted and cooked by the locals and serves as a protein source. The virus is usually transmitted via the urine or feces of the animal when they access stored food in peoples’ houses or even in store houses.

According to a statement by the World Health Organization on the prevalence of the disease in Nigeria, “… Person-to-person transmission occurs through direct contact with sick patients in both community and health care settings. Those at greatest risk are those living in rural areas where Mastomys are found. Health care workers are at risk if adequate infection control practices are not maintained.” In the first quarter of 2012 alone, 623 suspected cases, including 70 deaths in 19 of the 36 states were reported by the Nigerian F.M.O.H to the W.H.O. as of March 22. That is nothing short of an epidemic, if you ask me.

The cases are likely to have increased towards the latter part of the year as various states experienced flooding issues. This would have resulted in the mouse in question, along with other animals of course, being displaced. Some would probably have found their way into people’s homes in search of food and shelter thereby increasing the risk of infection for the human occupants.

The diagnosis for Lassa fever isn’t much different from that of the regular malaria fever. The symptoms include diarrhoea, vomiting, cough, headache, sore throat, nausea, etc – very much like the ones associated with malaria fever, (although other more markedly different symptoms occur in some few cases) except that it’ll refuse to be tamed by the usual drugs that are used to combat malaria. Many doctors are likely to miss it – and that fact isn’t as much a slight on their competence as it is on the general awareness level regarding the infection. The most efficient way to combat the disease at the moment is early administration of the Ribavarin injection or tablets. The drug is relatively expensive and not readily accessible.

The problem with Lassa is that you can hardly do anything about the pathogen carrier (eliminating the rats is practically impossible). And unlike aids, the slightest contact with an infected person increases your chances of contracting it, as the virus is present in all body fluids.

The F.M.O.H. is currently carrying out an awareness campaign regarding an outbreak of the disease and is supplying Ribavarin drugs and injections to the General Hospitals across the states. However, the problem of relative ignorance still persists in rural communities where the risk factors are higher. The awareness campaign has to be intensified and taken deep into the hinterlands as most of our foods are cultivated, stored and comes from there. Let’s say, for example, an infected bag of garri is bought at Oba Market in Benin, Edo State (which may have come from any village in the state) and transported to Lagos. Okay, you already know where I’m going with this.

If we’re to stem the tide of this epidemic, all hands are going to have to be on deck. People will have to store their foods better, and report immediately to the hospitals for treatment as soon as they notice feverish symptoms, instead of self medicating, as the majority of us are prone to do. The government, through the F.M.O.H., should ensure that efforts are increased to ensure that Ribavarin is supplied to more hospitals and maybe work out a partnership with corporations in the health sector to help leverage on the price of the drug. Most importantly, the awareness campaign is everyone’s responsibility. If you know about the disease and how to prevent it and your neighbor doesn’t, it’s your duty to educate them. It just might save your life.

*name has been changed for confidentiality sake.