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.”
No comments:
Write comments