Governor, caregiver narrate experiences with Lassa fever

Lassa fever
Lassa fever

David Eseile is a medical doctor with over 10 years’ experience relating to Lassa fever patients.

Mr Eseile is one of the dozens of caregivers who have been infected with the disease while treating patients.

“One minute I was all kitted up in my protective gear collecting blood samples from Lassa fever patients in the ward and days later, I became a patient in the same ward,” he said.

Lassa fever is a haemorrhagic fever which is usually transmitted from rodents to humans and spread through human to human transmission.

Lassa fever virus may be spread through faeces of the multimmate rat or humans having direct contact with blood, urine, faeces, or other bodily secretions of a person infected with the fever. According to the World Health Organisation, there is no epidemiological evidence supporting airborne spread between humans. However, sexual transmission of the Lassa virus has also been reported.

The outbreak of the disease has become yearly in Nigeria. It is usually an all-year-round disease but peaks around January to April.

Caregivers, unfortunately, have also fallen victims of the disease while handling patients. This phenomenon has contributed to the high figure of mortality from the disease.

Mr Eseile said it was traumatic going from being a caregiver to a patient. He still could not explain how he contracted it in 2018.

“Having knowledge of the disease, the harm and the side effect of the drugs, I was distraught,” he recalled his immediate reaction.

Mr Eseile is one of the caregivers who contacted the disease in the line of duty. He is also one of the few lucky survivors. The mortality rate of the disease in the country is about 25 per cent.

He narrated his experience at the Lassa Fever International Conference held in January in Abuja to mark 50 years of the disease.

“I was not in contact with rodents or working with patients of Lassa fever. I must have contacted the disease through the ward. But how still remains a question which is yet to be answered,” he said.

Mr Eseile said it is fallacy to believe that most caregivers who contacted the disease did so due to their carelessness and not wearing protective gear when they handle such cases.

He said he was always kitted up when attending to his patients because he understands the harm the disease can cause, having lost friends and colleagues to the disease during his university days in Edo State.

Mr Eseile, who hails from the state, one of the high Lassa fever prevalent states in the country, works at the Federal Medical Centre, Owo in alliance with an NGO at the infectious diseases centre in Owo, Ondo State.

“Prior to my admission to study medicine at Ambrose Alli University in 2006, we had been hearing about Lassa Fever and death from it and the great burden it has caused to dwellers of Edo North and Edo Central and the fatality rate.”

Edo, Ondo and Ebonyi are the three high prevalence Lassa fever states in Nigeria. However, over 23 states often report at least one case during the yearly Lassa fever outbreak.

Mr Eseile said he was one of the physicians in charge of treatment and his centre operated one of the best IPC expected in such situations, as the health workers were aware of how deadly the disease is.

He, however, remembered there was once a blood splash on his gear when he was transferring a patients’ blood sample into the test tube bottle.

“I did not attach much importance to it because I was well kitted. After that incident, I went down with what I thought was malaria and I was treating malaria but not getting better. At some point, my sister who I was staying with also came down with malaria with her daughter, but I never thought I could have contacted the disease,” he said.

Mr Eseile said it took the intervention of his colleagues to run his sample for Lassa fever.

“My colleagues became worried when I was not getting better and when my sister lost her pregnancy. It was when they came to take her blood sample that they forcefully took mine too. Behold, my sister and her daughter were negative while I tested positive to Lassa fever,” he said.

“I could not believe I contacted the disease. Having been taking care of people who had the disease such as my roommate who we thought had malaria and typhoid until he was diagnosed with Lassa fever and died of the disease in 2007. Knowing the side effect of the drug, I was apprehensive. But here I am today. It is not an easy feat.”

There are many other survivors of the disease in Nigeria. The disease can be managed if cases are detected and treated early.

The governor of Nasarawa State, Tanko Alamakura, contacted the disease about 31 years ago. He is not a health worker.

Mr Alamakura lost a son to the disease but he and another of his children survived it. Though they won the battle against the disease, it left on them permanent scars.

“I consider it a rare honour to be alive today to share how I was afflicted by Lassa fever and how I live each day with emotional and physical trauma and scars imprinted in my life and in my psyche by Lassa fever,” the governor said.

