29 January 2013

Nigeria: In Denial About Lassa Fever - Prof Tomori

A flurry of activities has kicked off in attempts to contain an outbreak of Lassa fever, which has killed three persons in Benue.

Hundreds have died of the fever since its discovery 44 years ago. Why is Nigeria still battling with Lassa fever? Virology Professor Oyewale Tomori heads a committee of experts which reviews polio eradication efforts and says Nigeria has never been serious about its health.

Lassa fever has been endemic in Nigeria since the 1960s when it was discovered. Why has it become a recurring disease?

Since the first reported outbreak of Lassa fever in Nigeria, we have always adopted an attitude of denial to the disease. We are still in a state of denial, 44 years after the first reported case of Lassa fever in 1969.

Remember, the first cases reported in Nigeria were in missionary doctors and nurses. Though many more Nigerians died from the 1969/1970 Lassa fever outbreaks, the names of the victims publicized were those of the dead and surviving foreign missionary health and other laboratory workers.

At one stage, the people from Lassa and other Nigerians took up arms to change the name of the disease from Lassa fever to something else, in the ignorant believe that it was a disease of foreigners. I remember vividly in 1974 during the Lassa fever outbreak with the first case reported at the Charles Borromeo Hospital in Onitsha, we focused our attention on the expatriate doctor who admitted an expatriate Lassa fever case from the Onitsha hospital into UCH Ibadan.

We hounded him out of the country, and accused him of attempting to spread the dreaded Lassa fever disease all over the country. Such was the case in 1976, when an expatriate worker with Wimpey Construction Company in Pankshin took ill with a disease suspected to be Lassa fever.

He was evacuated to the UK, where the British press went to town declaring there was an outbreak of Lassa fever in Nigeria. Our government also went to the villages to confirm that there was no Lassa fever in Nigeria.

A few days later, the Daily Times of August 23 1976, came out with bold headlines: Lassa Fever Not here Not There. The editorial on that day went on to accuse the entire British media (instigated by the British Government) of trying to sabotage Nigeria's efforts to host the 1977 All Africa Festival of Arts and Culture (FESTAC '77).

Apart from the 1969-70 outbreak of Lassa fever in Jos, it would appear that Lassa fever occurs every year killing an unknown number of people especially in our rural areas. Notable Lassa fever outbreaks were reported in 1974 in Zonkwa and Onitsha; and in 1976 in Pankshin.

In 1989, the epidemic shifted further south, with Ekpoma, Aboh Mbaise, and Aba affected.

The Ekpoma Lassa fever outbreak was distinct from and independent of the Aba-Aboh-Mbaise outbreak. From 1989 till date, we have reports indicating that cases of Lassa fever are seen annually between November and February in Ekpoma area of Edo state.

An outbreak of Lassa fever was reported in Lafia, from December 1993 to February 1994. A single case of Lassa fever was also reported in Lagos of a patient from Ekpoma in August 1994. According to scientific reports, except for a report on a Nigerian Lassa fever case imported to Germany in 2000, no data have been published on Lassa fever activity in Nigeria for the last decade. There were reports of suspected outbreaks of Lassa fever in the northern part of Edo state, including Ekpoma, Igarra, and Ibillo between 2001 and 2004.

The Federal Ministry of Health Epidemiological division reported that in 2011, there were 1172 cases of Lassa fever, with 50 deaths. In 2012, the number of reported Lassa fever cases was 1656, with 112 deaths in 23 states. In spite all these, Nigeria remains unprepared to contain the disease, running like a decapitated chicken in any direction, and forgetting about the disease till another year - another outbreak.

What is your assessment of how Nigeria deals with Lassa fever?

My assessment of how we deal with Lassa fever is summed up in just nineteen words: We have never been serious, nor are ever going to be serious about important developmental issues, including our health.

Forty-four years after Lassa fever was first described in Nigeria, the disease remains an annual recurrent budget of death for the poor people of Nigeria, because we have lived in a state of denial of the disease and handled it with characteristic laxity, laissez-faire, negligence, sloppiness, slackness, disregard, triviality and freewheeling abandon.

From a public health point of view, how best can Nigeria manage Lassa fever--prevention, control, treatment?

