Lassa fever: Let’s replicate the 2006-2008 intervention

Dr. Gani Enahoro is Vice President, African Veterinary Association and former President of the Nigerian Veterinary Association of Nigeria.  He bares his mind on the solution to Lassa fever outbreak.

Lassa-fever

“Luckily, there has been a preponderance of circulating “Facts on Lassa Fever” in the social media, since this current outbreak that has affected 94 patients and killed 43 in 10 states as at 13th January 2016, resulting in a Case Fatality Rate of 44%.  This statistic and precautionary measures all trace their source to the press release by the Honourable Minister of Health, Prof. Isaac Adewole. A man I admire so much, since I had close encounters with him during Alumni reunion programmes two years ago as Vice Chancellor of University of Ibadan.
“This public document included the listing of symptoms to watch out for, GSM numbers to call, e-mail addresses for the internet savvy, pathogenesis and epidemiology of Lassa Fever, tracing its origin to rats of Mastomys natalensis- the hairless tail, multi-mammate rat, which is prevalent in West Africa, as the hosts or reservoirs of the Lassa fever virus. It also has an incubation period of 6-21 days with multi system failures that would eventually lead to death.
“The objective of this volume of information is laudable and meant to increase awareness through public education by warning and sensitizing people, but they could sometimes also frighten the citizens about the dangers of Lassa fever. Thanks to the advent of the social media, for making information dissemination very easy, cheap and just a single click away.
“However, beyond this hype and fears, there are fundamental issues and several questions that need to be addressed going forward, if we must conquer the scourge of Lassa fever, and by extension other viral haemorrhagic fevers.
“There must be a change in the past strategies employed by the health authorities, that has failed to stop the recurrence of this deadly zoonotic viral haemorrhagic fever, tapping from the experience of Ebola that we have just recovered from, and which seems to be our lot in West Africa and the successful experience in taming the Highly Pathogenic Avian Influenza popularly called Bird Flu.
“Lassa Fever has been with us since 1969 and is still regrettably being talked about with more frenzy today with a case fatality rate almost thrice the 15% that WHO considers a very bad situation. The reason could be that old and current strategies deployed have been the same and ineffective. As a nation, we must come out of the box and design a new and sincere approach to dealing with a disease that is quite endemic in our region, rather than continue with the fire brigade methods of raising alarm, daily blow-by-blow ministerial updates of deaths on television, setting up one-sided committee, begging for international donations and building professional silos around the outbreaks, as if an island exist around diseases. At best, what those steps have given us was to unfairly concentrate every effort in post infection management of patients and contact tracing of those who related with infected people, rather than a holistic multi-disciplinary approach that is more efficient, prudent and sustainable, when all hands are on the deck.
“The animal-human interface that makes elimination of rats and rodents critical in the case of Lassa fever has been completely ignored or played down, when the committees are formed and when funds are deployed. No expert in that area of competence has ever been found worthy of membership of Lassa Fever Committees, even when an unwieldy number of 26-man omnibus committee of solely medical doctors was formed in 2012.
“The failure of such one-sided panel beating of a very deadly situation is now steering us in the face today with the current recurrence. It sounds more logical that we should worry as much, if not more about the source of the disease and how to control it alongside the care for those already infected, in the hope that we could nip in the bud, exposing more people that could have been infected in future. This is the missing link, which could be traced to pecuniary benefits that may surround the funds that would be provided, under emergency, to deal with the disease. I hope we are all learning from Dasukigate, the infamous arms fund deal that has confirmed that blood money does not stink in some people’s pockets, no matter their status in the society.
“For every student of public health, the first lesson was that no dividing lines exist between human and animal medicine, because more than sixty-five percent of infectious diseases in man are traceable to their animal origins. It then means that collaboration between these two specialties must be promoted at all opportunities for the overall interest of the general public. I must appreciate that just the one time this collaboration was tasked, Nigeria got better for it, and that was during the two major outbreaks of Bird Flu in 2006-2008 and recently last year, the vestiges of which we are still dealing with today.
“The trust in the competence with which the Veterinarians handled the animal component of the disease has currently saved the public an almost equal hype that Lassa has generated. As at January 13, 2016, it was reported that poultry farms in Bayelsa, Plateau, Lagos, Kano and the FCT recorded severe mortality rates due to bird flu. With all modesty, the bio-security and bio-safety measures, introduced by the veterinarians kept the disease away from man in all the cases. It should never be forgotten that person-to-person transmission of mutated strains of HPAI virus is a possibility, with a case fatality rate (CFR) up to 60-70%. This is a more deadly situation than the worst of Lassa hemorrhagic fever outbreak known to history.
“At the peak of bird flu scourge in 2006-2008, what helped most was, that early recognition of animal and human components and the engagement of effective communicators at the Federal Ministry of Information who managed the information desk, and weighed the messages that should be passed to the public through the electronic and print media. Relevant jingles and posters were all over. Why can’t we replicate this beauty of multi-disciplinary intervention when Lassa fever is concerned?
“A more concerted effort is required inter-ministerial from the Federal Ministries of Health, Agriculture, Environment and Information, if we sincerely wish to deal with this scourge. The Pest Control Services section has always been domiciled in the Federal Ministry of Agriculture, just like the Department of Veterinary Services, and not anywhere else. There are Veterinary institutions like the National Veterinary Research Institute (NVRI), Vom in Plateau State, which can boast of diagnostic facilities of a similar Bio-Safety Levels (BSL 3 or 4) that is available at Irrua, which can confirm Lassa or possibly Ebola Viruses, such that samples from patients in Taraba would not have had to be transported all the way to Irrua Specialist Hospital in Edo State for confirmation.
“This benefit can only come from effective inter-disciplinary collaboration. Well, the Hon. Minister of Health has announced the formation of a 4-man Committee to deal with the current Lassa outbreak with Prof Michael Asuzu, who is President of Public Health Practitioners in Nigeria as Chairman. This is a perfect fit, as we await the other members’ identity and know if the change desired from the old ways has come.”