IN THE SHADOW OF EBOLA'S DARKNESS

In recent times, we have heard increasingly alarming reports of the continued spread of Lassa fever - the count of Nigerian states affected now standing at ten, viz the northern states of Bauchi, Gombe, Kano, Nasarawa, Niger, Plateau, Taraba, and the southern states of Edo, Oyo, and Rivers. The Nigerian government currently puts the number of deaths from this latest outbreak of Lassa fever at 36 out of a reported 76 suspected cases. Back in March 2014, a similar outbreak had killed 20 people out of about 319 reported cases.

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Although Lassa fever outbreaks are not exactly new to us, we still bear the scars - and hopefully the lessons - of Ebola, and it is important that we treat this Lassa fever outbreak with the fever-pitch awareness that was so instrumental in making Ebola’s stay in Nigeria a relatively short one. This is why, in what follows, we attempt to throw some light on the condition and suggests steps to take to curtail its further spread.

How Do We Get Infected?

Lassa fever is a serious illness that occurs in West Africa and is caused by the Lassa fever virus. The virus is usually passed to us humans

when we breathe in viral droplets from the air
when we ingest the viruses in our contaminated food or drink
when we touch clothing or other objects contaminated with the virus
when we expose ourselves to the open cuts and sores of other people who are already infected by the Lassa fever virus
when we eat rats infected with the virus (there are rural communities where the multimammate rat Mastomys natalensis is considered a delicacy, including some parts of Benue state; yet it is the same rat that is the reservoir for the virus)

It is not clear to what extent the Lassa fever virus can be passed through sexual intercourse. However, infected bodily fluids such as saliva, blood, urine, and semen are considered infectious.

The virus that causes the illness is transmitted to sufferers by a particular type of rat which is called the multimammate rat. This rat may be recognized by the numerous breasts which it carries, and which are visible only when the rat is flipped over so that it lies with its back to the ground and its belly facing up.

A rat that has been infected with the lassa fever virus stays infected throughout its lifetime. The rat passes copies of the virus out in its urine and feces, the droppings themselves being deposited on floors, beds, tables, food, and other surfaces in and around the home. Some of the viral particles in the urine and feces then get into the air where they float until they infect someone who inhales the air. Where the rat’s urine or feces contaminates human food or drink, then the consumption of such food or drink becomes another means by which a person may become infected.

What Are The Symptoms?

About one to three weeks after a person has come in contact with the virus, the person may begin to experience any number of the following symptoms:

sore throat
cough
feeling of unwellness (malaise)
fever (and sometimes shivering)
back pains
abdominal pains (the abdomen is that entire region from below your chest to above your groin; some people call this entire area the stomach, but that is actually the abdomen)
muscle pains
vomiting, which may be persistent
diarrhea (frequent passage of watery stools)
swellings of the face
swellings of the insides of the mouth, nose, throat, vagina, etc.
redness of the eyes
weakness
headache
difficulty breathing

When the illness begins to reach its advanced and fatal stages, other symptoms that begin to emerge include:

generalized bleeding from the mouth, nose, vagina, and other body orifices
vomiting of blood
bloody diarrhea
rashes
disturbances in mental health
problems with the heart and the blood pressure
collapse of different organs in the body including the kidneys, the liver, and the spleen
convulsions

Typically, a person is infectious only when the person has symptoms. But the same person can continue to shed copies of the virus in their urine for three to nine weeks after the beginning of their symptoms. Also, the virus continues to appear in semen for up to three months after the onset of symptoms.

What Can We Do?

Although work is ongoing to find a suitable vaccine for Lassa fever virus, that work is as yet unfinished. Therefore, the prevention and control steps available to take at the moment are the following:

RODENT CONTROL

The rat that carries the virus, the multimammate rat, often lives in rural areas where it breeds very frequently. It also tends to prefer to stay in houses rather than in the surrounding bushes. But where it does stay in bushes, bush-burning activities usually result in the rats scurrying to and living in whatever houses are nearby. Therefore,

Rodents in the house should be killed wherever possible. You may want to get a cat.
Rat-holes should be plugged.
Food and water in the house should be stored (and covered) in rat-proof containers at all times.

HYGIENE AND PERSONAL SAFETY

Frequent and proper handwashings are important. Fortunately, the know-how exists from Ebola days. This Lassa fever outbreak may just be an opportunity for us to remind ourselves of what we learned about handwashing during those dark moments.
As much as possible, and especially in endemic (rural) areas, foods being dried outside should not be left uncovered, lest infected foraging rats deposit their urine and feces on the foods so exposed.
Organic trash should be disposed of far away from human dwellings or buried in the earth and the site of the burial immediately covered up to prevent the inadvertent establishment of a convocation arena for an assembly of the offending rats.
Health workers and other concerned people should avoid contact with the bodily fluids of an infected patient.
Patients who have recovered from Lassa fever should avoid sex for three months. They should also be aware that they continue to pass the virus in their urine for three to nine weeks after the onset of their symptoms.

In summary, to prevent Lassa fever, keep a clean house, a hygienic life, and clean surroundings.

Information sources - all retrieved January 11, 2016.

Hugo Naijaman

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Monday, January 11, 2016

LASSA FEVER [Updated]