Confronting A Crisis: Nigeria’s Public Health Response To Lassa Fever Outbreak

Nigeria is in the midst of a public health crisis, fighting its biggest outbreak of Lassa fever to date. On April 1, the Nigeria Centre of Disease Control (NCDC) released a report announcing six new confirmed cases in the five states- Edo, Ondo, Bauchi, Plateau, and Abia. The report also confirmed two new deaths as a result of the outbreak. There have been 1706 suspected cases of Lassa Fever between January and April of 2018.

Since its onset in 2018, the Lassa Fever outbreak has been responsible for 92 confirmed deaths and nine probable deaths. The Case Fatality Rate in confirmed cases is 24.3%, indicating that roughly one in four people who contract the disease does not survive. The latest data shows a decrease in the incidence of new infections over recent weeks, indicating that Nigeria’s public health reaction has been somewhat successful in containing the outbreak. Although there has been a decline in the incidence of this illness over recent weeks, WHO representative to Nigeriaile, Wondimagegnehu Alemu, believes that Nigeria is not free from threat. Dr. Alemu warns that we need to be cautious of this trend. According to him, “We should interpret the recent declining trend in new cases with caution. The Lassa fever season is not yet over. We need to maintain vigilance and response operations, and ensure continued engagement with communities to help curb the further spread of Lassa fever.”

Nigeria is a federal republic in West Africa that borders Niger in the north, Chad and Cameroon in the east, and Benin in the west. The West African country is often referred to as the “Giant of Africa,” due to its large population and emerging economy. Nigeria’s north-east has faced one of the most severe humanitarian crises in the world due to the ongoing conflict over the last nine years. The crisis has led to issues regarding internal displacement and food insecurity, as well as a lack of essential health care services. According to the WHO, approximately one-third of the 749 health facilities in the state of Borno have been destroyed, causing people in the region to rely on mobile medical clinics to receive critical health care services. Unfortunately, the constant conflict in this region has made it difficult for the WHO and other health agencies to access those most in need of medical support.

Lassa fever, or Lassa hemorrhagic fever (LHF), is an acute viral disease that spreads to humans from exposure to urine and feces of Mastomys rats. A person can also become infected through direct contact with the blood, urine, and other bodily secretions of an infected person. Individuals living in crowded communities with poor sanitation are at a higher risk of contracting the infection. The infection can also be transmitted in healthcare environments- such as contaminated medical equipment, and particularly re-used needles cause the disease to spread. While it is intuitive to think of a healthcare environment as a safe place to treat infection, it is actually the site of many new transmissions. Health care workers are particularly susceptible to contracting the fever if they fail to use the adequate personal protective barriers and infection prevention practices when treating their patients.

This illness is endemic in Nigeria, as well as in Ghana, Guinea, Mali, Benin, Liberia, Sierra Leone, and Togo. The first documented incidence of Lassa fever comes from a case in Nigeria’s Borno state in 1969, when the virus was discovered as the cause of death of two missionary nurses, and was then named after the town in Nigeria in which that occurred. It is therefore evident that this is not the first time Nigeria has faced this threat. In fact, WHO reports that the country is currently in the midst of several concurrent public health emergencies, including Lassa fever, cholera, and a humanitarian crisis in the northeast of the country. Public health officials have also had to manage 341 suspected cases of yellow fever between July and December of 2017. However, the threat of contracting this illness, which is transmitted primarily by mosquitoes, has been diminished through widespread vaccination campaigns and mosquito control.

In order to prevent the further spread of the present Lassa fever outbreak, there has been a multi-agency public health response in Nigeria. On January 22, a national Emergency Operations Center (EOC) was established in Abuja in an effort to effectively coordinate a response and collaborate with external partners. Nigeria’s three most impacted states, Edo, Ondo, and Ebonyi, have also established Lassa fever treatment centers where ribavirin, the antiviral medication used to treat viral hemorrhagic fever, is readily available. The WHO has partnered with the NCDC and other organizations to deploy crisis teams to the areas with the highest prevalence of infection. These teams have worked together to identify and treat patients on the ground, as well as prevent the spread of further transmission in health facilities through the implementations of prevention protocols and community engagement.

Lassa fever is recognized as a “priority pathogen,” with the potential to incite a large-scale public health emergency. Critical research is being conducted on the current outbreak of the viral disease in an attempt to prevent any future crises. Preliminary research shows that this outbreak in Nigeria was caused by a strain consistent with other outbreaks, meaning the outbreak was not the result of a more evolved and virulent strain. To that end,  Chief Executive Officer of the NCDC, Dr, Chikwe Ihekweazu, has said, “We are researching what has led to so many people becoming infected with Lassa fever. Even with a downward trend, until we can better understand the causes behind its rapid spread, we must treat the outbreak as a priority.”