Posted on: Fri 29-03-2024

Recent reports from across the country have shown how Lassa fever continues to threaten the lives of health workers with some of them losing their lives from the disease while providing care to patients.

Experts say the death of healthcare workers from Lassa fever is becoming one too many, especially with the backdrop of inadequate medical personnel due to brain drain in the country.

They identified a low index of suspicion for Lassa fever as one of the reasons for healthcare workers’ infections.  

An infected health worker infects his colleagues, patients and the general population, thereby underscoring the need for increased efforts towards reducing the infection rate among them.

Dr Joseph Okoeguale, Director, Institute of Viral and Emergent Pathogens Control and Research (IVEPCR), Irrua Specialist Teaching Hospital (ISTH), Irrua, Edo State, said healthcare workers were a vulnerable population as they are usually the first point of call for suspected cases.

“In many cases, rising from a procedure of undiagnosed cases, such as exposure during caesarean section. This usually involves large numbers of healthcare workers being exposed at the same time, such as the doctors, nurses, cleaners, porters and supporting staff,” he said.

Lassa fever is a highly infectious and potentially deadly viral haemorrhagic fever that affects many West African countries. The virus is carried in multimammate rats, the common soft-furred African rat whose female has a double row of breasts.

The Lassa virus may also be spread between humans through direct contact with blood, urine, faeces, or other bodily secretions of a person infected with Lassa fever; laboratory transmission can also occur.

Since the beginning of this year, 3, 914 suspected cases of Lassa fever have been recorded in the country, with 682 confirmed cases, and   128 deaths in 27 states across 117 local government areas.

Healthcare workers among high-risk group

Healthcare providers are considered to be among the high-risk groups to contract the disease because of their contact with infected persons.

This includes doctors and nurses who provide direct patient care in the absence of standard precautions, cleaners, who disinfect contaminated surfaces, materials, and laboratory staff who handle blood samples of suspected Lassa fever patients without appropriate precautions and medical or hospital support staff who prepare and/or handle bodies of deceased Lassa fever cases without appropriate precautions.

Mtsenem Igbehemba Jacob, a nurse with the Benue State University Teaching Hospital, Makurdi, said it all started with fever while he was on night duty at the hospital. He said she took anti-malaria drugs but didn’t get better after five days of rest, instead his son started showing the same symptoms.

They were both admitted at the hospital and his doctor told him that a doctor had died of Lassa fever recently at the hospital and there was a likelihood Jacob also had the disease.

“He said the doctor’s diagnosis came late and that he wouldn’t take any chances again, so I was moved to the isolation unit.” He said he was diagnosed with the disease and got better with time. His wife also started manifesting symptoms of the disease a week later and was treated.

Data obtained from the NCDC showed that a total of 25 healthcare workers from Edo, Ondo, Bauchi, Taraba, Benue, Ebonyi, Kogi and Kaduna states, among others, have been infected this year.

The situation reports also revealed that eight new healthcare workers were infected with the disease in week nine alone this year.  

Last month, the 44 Nigerian Army Reference Hospital in Kaduna reported the death of three members of its staff and a patient from suspected viral haemorrhagic fever within 48 hours.  

The NCDC said the Kaduna State Ministry of Health notified it about the deaths, and that both institutions conducted a comprehensive investigation, adding that four of the six blood samples from suspected cases sent to the Bayero University Teaching Hospital in Kano were confirmed for Lassa fever.

In Nasarawa State, Chairman of the Nigeria Medical Association (NMA), Dr Peter Attah, said one Dr Ahmed Isaiah was performing surgery on a patient when he collapsed and was rushed to the National Hospital, Abuja. He was diagnosed with Lassa fever and later died on December 31, 2022. He had worked at a facility with one doctor attending to thousands of patients.

Also, according to the NCDC Lassa fever situation report, 10 healthcare workers were infected with the disease in 2021. Among them were two doctors who lost their lives to Lassa fever following the outbreak of the disease in Nasarawa State.  

In 2020 while the country was battling the COVID-19 pandemic, health workers were also getting infected and dying of Lassa fever. In April, the first four months of 2020, 37 health workers had been infected with Lassa fever, NCDC data showed.

Dzuana Vanen Philip, a medical doctor, lost his life to Lassa fever in the first week of April 2020. The young doctor was working with the Federal Medical Centre, Makurdi, before his demise.

Earlier in the year, two doctors at the Aminu Kano Teaching Hospital (AKTH) Kano, Dr Ummu Kulthum and Habeeb Musa Muhammad, had also lost their lives to Lassa fever.

Another doctor with the Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Dr Mansur Galadima, also lost his life to the disease. Low index of suspicion

A study on Lassa fever infection among healthcare workers in Nigeria in 2019, revealed that those infected with Lassa fever during the outbreak had a low index of suspicion for the disease with poor adherence to Infection Prevention and Control (IPC) best practices.

The study which was carried out by S. Mba, Elsie Ilori, Chikwe Ihekweazu, and other researchers showed that from January to April 2019, 16 healthcare workers were infected, eight (50%) were doctors, six (38%) were nurses (others included a radiologist and a medical lab scientist).

The research further revealed that two deaths were recorded with a case-fatality rate (CFR) of 12.5%.

Six healthcare workers were aware that they were exposed to a confirmed Lassa fever case, however, only two wore full Personal-Protective-Equipment (PPE) in the course of their work. Four healthcare workers reported a history of IPC training, while 12 (75%) did not suspect they had Lassa fever.

The researchers concluded that continuous sensitisation and training of healthcare workers on universal precautions is necessary.

Experts’ advice for healthcare workers

The Director General of the Nigeria Centre for Disease Control and Prevention (NCDC), Dr Jide Idris, advised healthcare workers to always practise standard infection prevention and control by using gloves, face masks, and other appropriate PPE while handling patients or providing care for an ill patient.

He said, “Healthcare workers should maintain a high index of suspicion for Lassa fever, that is, be vigilant and consider a diagnosis of Lassa fever when seeing patients presenting with febrile illness.”

Dr Joseph Okoeguale, who is also a past Chief Medical Director of Irrua Specialist Teaching Hospital, said it is important for healthcare workers to have a high index of suspicion during outbreak periods.

He said, “This is usually the problem.  A high index of suspicion will lead to earlier screening.  Some cases may present atypical, such as some pregnant women presenting with seizures, bleeding, fetal demise, and first-trimester abortion.  

“To the gynaecologist or obstetrician, these may just be obstetric complications. However, during surge periods, these may be atypical presentations of pregnant Lassa fever patients.  

“Furthermore, maintaining universal standards of operating procedures will prevent a lot of health-related infections.  The healthcare worker must be able to maintain high standards of IPC for dreaded infections such as Lassa fever, and other Viral Haemorrhagic Fevers.”  

Thus, there is a need for increased awareness of Lassa fever, high index of suspicion and IPC measures among healthcare workers while providing care. It is also important to strengthen the capacity of healthcare facilities by instituting strict prevention and control measures across the country.