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New Image International:'An ugly disease that always comes as a surprise': On the front line of Nigeria’s Lassa outbreak

'An ugly disease that always comes as a surprise': On the front line of Nigeria’s Lassa outbreak

Global newsJune03

The epidemic, which started in December, has already claimed 40 lives this year. The fever is endemic in much of West Africa. As one of three members of the same family diagnosed with Lassa fever died in a Bedfordshire hospital on Friday, doctors in Nigeria were working around the clock at the epicentre of an outbreak.

The epidemic, which started in December, has already claimed 40 lives this year. The fever is endemic in much of West Africa, where there are around 100,000 infections every year and an average of 5,000 deaths.

“It’s an ugly disease that always comes as a surprise,” said Dr Hilde de Clerck, emerging infectious diseases expert at Médecins Sans Frontières (MSF). “When people present with severe diseases, often the kidneys are heavily affected, there’s fluid in the face and body, they’re sometimes bleeding, they lose their hearing, they deteriorate very quickly.”

Lassa fever is an acute viral haemorrhagic illness, similar to Ebola and Marburg. People usually become infected through exposure to food or household items contaminated with urine or faeces of infected rats. Person-to-person transmission can also occur, particularly in a hospital environment with inadequate infection control measures, via bodily fluids.

While most people who catch Lassa fever make a full recovery, 15 per cent of those hospitalised die.

Dr de Clerck said outbreaks are often only officially detected when clinicians and doctors start dying. “One of the main issues is that, clinically, it presents like many other infectious diseases. Even for the severe cases, this is the case during the early days,” Dr de Clerck said. “It’s scary, especially for the clinicians that are not yet working in a setting where all the preventative measures are in place.”

Symptoms of Lassa start gradually, with fever and malaise, and after a few days a headache, muscle pain and vomiting may kick in. In severe cases, the virus triggers facial swelling, fluid-filled lungs and intense bleeding from the mouth, nose and other orifices.

When a patient is admitted to a normal ward, without personal protective equipment, the staff become endangered, Dr de Clerck said.

“It’s tough to be on the frontline of Lassa, it’s hard to detect and protect yourself at all times,” she added.

In December, two doctors – who had operated on a pregnant patient with the disease – died. The woman and her child also died of bleeding.

A doctor currently on the frontline treating Lassa fever in Nigeria, Dr Luigi Sportelli, told The Telegraph: “When a patient is in a severe condition, in intensive care, there are a lot of fluids and blood. That’s a big risk to the health worker.”

Dr de Clerck also warned that Lassa is tough to detect clinically: “It changes rapidly and is genetically diverse. There are two or three strains circulating in Nigeria, and then the strains have sub-stains.”

While PCR tests can detect Lassa, a safety level three lab is needed, with trained staff – it takes up to five hours to run the test, she said. No rapid tests for the disease exist. “With malaria, you can do a rapid test. With Lassa, PCR testing for every case is recommended, but this needs a more advanced lab set up,” she added.

Another crucial problem is that – despite being discovered over 50 years ago in 1969 – there’s been little research into Lassa fever. Each year, there are an estimated 100,000 to 300,000 cases of the disease and 5,000 deaths, but some 80 per cent of cases are thought to be asymptomatic so the true toll is hard to gauge.

“It’s one of those diseases that was so forgotten, it wasn’t even on the forgotten diseases list,” said Dr de Clerck. An antiviral drug – ribavirin – is used to stop the reproduction of the virus, but needs to be used within the first seven days of an infection. Even then, it's not clear how much difference it makes as “there haven’t been many studies that show the drug is really effective and efficient,” said Dr de Clerck.

Dr Sportelli added: “In 50 years there have not been many advances. We don’t know much about how the virus survives on surfaces. We’re not even sure how effective the drug we use to treat the disease is.” Patients also require other treatments, like dialysis. “It affects nearly all of the organs, the kidneys, the brain, the lungs, the liver,” Dr de Clerck said.

Dr Tom Fletcher, an infectious disease specialist at the Liverpool School of Tropical Medicine, told The Telegraph that a conference is set to take place in the Ivory Coast next week, where scientists will discuss how to design and enact trials for new treatments. But funding is lacking, so conclusions will be “theoretical”. “There is a complete dearth of funding for good drugs to treat Lassa and CCHF – that is criminal,” he said.

“Lassa is a very serious disease. The scientific community should do more to find treatments,” added Dr Sportelli.

The Coalition for Epidemic Preparedness (Cepi) is funding six vaccines, two of which entered phase one trials in 2019, and another started human trials last year. Dr de Clerck also said that it’s unknown how many mild cases of the disease there are, as people will treat themselves and recover at home.

“We only see the tip of the iceberg – the most severe cases,” she said. “My colleagues keep telling me fatalities are very high, which suggests people are coming late to the hospital with severe disease.” Recovery takes time, too. Most people who survive stay in hospital for up to three weeks, but they may suffer long-lasting problems like loss of hearing.

Most of those who have died in Nigeria this year have been aged 21-30, but children also catch the virus, which is thought to happen after crawling on the ground at home. Track and trace places a big role in how Nigeria tackles the disease, along with public health campaigning.

“There’s a stigma that’s attached to the disease,” Dr de Clerck said. Survivors sometimes lose their jobs and are rejected from their communities. One school boy was unable to return to classes because neighbours feared he would infect others.

Since preventive measures were introduced in Dr Sportelli's hospital in Abakaliki in 2018 by MSF – brought in because of large numbers of doctors dying – no hospital workers have since passed away from the virus. Measures included building observational bays for patients suspected of carrying Lassa, and stringent PPE rules.

Other measures include rigorous burial procedures, to avoid contamination. It’s unclear how many people will die from this outbreak in Nigeria, Dr de Clerck said. The disease is seasonal, starting in October and ending around March. “The months of January, February and March can have very high cases, we don't know how many in total there will be,” she said. Despite the difficult circumstances for doctors and nurses, Dr Sportelli said: “As healthcare workers we cannot leave the patients behind.

The Telegraph

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