How not to Tackle Lassa Fever

HOW NOT TO TACKLE LASSA FEVER

     Though first described in the 1950s, the virus causing Lassa disease was not identified until 1969 when it was fully discovered in Nigeria, specifically in a village called ‘Lassa’ in Borno State; suffice to say that the virus was named after the said village.

      

Lassa fever is an infectious disease caused by a virus known as ‘Lassa virus’, which is a single-stranded Ribonucleic Acid (RNA) virus belonging to the virus family Arenaviridae. Lassa fever is a zoonotic disease meaning that humans become infected from contact with infected animals. The animal reservoir or host of Lassa virus is a rodent of the genus Mastomys commonly referred to as the ‘multimammate rat’. Mastomys rats infected with Lassa virus do not become ill, but they can shed the virus in their urine and faeces.

      

Thus, Lassa fever is an acute viral haemorrhagic illness of 1-4 weeks duration that occurs typically in West Africa. The Lassa virus is transmitted to humans via contact with food or household items contaminated with urine or faeces of infected rodents such as flying squirrels, rats, rabbits, among others. Person-to-person infections and laboratory transmission are equally possible, particularly in hospitals lacking adequate infection prevention and control measures.

     

Currently, Lassa fever is known to be endemic in Benin Republic where it was diagnosed for the first time in November 2014, Guinea, Liberia, Sierra Leone and parts of Nigeria, and probably exists in other West African countries as well. According to the World Health Organization (WHO), the overall case-fatality rate is 1%; observed case-fatality rate among patients hospitalized with severe incidents of the virus is 15%.

    

About 80% of people who become infected with Lassa virus have no symptoms. Because the clinical course of the disease is so variable, its detection in infected patients has been very difficult. It is worth noting that one in five infections result in severe disease, where the virus affects several essential organs to include the liver, spleen and kidneys. It has been proven that when presence of the disease is confirmed in a certain community, prompt isolation of affected or suspected persons, good infection protection and control practices, as well as rigorous contact tracing can stop the outbreak.

    

The incubation period of Lassa fever ranges from 6–21 days. The onset of the disease when it is symptomatic is usually gradual starting with fever, general body weakness, and malaise. After a few days, headache, sore-throat, muscle pain, chest pain, nausea, vomiting, diarrhea, cough, and abdominal pain may follow suit. In severe cases, facial swelling, fluid in the lung cavity, bleeding from the mouth, nose, vagina or gastrointestinal tract, and low blood pressure may develop. Protein may be noted in the urine in some cases. More so, shock, seizures, tremor, disorientation, and coma might be observed in the later stages.    

      

Deafness occurs in 25% of patients who survive the disease; in half of these cases, hearing returns partially after 1-3 months. Transient hair loss and gait disturbance might set in during recovery stage. Death often takes place within 14 days of onset in fatal incidents. The disease is mostly severe in pregnancy, with maternal mortality and/or foetal loss occurring in greater than 80% of incidents during the third trimester.

     

Lassa virus can also be spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of a person infected with the virus. We must note that there’s no epidemiological evidence supporting airborne transmission between humans; but the virus can be spread via sharing of medical equipment such as needles as well as through sexual acts.

      

Since Lassa fever can be hardly distinguished from other haemorrhagic fevers like Ebola virus disease and many other diseases that cause fever including malaria, typhoid, yellow fever, shigellosis, its infections can only be diagnosed definitively in the laboratory using the following tests: antibody Enzyme-Linked Immunosorbent Assay (ELISA), virus isolation by cell culture, Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) assay, and/or antigen detection tests.

    

The antiviral drug, Ribavirin seems to be an effective treatment for Lassa fever if given early in the course of clinical illness. There is no proof to support the role of ribavirin as post-exposure prophy lactic treatment for Lassa fever. Currently, there’s no vaccine that protects the body against Lassa fever.

