11 March 2009

Nigeria: Battling the Lassa, CSM Outbreaks

Lagos — Nigerians are still reeling from recent outbreaks in Lassa fever and Cerebrospinal Meningitis (CSM), which occurred in various parts of the country. Against alleged inaction on government's part to check the epidemics, Abimbola Akosile examines efforts by the Federal Ministry of Health (FMOH) to curtail the alarming outbreaks

Lassa fever is an acute febrile illness, with bleeding and death in severe cases, caused by the Lassa fever virus. The disease was first described in the 1950s, while the virus was identified and named in 1969 after Lassa, a village in Borno State, North Eastern Nigeria where the first cases of the disease to be described originated.

The reservoir, or host; of the Lassa virus is the 'multimammate rat' Mastonys natalensis. The rats are frequent breeders, produce large numbers of offspring and are numerous in the savannah and forests of West, Central and East Africa.

They also generally readily colonise human homes. These factors contribute to the relatively efficient spread of Lassa fever virus from infected rats to humans.

The symptoms are similar to those of many other common febrile illnesses such as flu, malaria and typhoid. This creates initial problems of diagnosis. Although imprecise, about 200,000 to 500,000 Lassa fever virus infections are estimated to occur every year in West Africa.

Antibodies to the virus have been found in 21 per cent of the population in Nigeria. Approximately 15 per cent -20 per cent of patients hospitalised for Lassa fever die from the illness. The death rate during epidemics is however far higher, ranging between 30-60 per cent.

Lassa fever was outbreak was first recorded in Nasarawa State on January 8 of this year with 2 cases and one death. A total of five cases, 3 deaths were recorded from the state. As at March 3, no new case has been recorded from there.

There were also outbreaks in FCT, Ondo, Anambra, Taraba, and Gombe states. While some of those infected with the fever died, which sparked nationwide alarm, most of the victims were treated by the Federal Ministry of Health, which moved rapidly to allay the fears of the public on the fever.

THISDAY spoke to the Special Assistant to the Minister of Health, Mr. Niyi Ojuolape, who confirmed that in Nigeria, some states including Edo, Borno, Taraba, Ebonyi, Imo, Anambra, Nasarawa and Plateau are known to have been affected by the disease, with high case fatality rates.

One sad development of the Lassa fever scourge is that it has killed quite a number of health workers including doctors and nurses involved in the management and care of patients in hospital settings since the first reported outbreak in the country in 1969.

Ojuolape revealed that Ribavirin (injectables and Tablets) with Personal Protective Equipment (PPE) was supplied to the National Hospital, Abuja, FCT Health Department, Nasarawa, Lagos and Taraba States.

"The FMOH in collaboration with the FCT Health Department and the National Hospital, Abuja conducted Clinicians' sensitisation meeting with public and private health facilities to ensure improved awareness among the health workers for early case detection and prompt management", he disclosed.

To him, the need for appropriate universal precaution to be maintained by all health professionals is therefore imperative to prevent nosocomial transmission.

The FMOH, Directorate of Public Health, through the Division of Epidemiology/Health Emergency Response and Central Public Health Laboratory is to coordinate the control and prevention of Lassa fever infection.

In the case of cerebrospinal meningitis (CSM) there has been a recent upsurge in the reported cases of in the country and this is particularly endemic in the states classified under the Meningitis belt.

The increased number of cases was first noticed in the Zinder Region of Niger republic. The Zinder Region of Niger borders Katsina, Jigawa and Kano States in Nigeria.

Meningitis is a potentially fatal infection of the meninges (a thin lining covering the brain and the spinal cord). It is an epidemic prone disease of public health importance. The bacteria first infect the nasopharynx causing sore throat from whence the infection ascends to infect the meninges and the cerebrospinal fluid.

The signs and symptoms are; sudden onset of fever 38.5C axillary or 38C rectal including all or some of the following, stiffness of the neck, headache, vomiting, irritability, lethargy (severe fatigue), photophobia, seizures, confusion and eventually coma and death.

All ages and sexes are at risk, though children and young adults below 30 years are most affected in the community.

The causative organisms are spread by direct close contacts with the discharges from the nose and throat of an infected person. It therefore follows that staying close to infected persons when they cough, sneezes, shaking hands with them, changing napkins of an infected infant, overcrowding and kissing can predispose a susceptible person to the infection.

As at today, the FMOH has recorded 5,323 cases with 333 deaths in 22 states and 217 LGAs in Nigeria.

According to Ojuolape, it is important that the general populace understand that CSM vaccines are for prevention and the immunity conferred by the vaccine lasts about 3 years; and that the drugs will treat people who get the disease and therefore prevent death and other complications.

Upon receiving the information in January this year of the outbreak in the Zinder region bordering Katsina, Kano and Jigawa states, the FMOH responded immediately.

Its officials brought the information to the attention of the Governors of the three States informing them of the outbreak in Niger republic and the need for them to put in place a mechanism to forestall the outbreak spreading to their States. The Ministry outlined the measures that needs to be taken to forestall this crisis.

It immediately deployed the Ministry's Epidemic Rapid Response Team to undertake supportive supervision and facilitation for active disease surveillance, case detection and investigation in all the 26 'CSM at risk states'; and also commenced the distribution of about 25, 000 doses of the stockpile Oily Chloramphenicol injection to the 26 states.

The FMOH also commenced the process for the procurement of 1.5 million doses of CSM vaccines through UNICEF which has now arrived Abuja and are being distributed to states based on severity of outbreak.

In addition, WHO and MSF has provided 1 million extra doses of vaccines which are being made available to the high risk States.

In addition to the drugs, the Ministry - in collaboration with WHO and other Partners - undertook a training workshop of 26 CSM - at - risk States' Lab scientists, State Epidemiologists, Directors of Public Health and Clinicians to enhance epidemic preparedness and response including surveillance, lab confirmation in Feb 2009.

It convened an advocacy meeting with all State Commissioners for Health from the 26 'CSM at risk states' on the Way Forward to control the epidemic.

The ministry's Development Partners - particularly WHO, UNICEF and MSF - have also provided support for the control of the outbreak which includes Laboratory reagents and consumables, which has assisted the states in confirming the cases of CSM.

Among the challenges faced by the FMOH is her inability to rapidly access significant quantities of vaccines to mount large scale mass vaccination campaign in the affected areas.

This is because of the global shortage of vaccines and the large number of Countries in the Meningitis belt all competing for this limited number of CSM vaccines.

The Federal Ministry of Health is striving to create awareness and give appropriate information to prevent the spread of the outbreak. The Ministry wants the general public and parents in particular to know the symptoms of Cerebrospinal Meningitis.

People should report immediately to their nearest health center if they notice any of these common signs and symptoms fever, headache, neck stiffness, vomiting, irritability and lethargy.

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