Alan is 35 years and lives in the rural area. She is married to a farmer and together they have 5 children with her youngest child just clocking 8 months of age. Recently sleeping at night has been an issue for her family, as rats hold their council meetings in her home and all methods employed to deal with these creepy little mammals had so far proved abortive.
She sleeps with her 5 children and husband in one room. In her kitchen,she stores household food stuff and her ritual almost every morning was to clean rat faeces deposited by the rats during their night council meetings; yet every day the size of the droppings seemed to increase. She sometimes noticed these black droppings in her garri bag which was usually not properly closed as well as the rice bucket which had a broken cover but ignorant Alan ignored these all as she said “Dirty no dey kill African man.”
“How can I discard a whole bag of garri and bucket of rice”, she murmured to herself; NO WAY!!!What will these children and mama eat? She throws her refuse at the back of her house and rats usually feasted on discarded food remnants all day long. One of the favourite pastimes of her children was killing these rats with their catapults and handling dead rats with their bare hands.
In fact many times they conducted mini rat killing tournaments and any one that killed the highest number of rats usually went home with the bragging rights.
Three weeks ago she suddenly started feeling weak and developed a fever. Her husband took her to the local chemist who gave her antimalarial and anti-typhoud medications as well as drugs for her fever, however her symptoms worsened as she soon started vomiting and passing watery stool. Her baby who was been breastfed also started having similar symptoms.
Seven days later,despite the earlier treatment the fever still persisted and she started having severe abdominal pain as well as difficulty in swallowing. She was then rushed to the General Hospital by her husband. By this time three of her other children were ill. She was investigated and again treated for typhoid fever and despite the drugs she was on, her condition seemed to worsen.
Two days into the admission her eight months old baby who was been breastfed died by her side. While grieving for her baby she suddenly started vomiting blood and bleeding from her nostrils.
The doctor in charge of the health facility immediately became suspicious and reasoned he could probably be dealing with a viral haemorrhagic fever. Blood samples were taken from her and a call was put across to the State epidemiologist, who responded quickly. Few hours later Alan gave up the ghost.
Her blood sample was taken to the infectious disease laboratory and the fear of the doctor came true, when he received a call from the epidemiologist. His hospital had just handled a case of Lassa fever.
Lassa fever also known as Lassa Hemorrhagic fever is an acute viral haemorrhagic illness which is caused by the Lassa virus a single-stranded RNA virus.
Lassa fever was first described in the 1950s, however the virus causing Lassa Fever was not identified until 1969 when two missionary nurses died in Lassa a town in Bornu State Nigeria. Lassa fever is endemic in parts of West Africa including Sierra Leone, Liberia, Guinea and Nigeria.
SIGNS AND SYMPTOMS
80% of people who come in contact with the virus either have no symptoms or come down with mild symptoms and are undiagnosed. The remaining 20% are symptomatic. Symptoms usually begin 6 – 21 days after contact with the virus.
Symptoms are non-specific and may include fever, general malaise and weakness as well as headache.
Symptoms may progress to include vomiting and stooling which may be bloody, stomach pain, difficulty in swallowing, unexplained bleeding, difficulty in breathing, chest pain and shock.
Some patients may also have hearing loss, seizures, meningitis and encephalitis. Death usually occurs as a result of multi-organ failure. Pregnant women in the 3rd trimester usually have high death rates;not forgetting high rates of spontaneous abortion. Because of how unspecific and variable the symptoms of Lassa fever are, it is usually difficult to diagnose clinically.
Multimammate rat a rodent found in most homes and eaten as a delicacy in some areas is the host of Lassa Virus. When these rats
become infected with the Lassa Virus they do not become ill, but rather they shed the virus in their urine and faeces.
Humans become infected by direct contact with infected rats and their excrement. Contact with the virus can occur through inhalation of excrements which can occur during sweeping and dusting. It can also occur through eating contaminated food, exposure to cuts and open wound and touching of contaminated material. It can also be contacted directly by eating contaminated rats.
Person to Person transmission occurs via direct contact with body fluids and secretions of infected individuals. Sexual transmission of Lassa virus has been reported. The virus is excreted in urine for 3-9 weeks and in semen for 3 months. There is no evidence of airborne person to person transmission. Health workers and caregivers are at a very high risk of been infected.
Definitive diagnosis requires testing that is available in only specialized laboratories.
At present there is no vaccine available that protects against Lassa fever. Ribavarin an antiviral drug has been found to be very useful in the treatment of Lassa fever patients especially when started early.
PREVENTION AND CONTROL
The role of community hygiene in the prevention of Lassa fever cannot be overemphasized. Foodstuff and grains should be stored in Rodent-proof containers; refuse thrown far from the house which must be properly cleaned. Placement of traps in and around homes can help reduce rodent population. Bear in mind that rats must not be handled or eaten and keeping of cats should be encouraged.
Family members should avoid touching body fluids while caring for sick persons. Hospital Staff should always apply universal safety precautions when handling patients.
In Nigeria, healthcare workers seeing a patient suspected to have Lassa fever should immediately contact the Local Government Disease Surveillance and Notification Officers (DSNOs) and/or epidemiologist in the State
Ministry of Health or call the Federal Ministry of Health using the following numbers: 08093810105, 08163215251, 08031571667 and 08135050005.