    

In a critical situation like this, we cannot ignore the obvious fact that prevention is far better than cure. Since Lassa fever is yet to boast of a vaccine, the most reliable preventive measure remains total abstinence or optimum utilization of avoidance approach. The general public, particularly our young ones, rather than posting comic commentaries on various social media as regards the epidemic ought to be meant to acknowledge this fact headlong without much ado. It’s baffling to realize that most people are making fun of an epidemic that have claimed several lives, thus all hands are expected to be on deck towards orientating the populace.

    

In view of the above assertion, it’s worthy to note that measures such as sustenance of community hygiene to discourage rodents from entering living places, storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from homes, maintaining clean households and keeping cats away from our consumables, are mostly required. Similarly, family members should always be careful to avoid contact with blood and other bodily fluids while caring for sick relatives.

     

People must also desist from consuming raw foods, or intake of foods and waters that are not properly boiled or cooked as the case may be. In the same spirit, any fruit or vegetable gotten from the gardens that have already been pierced or bitten by animals, probably squirrels, should be thoroughly washed with salt and water, and thereafter ought to be well heated before they would be consumed.

    

On their part, health workers caring for patients with suspected or confirmed Lassa fever should apply extra infection control measures to prevent contact with the carrier’s blood and other bodily fluids as well as contaminated surfaces or materials such as clothing and bedding. When in close contact with Lassa fever patients, health care attendants should endeavour to wear face mask cum goggles, a clean long-sleeved gown, and gloves. Laboratory technicians are also advised to properly handle samples taken from humans or animals for investigation of Lassa virus infection and ought to be processed in suitably equipped laboratories.

     

More so, travellers coming from other countries especially West African nations should be quarantined on arrival at the airports and therein adequately tested for Lassa fever as well as other related infections. Among all, we shouldn’t be cautious of only rats regarding the primary source/host of the virus as it is presently witnessed; rather we must endeavour to secure our edibles from other forms of rodent especially the ones within our reach to include squirrels and mice as well as cats which are invariably kept as pets by several families. To before warned is to before armed. Think about it!

 

Comr Fred Doc Nwaozor
Follow: @mediambassador  

             

Avian Influenza: Not Again!

AVIAN INFLUENZA: NOT AGAIN!

     It’s only a-day old kid that is yet to realize that Nigeria is currently bewildered by the reemergence of Avian Influenza popularly known as ‘Bird flu’. When Ebola virus was on board in the country some months ago, as an analyst and activist, in most of my commentaries I categorically stated that Nigeria would surely overcome the scourge if we could employ severe and sustainable measure just as we did during the era of avian influenza.

     To have used avian influenza as an instance as regards severe approach towards containing an epidemic signified that undoubtedly every needed step was taken when the country firstly experienced the disease (Bird flu) in 2006. To this end, the capital question that needs to be asked at this point is: why the reemergence, or why is the country experiencing the outbreak for a second time barely after nine years of its initial occurrence?

     The country was able to overcome the said pandemic infection during its previous outbreak, specifically in 2006, owing to the tactical and drastic approach employed by the government and other concerned bodies. This implies that the reemergence of the menace might not be unconnected to the fact that we went to sleep or on a recess; that is, apathy on the part of the concerned authorities and personnel regarding sustenance of the measure initially utilized. In view of this assertion, it’s high time we are awoke.

     Presently, survey indicates that seven outbreaks of highly pathogenic Avian Influenza have been discovered in Nigeria. Six of the A(H5N1) outbreaks were reported in the central and northern regions of the country, which affected states like Kano, Plateau, and the Federal Capital Territory (FCT); over 21 thousand birds were reportedly killed while over 17 thousand were destroyed in these six outbreaks. Another outbreak occurred in the southern region of Bayelsa, affecting 8-week old pullets; 850 poultry died whereas 2150 were destroyed in this very outbreak. Officials said that farm workers visit other farms in the affected areas, which has great implications for possible infection routes and biosecurity.

