On the frontlines of the fight against Lassa fever in Nigeria

March 2018

WHO/S. Oka

In early January, John had one of the most terrifying experiences of his life. The mechanic from a rural community in Edo state in southern Nigeria came down with Lassa fever.

“I was scared the illness would kill me,” says John, who prefers to go by a pseudonym.

Initially, he went to a hospital near his home and was discharged a few days later. But he was still feeling unwell, so he consulted another doctor who suspected Lassa fever.

John was taken to the Institute of Lassa Fever Control, a renowned treatment and research centre located in the Irrua Specialist Teaching Hospital, where he was correctly diagnosed and treated.

“I was bleeding through my nose, mouth and ears,” says John.

Lassa fever is an acute viral haemorrhagic fever, which is transmitted through direct contact with the blood, urine or other bodily secretions of an infected person or through exposure to the urine or faeces of infected rats.

“The doctors and nurses were very good,” he adds. “I stopped bleeding.”

The institute in Irrua is at the epicentre of Nigeria’s response to the country’s worst outbreak of Lassa fever on record. It is located in Edo state, where more than 40% of the 365 confirmed cases have occurred. The hospital has a special isolation unit for Lassa fever patients.

“In the isolation ward, we usually take in a maximum of 24 patients but sometimes we get as many as 45 at a time,” says Professor Sylvanus Okogbenin, Chief Medical Director, Irrua Specialist Teaching Hospital. “We have had to put new wards in some of our buildings that are still under construction.”

Isolation tents recently set up by the Alliance for International Medical Action (ALIMA) are being equipped to treat more patients.

The hospital staff are working long hours due to the dramatic increase in their workload.

“You arrive for morning duty but then you end up doing both morning and afternoon duty. We do not have enough manpower,” says Patience Osobase, Assistant Nursing Officer.

While the Irrua institute has not had any Lassa fever infections among its staff, 16 healthcare workers in Nigeria have become infected and four have died. The hospital follows a protocol to prevent transmission from patients to staff, but the heavy workload has challenged these procedures.

The Nigeria Centre for Disease Control (NCDC) is leading the response to the Lassa fever outbreak in collaboration with State Ministries of Health and local government health departments.

“The Nigerian Centre for Disease Control has elevated the response to this outbreak to the very top level,” says Dr Chikwe Ihekweazu, NCDC National Coordinator and Chief Executive Officer. “We have activated our Emergency Operations Centre and we are doing everything we possibly can to respond to this outbreak.”

NCDC, the World Health Organization and other partners have sent staff to support the institute at Irrua. Kevin Ousman – a WHO expert in Infection Prevention Control – is working with healthcare workers to ensure that the infection does not spread within the health facility.

“We have identified what we think are some very quick fixes which are being introduced urgently,” said Mr Ousman. “We are also helping to train staff, ensuring sustainable solutions for the clinic.”

WHO is supporting the response with a focus on strengthening coordination, surveillance, laboratory testing, clinical management, community engagement, and measures for infection, prevention and control.

“The sooner treatment is started, the greater the chances of survival for patients,” says Dr Wondimagegnehu Alemu, WHO Representative to Nigeria. “So it is absolutely crucial that we get patients as early as possible to the treatment facilities.”

John knows that early treatment saved his life. On February 15th he was declared Lassa fever free and discharged from hospital. He is now at home, working on building up his strength by taking walks around the house.

“This sickness does not have to kill people,” he says. John hopes to get back to work soon to be able to support his elderly mother.