30 January 2023 | NCDC Activates Lassa fever Emergency Operations Centre to Strengthen the Response to Rising Cases of Lassa Fever in Nigeria
The Nigeria Centre for Disease Control and Prevention (NCDC) has activated the national multisectoral Emergency Operations Centre for Lassa Fever (LF-EOC) at level 2 to coordinate and strengthen ongoing response activities in the country. The LF-EOC was activated following a risk assessment carried out on the 20th of January 2023 by subject matter experts from the NCDC, relevant Ministries, Departments, and Agencies (MDAs), stakeholders and major partners. The outcome of the risk assessment placed the country at a very high risk of increased Lassa fever transmission due to the following;
An unprecedented upward trend in the number of confirmed cases being reported compared to previous years.
Increased number of states reporting cases in comparison to previous years
Increased risk of healthcare worker infections and deaths due to Lassa fever infection
The situation report of 22nd January 2023, showed a total of 244 confirmed cases with 37 deaths and a case fatality rate of 15.1 % from 16 states and the FCT - Ondo (90), Edo (89), Bauchi (13), Taraba (10), Benue (9), Ebonyi (9), Nasarawa (7), Plateau (5), Kogi (4), Anambra (2), Delta (1), Oyo (1), Adamawa (1), Enugu (1), Imo (1), and FCT (1). Infection and death among the healthcare workers accounted for 5 and 1 of the of the confirmed cases and deaths respectively highlighting the need for an increased index of suspicion among healthcare workers.
The purpose of EOC activation is to achieve a coordinated national response and especially across the affected states to interrupt disease transmission, reduce the impact of the disease by reducing suffering and death (morbidity and mortality), and other socioeconomic complications of this disease.
Healthcare is a collective responsibility of communities and governments at all levels. While the NCDC is mandated to lead the prevention, emergency preparedness, and response to public health emergencies, we rely on the cooperation and support of States in the development and implementation of evidence-driven outbreak response plans for their territories.
Prior to the activation of EOC, the Nigerian government through NCDC's multisectoral Lassa Fever Technical Working Group (TWG) had put the following measures in place to respond to the rising cases of Lassa fever:
Prepositioning of medicines and commodities to support Lassa fever response management
The deployment of national rapid response teams (NRRT) to hotspot states to support contact tracing, case management, risk communication and community engagement, among others.
Development of a national Incident Action Plan (IAP) to ensure coordinated response at all levels.
Planned deployment of Surge staff for Lassa fever case management to high-burden states
Ahead of the projected rise of Lassa fever cases and as the country began to witness a rise in cases in the last week on November 2022, the NCDC prepositioned supplies for case management, infection prevention and control, laboratory diagnosis, etc. in all historical Lassa fever hotspots in the country. This was complemented by correspondence sent to the Honourable Commissioners of Health, the Nigerian Governors’ Forum, State Ministries of Health, and respective professional bodies of healthcare workers to alert and sensitize them on the situation as well as to advocate for in-State activities to respond to Lassa fever.
About Lassa Fever
Lassa fever is an acute viral haemorrhagic fever (VHF) caused by the Lassa virus. The natural reservoir for the virus is the Mastomys natalensis rodent (commonly known as the multimammate rat or the African rat). Other rodents can also be carriers of the virus.
The virus spreads through:
Direct contact with urine, faeces, saliva, or blood of infected rats.
Contact with objects, household items and surfaces contaminated with the urine, faeces, saliva, or blood of infected rats.
Consuming food or water contaminated with the urine, faeces, saliva, or blood of infected rats.
Person-to-person transmission can also occur through contact with blood, urine, faeces, vomitus, and other body fluids of an infected person.
Lassa fever initially presents like other commonplace illnesses accompanied by a fever such as malaria. Other symptoms include headache, general body weakness, cough, nausea, vomiting, diarrhoea, muscle pains, chest pain, sore throat, and in severe cases, bleeding from ears, eyes, nose, mouth, and other body openings. The time between infection and the appearance of symptoms of the disease is 3 to 21 days. Early diagnosis and treatment of the diseases greatly increases the chances of patient survival.
People most at risk for Lassa fever are:
People of all age groups who come in contact with the urine, faeces, saliva or blood of infected rats.
People living in rat-infested environments.
People who consume potentially contaminated foodstuff, especially those left open overnight or dried outside in the open.
People who handle or process rodents for consumption.
People who do not perform hand hygiene at appropriate times.
Caretakers of infected persons with poor infection prevention and control measures.
Healthcare workers including:
Doctors, nurses, and other health workers that provide direct patient care in the absence of standard precautions.
Hospital staff who clean and disinfect contaminated surfaces, materials, and supplies without adequate protective gear.
Laboratory staff who handle blood samples of suspected Lassa fever patients without appropriate precautions.
Persons who prepare and or handle bodies of deceased Lassa fever cases without appropriate precautions.
The Nigeria Centre for Disease Control and Prevention (NCDC) offers the following advice to reduce the risk of Lassa fever infection:
Keep your environment clean always.
Block all holes in your house to prevent the entry of rats and other rodents.
Cover your dustbins and dispose of refuse properly. Communities should set up dump sites very far from their homes to reduce the chances of having rodents within their homes.
Store foodstuff like rice, garri, beans, corn/maize etc. in containers that are well covered with tight-fitting lids.
Avoid drying food stuff outside on the floor, or roadside where it will be at risk for contamination.
Avoid bush burning which can lead to the displacement of rats from bushes to human dwellings.
Eliminate rats in homes and communities by setting rat traps and other available means.
Practice good personal and hand hygiene by frequently washing hands with soap under running water /or use of hand sanitisers when appropriate.
Visit the nearest health facility if you notice any of the signs and symptoms associated with Lassa fever as mentioned earlier
Healthcare workers are advised to always practice standard precautions: i.e., wear gloves and other appropriate personal protective equipment while handling patients or providing care to an ill patient/relative.
Healthcare workers should maintain a high index of suspicion for Lassa fever i.e., be vigilant and consider a diagnosis of Lassa fever when seeing patients presenting with febrile illness.
Healthcare providers should report all suspected cases of Lassa fever to their local government Disease Surveillance and Notification Officer for immediate access to healthcare. This is essential because early identification and treatment of cases appear to be more effective and can save lives.
The Nigeria Centre for Disease Control and Prevention (NCDC) is the country’s national public health institute, with the mandate to lead the preparedness, detection, and response to public health emergencies. The Bill for an Act to establish NCDC was signed into law in November 2018 by President Muhammadu Buhari. The mission of the NCDC is to protect the health of Nigerians through evidence-based prevention, integrated disease surveillance and response, using a One Health approach, guided by research, and led by a skilled workforce.
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Dr Ifedayo Adetifa
Nigeria Centre for Disease Control and Prevention.