     Avian influenza is an infectious viral disease of birds particularly wild water fowls like ducks and geese among other such animals as pigs, whales and horses. Most avian influenza viruses don’t infect humans; however, some to include A(H5N1) and A(H7N9) have caused serious infections in people. It is noted that outbreaks of A1 in poultry may raise global public health concerns as a result of their effect on poultry populations, their potential to cause serious disease in people, and their pandemic potential.

     The majority of human cases of A(H5N1) and A(H7N9) infection have been associated with direct or indirect contact with infected live or dead poultry. There is no evidence that the virus can be spread to people through properly cooked food. It’s worthy to acknowledge that controlling the disease in animals is the first and basic step towards curtailing risks to humans. It often causes no apparent signs of illness among the infected animals.

     A1 viruses can sometimes spread to domestic poultry and cause large-scale outbreaks of serious disease. Some of these A1 viruses have also been reported to cross the species barrier and cause disease or subclinical infections in humans and other mammals. We need to note that A1 viruses are divided into two major classes based on their ability to cause disease in poultry namely, high pathogenicity and low pathogenicity.

      Highly pathogenic viruses usually result in high death rates, up to 100% mortality within forty-eight hours in some poultry species. On the other hand, lowly pathogenic viruses also cause outbreaks in poultry but are not generally associated with severe disease or attack.

     The case fatality rate for A(H5N1) and A(H7N9) virus infections in people is much higher compared to that of seasonal influenza infections. The A(H7N9) virus mostly affects people with underlying medical conditions. In many patients, the disease caused by the A(H5N1) virus follows an unusually aggressive clinical course with rapid deterioration and high fatality. Like most emerging disease, A(H5N1) influenza in humans is yet to be well understood.

     The incubation period for A(H5N1) Avian Influenza may be longer than that for normal seasonal influenza which is around two to three days. Current data for A(H5N1) infection indicate an incubation period  ranging from two to eight days or possibly as long as seventeen days. Whilst, present data for A(H7N9) infection indicate an incubation period ranging from two to eight days.

     Initial symptoms of Avian Influenza include high fever usually with a temperature higher than 38 degrees Celsius, and other influenza-like symptoms including cough and sore-throat. In some patients, signs such as diarrhoea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums might also be noticed. One feature often seen in most patients is the development of lower respiratory tract in the early stage of the illness; also, a hoarse voice, respiratory distress, and a crackling sound when inhaling are commonly observed. Sputum production varies in individuals and sometimes bloody. Complications of A(H5N1) and A(H7N9) infections include hypoxemia, multiple organ dysfunction, as well as secondary bacterial and fungal infections.

     The fundamental risk factor for human infection, as stated earlier, appears to be direct or indirect exposure to infected live or dead poultry, or contaminated environments such as live bird markets. Indeed, controlling circulation of the A(H5N1) and A(H7N9) viruses in poultry is essential to reducing the risk of human contraction. There is no proof to suggest that the aforementioned viruses can be transmitted to humans through properly prepared poultry meals including meats and eggs.

     A few A(H5N1) human cases have been linked to consumption of dishes made of raw or contaminated poultry blood. More so, slaughtering, defeathering, handling carcasses of infected poultry and preparing poultry for consumption especially in household settings are likely to be risk factors. Most importantly, it’s imperative to comprehend that most humans have little or no immunity to A(H5N1) and A(H7N9) viruses.

      Strong evidence suggests that some antiviral drugs, notably Oseltamivir, can reduce the duration of viral replication as well as improve prospects of survival. In suspected cases, the aforesaid drug ought to be prescribed as soon as possible, ideally within 48 hours following symptom onset, to maximize its therapeutic benefits. Notwithstanding, given the significant mortality currently associated with A(H5N1) and A(H7N9) infection and evidence of prolonged viral replication in this disease, administration of the drug should also be considered necessary in patients presenting the symptom(s) later in the course of illness. Mind you; the use of corticosteroids is prohibited.

