Lassa fever that murders; Lesser fervour than others

 

The fervour with which relevant authorities (Federal & State governments) and their partners (international, regional & local Non-Governmental Organizations) create awareness about some chronic infectious diseases (e.g. HIV, Tuberculosis) and diseases of public health importance (e.g. Cholera, COVID-19, Ebola, Meningitis) among the Nigerian public appears not to be extended to Lassa fever. From the Lassa Fever Situation Report released weekly by Nigeria Centre for Disease Control & Prevention (NCDC), the 10th – 16th March 2025 report showed that out of 604 confirmed cases of Lassa fever,113 deaths have occurred in Nigeria since the beginning of year 2025 till the period of reporting.  And 3 States – Ondo, Bauchi & Edo – are responsible for 71% of confirmed cases of Lassa fever.  Later parts of the report indicated that “the predominant age group affected is 21-30 years (Range: 1 to 94 years, Median Age: 30 years) [and] the male-to-female ratio for confirmed cases is 1:0.8”.

Source – Nigeria Centre for Disease Control and Prevention

Ondo State (a Lassa fever epidemic zone) lost a dashing and diligent medical doctor to the cold hands of Lassa fever-related death on Saturday, 1st March, 2025. His last official duty post was at the Ondo state Contributory Health Commission - ODCHC (the state health insurance Agency) where I had previously worked, was trained overseas and inducted into the Nigerian medical profession few years ago. His mum, a Community Health Officer (CHO) with the Ondo State Primary Health Care Development Agency (OSPHCDA), who I fondly call Aunty Dami outside the workplace, was my colleague while I was Deputy Director, Medical Services, at OSPHCDA. She had taken it upon herself to regularly update and seek counsel from my humble self (a medical doctor & her son's senior colleague) about his career progress since his medical training in Ukraine. Last of such career brief was in December 2024 when she called me saying “your aburo (younger brother) has just pitched tent with ODCHC to follow in your footsteps”.

As a matter of fact, his pre-wedding plans were quietly being laid out to culminate in a formal tie to his Edo State-born soulmate later in the year. All these lofty dreams and sundry aspirations were halted with his last breath at a private hospital in Akure. He died in his prime, not from deploying his medical knowledge & skills to treat a Lassa fever patient in the hospital but sadly by being a victim of the dreaded viral illness. It took a laboratory investigation, for which blood sample was taken few hours before he eventually gave up the ghost and result retrieved after his passing, to unravel that he tested positive for Lassa fever virus and had died form its complications, including bleeding from some orifices. He had cut short his stay in the United Kingdom (UK), where he was on a visit for a few days before developing certain non-specific symptoms with little suspicion of Lassa fever over there, and dashed back to Nigeria, en route a hospital in Akure, for proper healthcare. Alas, history later revealed that the young doctor had a trip to Edo State (another Lassa fever epidemic zone) some weeks prior to his UK visit.

My write-up will neither revive this gallant medical doctor nor console his grieving parents and  siblings. He was the first child of this lovely family. Regardless, I hope this piece will stimulate government at all levels in Nigeria and her healthcare partners (global, regional, local) to commit similar the zeal with which they mobilize effort to make Nigerians aware of HIV/AIDS to driving home the Lassa fever message in memory of the late doctor. The awareness of this dangerous illness caused by some species of rats (multi-mammate rats – having plenty breasts) is unacceptably low in Nigeria.

What do we need to know? According to the World Health Organization (WHO), Lassa fever is an acute haemorrhagic illness caused by Lassa virus (a member of the arenavirus family) that is present in multimammate rats (rats “with plenty breasts”; also called mastomys rats) as its animal reservoir or host. These rats do not become ill from the virus but only shed it in their urine and faeces. How can we identify and detect a Lassa fever case? According to NCDC 2018 National guideline for Lassa Fever Case management, health workers and the community needs to pay attention to the following two subheadings.

1. History of suspected person for risk assessment - Contact with rat urine and droppings or history of handling/consumption of rats; Close contact (e.g. family members, caretakers, traditional healers, participants in traditional burial rites) of a Lassa fever patient within 3 weeks of date of onset of their illness; Receiving health care from a provider who is also treating patients infected with Lassa fever;  Sexual partner of a known or suspected case (virus can be present in semen for up to 3 months after clinical recovery); Children, pregnant women, adults >40 years and those with comorbidities (Diabetes Mellitus, Hypertension, HIV/AIDS etc.) have a greater risk of severe illness.

2. Clinical assessment (at the hospital) - Non-specific clinical features (feve, headache, vomiting, diarrhea etc.). Early diagnosis is difficult. However, healthcare workers are advised to maintain a high index of suspicion. Also, a detailed clinical examination is advised as patients may present with complications. The incubation period is 2-21 days and severity of illness may depend on several factors including the body’s natural immune response, mode of transmission, duration of exposure, viral infecting dose, phase of illness in the case, and possibly even the virus strain. However, swollen face and neck, sore throat and hearing loss are suggestive of Lassa fever. Hemorrhage (bleeding) is seen in only about 20% of Lassa fever patients. Therefore, health workers are advised to exclude other common causes of fever. Early laboratory diagnosis of Lassa fever is important to have a good outcome with ribavirin (antiviral medication for treatment) administration.

Regarding safe burial for people who died from Lassa fever, NCDC warns that “There is a major risk of transmission when a patient dies of Lassa fever, as the dead body remains contagious for several days after death. The family and members of the community are also at risk, if the burial rites involve manipulation and cleaning of the body”.

Moving on, how can we prevent Lassa fever transmission? Please note the following.

1·       1. Avoid processing cassava by spreading/drying in open places (e.g., along the road) where rats may urinate and defecate on it.

·        2. Limit contact with rodent (rat)population. For example, de-rat your house and environment from time to time.

·       3. Wash fruits properly before eating (a doctor colleague who works in a Lassa fever treatment facility informed me some weeks ago that 2 out of 3 persons managed at his place of work last month had a history of eating ‘unwashed bananas’ – a prevalent behaviour among many Nigerians due to the feeling that the inner portion and not the outer peels) is the ultimate destination for consumption, forgetting that our hands would likely have been contaminated by the micro-organisms on the peels. While trying to take out the peels usually from the banana tip, the contaminated fingers will most likely transfer the virus (if present) to the tip before we bite and swallow.

·       4. Take sick people to hospital promptly

With the zeal deployed towards raising awareness about other public health diseases, I urge the Federal government and the State governments of Ondo, Bauchi and Edo – the three States with the highest endemicity of Lassa fever – to work collaboratively with health sector partners in letting Nigerians hear loudly and clearly of this disease that murders. Knowing that no vaccine is licensed for human use to prevent Lassa fever infection as at today, this call is timely to avert more preventable deaths from this rat-borne ailment. Rest in Peace, my dear Dr Victor, as I pray God continually comforts your loving parents.

Dr. Adetolu Ademujimi is a Medical Doctor, Health Finance Specialist, Author, Reformer, Coach, Public Policy expert and social entrepreneur who can be reached in Abuja via adetoluademujimi@gmail.com