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LETTER TO EDITOR
Year : 2019  |  Volume : 22  |  Issue : 1  |  Page : 144-145

Lassa fever: Time to eradicate the deadly disease in Nigeria


Department of Medical Microbiology, University of Nigeria Teaching Hospital Ituku Ozalla, Enugu, Nigeria

Date of Web Publication21-Jan-2019

Correspondence Address:
Dr. I N Nwafia
Department of Medical Microbiology, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_116_18

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How to cite this article:
Ohanu M E, Nwafia I N. Lassa fever: Time to eradicate the deadly disease in Nigeria. Niger J Clin Pract 2019;22:144-5

How to cite this URL:
Ohanu M E, Nwafia I N. Lassa fever: Time to eradicate the deadly disease in Nigeria. Niger J Clin Pract [serial online] 2019 [cited 2019 Nov 14];22:144-5. Available from: http://www.njcponline.com/text.asp?2019/22/1/144/250500



Dear Editor,

The medical history of Lassa fever started in Lassa, in South-West of Borno state Nigeria. The index case was traced to a missionary nurse from the USA posted to the local hospital in Lassa in 1969;[1] she had a troublesome fever, which did not respond to malaria treatment. She, doctor and the nurse that attended to her all died. Samples sent to the Center for Disease Control, USA revealed a previously unknown arena virus later named Lassa fever virus.[2]

This virus establishes chronic infection in rodents and humans get infected through contact with rodent excreta or urine.[3] Spread through aerosol in hospitals are usual.[4]

Most infections that are widespread in West and Central Africa are asymptomatic though few present with mild fever. Severe Lassa fever presents with fever, mouth ulcers, muscle aches, and hemorrhagic skin rashes.[4] Complications include pneumonia, organ damages, deafness, fetal death, and increased maternal mortality.

Diagnosis requires clinical suspicion, laboratory assessment including serological (ELISA),[5] tissue culture, and polymerase chain reaction.[2] Laboratory assessment is done in a high containment laboratory with good laboratory practices under biolevel safety 4 condition. Lassa virus is on the list of potential bio-weapons agents.[6] Incubation period is 6–21 days.[4] Nigeria is experiencing an epidemic that started in Ebonyi state in January 2018, has affected 450 people in 17 states with 317 confirmed cases and 43 deaths including four health workers.

Lassa fever prevalence can be brought to its lowest rate through a combination of approaches. First, standard universal precautions and barrier nursing procedures can prevent transmission to hospital personnel.[7] Vaccine or immunotherapy is not available, but ribavarin an antiviral drug is effective when given early.[6]

Let us apply the old formula of D = NV/R (where D is disease, N is number of pathogens, V is virulence of pathogen, and R is resistance of host).[8] If the regional governments wage war to drastically reduce the number of rodents, NV diminishes. However, increasing R will be the ultimate game changer in eradicating Lassa fever. To rightly increase immunity, the best approach is through vaccination.[9] A vaccine against the Lassa virus will control the disease in Africa, protect health workers, and contain viral outbreaks. Candidate vaccines carry genetic materials from the harmful Lassa virus including the highly immunogenic glycoproteins and immunosuppressive nucleoprotein (See illustrated viral structure [Figure 1]) are inserted into a harmless virus (the carrier).[10] When West and Central African countries have the will, abolish dictatorship (that orchestrate civil unrest that leads to spread of communicable diseases), come together, allocate appropriate money to the health sector, contribute enough funds toward the development and use of an overdue effective Lassa fever vaccine, the disease will be vanquished. The African countries in conjunction with their health related research institutions and backed by their National Medical Associations should invite reputable foreign partners for the vaccine development. Similar plans can be applied to eradicate other diseases such as Ebola and malaria. A healthier and safer African continent will ensure lower morbidity and mortality from preventable diseases, increase life expectancy, and foster economic growth.
Figure 1: Illustrated structure of Lassa fever virus[10]

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Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Call it “Cassel's virus “not “lassa fever”. Describing the events and circumstances that surrounded the occurrence of the so called “lassa fever' Gadzama, New Nigerian; 2nd May, 1974.  Back to cited text no. 1
    
2.
World Health Organization. Lassa Fever. Available from: http://www.who.int/mediacentre/factsheets/fs179/en/.[Last accessed on 2017 Feb 14].  Back to cited text no. 2
    
3.
Buchmeier MJ, Bowen MD, Peters CJ. Arenaviridae: The viruses and their replication. In: KnipeDM, Howley PM, editors. Fields Virology. 4th ed. Philadelphia: Lippincott-Raven; 2001. p. 1635-68.  Back to cited text no. 3
    
4.
Brooks GF, Butel JS, Morse SA. Jawetz, Melnick and Adelberg's Medical Microbiology, Lange International, Boston Burr Ridge; 2004.p. 530-1.  Back to cited text no. 4
    
5.
Bausch DG, Rollin PE, Demby AH, Coulibaly M, Kanu J, Conteh AS, et al. Diagnosis and clinical virology of Lassa Fever evaluated by enzyme-linked immunosorbent assay, indirect fluorescent-antibody test, and virus isolation. J ClinMicrobiol 2000;2670-7.  Back to cited text no. 5
    
6.
Borio L, Inglesby T, Peters CJ, Schmaljohn AL, Hughes JM, et al. Hemorrhagic fever viruses as biological weapons. Medical and Public health management. JAMA 2002;287:2391-405.  Back to cited text no. 6
    
7.
Fisher-Hoch SP, Tomori O, Nasidi A, Perez-Oronoz G, Fakile Y, Hutwagner L, et al. Review of cases of nosocomial Lassa fever in Nigeria. The high price of poor medical practice. Br Med J 1995;311:857-9.  Back to cited text no. 7
    
8.
Willey JM, Sherwood LM, Woolverton CJ. Prescott's Microbiology, 8th ed, McGraw –Hill International Edition; 2011. p. 740.   Back to cited text no. 8
    
9.
Fisher-Hoch SP, McCormick JB. Towards a human Lassa fever vaccine. Rev Med Virol 2001;11:331-41.  Back to cited text no. 9
    
10.
Kimberlin CR, Zandomatti M, Proceedings of the National Academy of Sciences 2011;108:2396-401.  Back to cited text no. 10
    


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