     In cases of severe infection with the viruses, clinicians may need to consider increasing the recommended daily dose and/or the duration of treatment. In severely ill A(H5N1) or A(H7N9) patients, or in carriers with severe gastrointestinal symptoms, drug absorption may be impaired; this possibility ought to be considered when managing these patients. Furthermore, most A(H5N1) and A(H7N9)  viruses are predicated to be resistant to adamantine antiviral drugs, which are usually recommended for use during treatment.

     According to World Health Organization (WHO), in view of the persistence of the prevalent avian influenza viruses in some poultry populations, control or eradication would require long-term commitments from affected countries as well as strong coordination between various animal and public health authorities.

     Acknowledging the unarguable fact that prevention is extremely better than cure, there’s a compelling need for the general public to be thoroughly educated on the prime causes and mode of transmission of the virus. Since human-to-human transmission is presently far-fetched or rarely possible, it’s imperative for us to apply adequate caution while dealing with the primary hosts of the dreaded virus such as fowls, ducks, pigs, whales, and horses, among others, particularly the fowls or poultry at large which are the closest to human beings; hence, the various poultry owners across the federation ought to be properly sensitized in respect to this obvious fact.

      The farmers in question must be meant to comprehend that there’s need for them or anyone else who intends to enter into their farms to be well kilted. There’s also a crucial need for the said farms and other related environments like poultry markets and what have you, to be adequately fumigated from time-to-time. Every poultry keeper, or livestock farmers in general should ensure that his/her farm is entitled to a qualified and reliable veterinary doctor and the medic ought to endeavour to regularly visit the farm. In the same vein, poultry consumers ought to be conscientized to endeavour to properly boil or cook any meat or egg before consumption. The media, ministries of Agriculture, various farmers’ unions, the civil society and the National Orientation Agency (NOA) have a very vital and cogent role to play in this aspect.

      Similarly, the concerned government authorities or agencies, but not limited to, ought to regularly make the Avian Influenza vaccine available in every nook and cranny of the country to enable the citizenry assess them easily; and such practice should be subsequently sustained even having overcome the scourge. No doubt, the above proposed measure if holistically adhered to would go a long way towards salvaging the country in its entirety from this unforeseen mess. Think about it!

 

Comr Fred Doc Nwaozor
Follow: @mediambassador  

Aftermath of Imo Concession Policy

AFTERMATH OF THE IMO CONCESSION POLICY

      Few nights ago, I was as not unusual listening to my radio set with keen passion not until I became saturated with the very station I was following; hence I thought it wise to touch the dial with the intention of tuning to other wave bands to ascertain which one would suit my listening pleasure. Before I could take the step as planned, a melody that rekindles my humble soul was instantly played by the Disc Jockey on duty; consequently, therein my arms became seemingly paralysed or were tightly tied.

      What is currently witnessed in Imo State otherwise known as the ‘Eastern Heartland’ as regards the state’s recent concessioning policy might be synonymous with the above narrative. The former comprises Gov Rochas Okorocha, Imo workers and the Nigerian Labour Congress (NLC), whereas the latter (the narrative) is made up of the radio set, the listener and the Disc Jockey (DJ); in this case, Gov Okorocha could be linked to the listener having linked the Imo workers to the radio set, whilst the NLC is apparently similar to the DJ. The rest is history.

      Let’s face the reality. It is no longer news that most of the state-owned parastatals and agencies in the said state were recently concessioned by the Rochas Okorocha led administration; and in consequence to the measure, the affected civil servants were purportedly suspended indefinitely by the government - a mandate that had succeeded in generating uncontrollable uproar both in the state and beyond.

      The NLC has warned the workers involved not to adhere to the purported suspension notice issued by the state government thereby asking them to remain in their various offices and duty posts without exercising any iota of fear even if they are served with death warrants owing to their rebellion.