Mr Alamkura said he contacted the disease from his deceased son who was convulsing and he dipped his hands into his mouth to prevent it from closing.

He said his two sons were earlier diagnosed with typhoid fever. They were in the hospital when on the fourth day one of them in a fit was gritting his teeth as the doctors were giving medication.

“Intuitively, I rushed to put my fingers in his mouth so that his teeth did not cut his tongue. In the course of that, I got bitten on one of my fingers. It was a slight cut with no much blood. I did not know that was the beginning of a story I will be telling you this afternoon,” he said at the conference.

He was unaware the son had Lassa fever. After he was bitten he became ill. At first, he thought it was malaria until all the drugs he took did not work.

His second son who was also on admission survived but developed a profound sensory neuro defect.

The Alamakuras were lucky due to the intervention of a virologist, Oyewale Tomori, who suggested they should be tested for Lassa fever.

“As at the time, there was no laboratory to test for the virus in Nigeria. My sample was sent to a laboratory in Atlanta, Georgia. When my result came I was positive. I was later told by the doctors that my infection was as a result of the bite when my son was in a fit,” he said.

Due to the late diagnosis and treatment, Mr Alamakura became deaf after his treatment and is using hearing aids to date. He also lived with the same illness of sensory neurotic disorder for 20 years before help came.

His situation could have been averted if there was early diagnosis and treatment. This has been affecting the fight against the disease in the country. The Nigeria Centre for Disease Control (NCDC) attributes the high rate of mortality to late presentation and diagnosis of the disease.

The Director-General of NCDC, Chikwe Ihekweazu, said Nigeria can now diagnose Lassa fever early as the country now has four reference laboratories.

According to an epidemiological report of the NCDC, Nigeria recorded the highest number of Lassa fever cases in the history of the country in 2018. That year, 3498 suspected cases were reported from 23 states. Of these, 633 were confirmed positive, 20 probable and 2853 negative. A total of 171 deaths were recorded from the confirmed cases.

This year, NCDC has declared an ongoing Lassa fever outbreak in the country.

A report on the disease from NCDC shows that from January 1 to February 17, a total of 1139 suspected cases were reported from 19 states and the FCT.

“Of these, 355 were confirmed positive, 3 probable and 781 negative (not a case). However, 1168 suspected cases have been reported from 30 states and FCT,” NCDC Chief Executive Officer, Chikwe Ihekweazu, said.

The 75 deaths reported in 2019 put the case fatality ratio in confirmed cases at 21.1 per cent.

Mr Ihekweazu advised health workers to always take precaution when handling patients and imbibe the best clinical precautionary guidelines.

He said though there are hopes for a vaccine soon, it is still in the pipeline as none is yet to pass clinical tests.

Mr Tomori, a professor of virology, lamented that 50 years after the first case of Lassa fever was discovered in Nigeria, the county is still struggling to cope with the disease.

He attributed this to the carelessness and lack of political will of Nigeria leaders and academics.

He said Lassa fever has been making “mincemeat and sausage rolls of Nigerians” because the country has refused to fund science and grow knowledge against the disease.

He blamed the filth in the society as part reasons why there has been an increase in Lassa fever cases in recent years.

He said the older communities picked up the infection through hunting in forests where they may have encountered the rodents. However, Lassa fever is now contracted at doorsteps in the modern communities because of the piles of food and filth which are luring rodents out of the forest.

“Over the years we have grown filthy as a nation. Rats are not stupid, they look for food and they come right into the master bedroom. You are killing your loved ones, your doctor is killing you and the doctor is committing suicide from utter disregard for infection prevention and control,” he said.

Mr Tomori said health workers and others contract the disease when handling febrile patients and loved ones. He said this is the quickest way of spreading Lassa fever.

The professor of virology warned that much success would not be recorded until the country gets serious in its commitment to fighting the disease.

He lamented the lack of a treatment facility in the north. He noted the government in 2002 released N100 million each for three reference centres to be situated in Irrua, Maiduguri and Owerri to help diagnosis and treatment.

Out of these centres, only Irrua is fully functional and has an effective response to diagnosis and treatment in the country. That of Maiduguri never saw the light of the day.

He said for Nigeria to curb the disease, it needs to take a lead and be serious about it. He said the country should stop waiting for the international community but should take responsibility for its problems.

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