The best approach is prevention. You can only carry out the prevention of the disease, when you thoroughly know the epidemiology of the disease - natural host and habits, modes of transmission, as well other factors - environment, human behaviour. When you have such information, you are able to map out and implement interventions for prevention and control. The studies on the rodent host of the disease in Nigeria--their distribution, habits and habitats--are yet to be carried out.

Another important aspect is the awareness of the disease - not only by health workers but also the citizens, especially dwellers in rural areas. I am not sure how many of our medical students or their teachers have seen a case of Lassa fever, or know it when they see it. Yet in 2012, Nigeria reported more than 1,600 cases in 23 states of the federation.

Our different information channels should be used to educate people about the mode of transmission, the roles played by rodents and how to prevent rodents from contaminating food sources with their urine and droppings. Those who hunt field rodents should also be made aware of the dangers of exposure of cuts and abrasions to the virus that may be present in the blood of the trapped rodents.

Currently there is an effective drug Ribavirin used for treating Lassa fever cases; however its effectiveness is dependent upon earlier diagnosis and commencement of treatment within the first week. In a situation of denial, lack of awareness, and near absence of laboratory confirmation, Ribavirin may not be of much use.

At present there are only about two centres for Lassa fever diagnosis and the extent of their work seems uncertain. In addition, samples are still being taken abroad for analysis.

Most of the salient studies that will enable us institute prevention and control as well as treatment interventions, were and are still conducted by foreign institutions or researchers. There is a glimmer of hope: we have a foreign grant supported Institute of Lassa Fever Research and Control (ILFRC), located in Irrua Specialist Teaching Hospital (ISTH), Edo State.

This is the only functional Lassa fever research centre in Nigeria. The other laboratories set up by the federal government never really took off, for such common reasons as lack of genuine government commitment, mismanagement and mis-application of funds by research staff in collaborative collusion with ministry staff.

Each one gladly swallowing money that should have been used to help with preventing deaths from Lassa fever - blood money!! The prayer is that the Irrua outfit will continue to attract foreign grant, because I am sure our government will not put a kobo to support the place. Yet, it was the laboratory that provided all the laboratory diagnosis for the 2012 Nigerian Lassa fever cases.

Why do you think there still has not been a nationwide surveillance to map the distribution of the rodents responsible for transmission of Lassa fever virus in Nigeria?

We do not have a reliable, dependable, responsive disease surveillance system, not just for Lassa fever, but for any fever at all. When our disease surveillance system wakes up, then we will be able to define the burden of the disease, by all its epidemiological parameters. Only then can we begin to map out what research activities to carry out, the results of which will guide our intervention strategies.

Considering it is endemic to Nigeria, what should the country be doing to contain any outbreak?

Overhaul the disease surveillance system. Government must treat disease surveillance with all the seriousness it deserves. The system must be provided with appropriate funding to make it functional. It is a disgrace that the Federal Epidemiology Division does not have the basic requirements for minimal functioning - inadequacy in some areas of adequately trained staff, transportation resources, facilities for data management, laboratory resources. The neglect of epidemiology divisions is a national disease, affecting all the 36 states, including the federal capital territory. It is indeed a chronic disease.

Until we change our attitude to disease surveillance, Lassa fever and other fevers will make mincemeat of us, especially the poor and rural dwellers.

Twenty years ago during the Lafia Lassa fever epidemic, I was asked a question. What do you think can happen in Nigeria to make the country take Lassa fever seriously? Without batting an eyelid, I said 'Not until a big man - a Director General in the ministry, an original minister or a minister of state, an honourable member of parliament, a prominent oba/eze/emir, a governor, or perhaps the vice president or even the president - dies of Lassa fever, before we will take the issue seriously.

Copyright © 2013 Daily Trust. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). To contact the copyright holder directly for corrections — or for permission to republish or make other authorized use of this material, click here.

AllAfrica publishes around 2,000 reports a day from more than 130 news organizations and over 200 other institutions and individuals, representing a diversity of positions on every topic. We publish news and views ranging from vigorous opponents of governments to government publications and spokespersons. Publishers named above each report are responsible for their own content, which AllAfrica does not have the legal right to edit or correct.

Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica. To address comments or complaints, please Contact us.