      In respect to the directive of the NLC, I reportedly learnt that efforts made by the Transition Committee Chairmen of most of the LGAs in the state who had gone to displace the distressed workers in their respective councils with the help of security personnel as were instructed by the government proved abortive. According to news making the rounds, the futility of their efforts was not unconnected to the repulsive measure taken by the members of the host communities where the various affected parastatals are situated; apparently the communities in question are not gladdened by the ‘unjust’ treatment received by the poor workers.

      I, albeit humorously, mocked one of my childhood friends some days ago amidst an informal gathering. Thereafter, the said fellow confided in me and disclosed wholeheartedly that he learned a lot from the sarcasm I used on his person. What are we saying in essence? Life is all about criticisms and ability of the supposed recipient to absorb or manage the constructive ones effectively. Thus if a certain criticism is targeted to someone, he/she ought not to be dismayed by the gesture, rather is expected to try as much as possible to learn something tangible from it.

      Concessioning, disengagement, suspension or what have you, may have been the order of the day in Imo thereby constituting series of cacophony in various quarters, but it’s imperative for us to comprehend some vital facts attached to the seemingly unpleasant or unwanted scenario. Lest I forget; this very piece was informed by the one I did penultimate week entitled ‘Okorocha and the suspended Imo workers’, the subsequent reactions generated by the piece in question as well as the latest development in regard to the purported disengagement.

      The fundamental and crucial facts we are meant to acknowledge are as follows: concessioning of firms or parastatals is a worthwhile idea provided tangible and rational reasons are given, and in this case we were informed the action taken by the government was occasioned by the obvious fact that the affected parastatals were moribund. Another vital fact is that most of the workers involved are due for retirement; hence deserve to go for a compulsory rest so that new ones or young and vibrant prospective civil servants would fill the gap – this would also go a long way to increase productivity because the old bloods are indeed weak and incapacitated.

       But at this juncture, we need to ask ourselves some rudimentary questions. If truly that those parastatals were moribund, who or what prompted their disgusting physiognomies? Was it the government, the workers or the public? Unravelling the answers to these questions would save us from distress. Unequivocally, it’s pitiable that every occurrence had been blamed on the present economic meltdown in the country; to this end, there’s a compelling need for us to go back to the drawing board with a view to putting some paramount things in order, especially at this moment we are preoccupied with the way forward or diversification of the existing IGR sources.

      Gov Rochas Okorocha might have taken a gigantic and commendable step but it’s important for his Excellency to note that diplomacy remains the best avenue towards reaching a dialogue, unless he actually doesn’t believe in the aforesaid factor – dialogue. Right now, in the interest of Imolites and the state at large, every logical being would understand that the only option is that the amiable and people friendly governor need to cuddle the affected workers and the labour union in general. Thus, it’s high time we went back to the discussion table.

      Several discussions undoubtedly might have taken place prior to this time but there’s need and room for more. Any project begins with discussion and equally ends with it. We can’t continue like this because the scene is already telling on the entire Imo populace coupled with the ongoing economic crisis, therefore there’s an urgent need for total turnaround. The private investors involved ought to also assist in the proposed peace talk if their intentions are really genuine. On their part, the workers and the NLC as an organized body must endeavour to eschew violence at all cost because that is the least we expect from them.

      My paramount worry is that the health sector is deeply affected by the ongoing mayhem especially at this moment the entire country is experiencing the reemergence of Lassa fever and Avian Influenza popularly called ‘Bird flu’ which is tantamount to placing the state’s health status to a state of jeopardy. The health workers whom are not willing to leave or vacant their duty posts are being heavily distracted on a daily basis, and we are aware of the consequences of such scenario. It isn’t funny at all.

I just learnt that the affected workers had been asked to report to their respective ministries or places of primary assignment for onward relocation or posting to other viable parastatals, departments or agencies. It’s no doubt a welcome development but I candidly plead with the government not to play politics with such sensitive issue that has already overheated the polity. Think about it!

 

Comr Fred Doc Nwaozor

Follow: @mediambassador