Oyewale Tomori, a formost virologist, is the Chairman of Biovaccines Nigeria Limited and former President of the Nigerian Academy of Science (NAS).
In this interview with APPOLONIA ADEYEMI, he discusses factors fuelling Lassa fever including increasing human-rodent contact, inactions of state governments, and poor attitude of health workers to hygiene, among others
What are the factors making Lassa fever to resurge in the country?
Lassa fever for the last 10 years has been a common feature of the disease profile of Nigeria. We record an average of 10 to 15 cases per week, with significantly higher number of cases during the dry season October, November, March and April.
Several factors are responsible for our failure to effectively bring Lassa fever under control, including: the increasing human-rodent contact from our filthy environment which attract rodents; a perpetual lack of awareness of the epidemiology of the disease; failure to institutionalise effective infection control practice in our hospitals and health centers; poor disease surveillance and inadequate laboratory support; and increasing and closer contact with rodents attracted by our filthy environment.
What are the federal and state governments not doing right?
It is more of what the state governments are not doing right. The disease predominantly occurs in rural settings, with attendant transmission within our hospitals in urban centers. Therefore, the first line of detection and response is at the state or local government area (LGA) level.
The Federal Government has rightly set up appropriate committees to advise on the annual outbreaks. Implementing the reports of the Committee is primarily the duty of the Federal Government, which sets up the committees in the first place. This is not to absolve the state governments, which regularly collect their monthly financial allocations, but forget to spend a kobo on disease surveillance, prevention and control.
What’s your take on more health workers that are killed by Lassa fever?
For Lassa fever to, annually reap a harvest of health workers – physicians, nurses and others, is not only sad for the nation, but it is also a reflection of the deplorable standard of medical practice in Nigeria. Next year, it will be 50 years since Lassa fever was first reported in Nigeria. We should all hang our heads in shame for the unacceptable occurrence of Lassa fever in Nigeria.
I say all of us, because we all know what to do – the government, the medical profession, the media, and the citizens-. But we will not do what we know is right. When Ebola came visiting, the government immediately declared a national emergency, provided adequate resources and continually provided correct information to the people. As soon as we overcame Ebola, we went back to sleep.
Certainly high government officials were scared to death by the possibility of Ebola Virus Disease (EVD) spreading all over the country. The fear of Ebola brought our nation to her senses, but we have lost “respect” or fear for Lassa fever, and as long as those we deem important have not died of Lassa fever, so we will continue to treat the disease with neglect and disdain.
What did these dead health workers not do right?
Many things – there is a profound lack of awareness of health workers, of the ever present danger of Lassa fever infection in Nigeria, and it is obvious that health workers are not adhering to the guidelines of infection control in the hospitals and health clinics. Our health workers are needlessly exposing themselves to danger of infection and death from Lassa fever and other diseases.
What should Nigeria do to contain this disease?
We need to improve disease surveillance, ensure we have sufficient numbers of well-equipped laboratories provided with adequate supply of diagnostic reagent and provide personal protective equipment (PPE) for health workers in our hospitals and clinics.
In addition, we should ensure that our hospitals must have adequate supply of appropriate drugs, public awareness about Lassa fever should be a continuous exercise and it is time Nigeria committed to finding and testing Lassa fever vaccines for preventive campaign.
Is this disease curable and why is it killing people?
Yes, it is one of the few virus diseases for which there is a drug for treating cases, However, cases must be detected early for treatment to commence on time. Commencing treatment too late in the course of the disease may increase the severity of the disease and lead to death.
What is the state of our laboratories for Lassa fever diagnosis?
It is deplorable to say the least. With just two or three labs having competence for Lassa fever diagnosis in Nigeria, we are far from providing rapid diagnostic confirmation for Lassa fever cases.
Most of the samples collected from Lassa fever patients is tested in the Lassa fever center in Irrua, Edo State. Getting samples to Irrua is a difficult venture and experience.
What is the role individual, families, health care workers in preventing and containing the spread of Lassa fever?
To prevent Lassa fever: promote good “community hygiene” to discourage rodents from entering homes.
• store grain and other foodstuffs in rodent-proof containers,
• dispose of garbage far from the home,
• maintain clean households and keep cats off the homes.
• avoid contact with blood and body fluids while caring for sick persons.
In health-care settings, when caring for patients, regardless of their presumed diagnosis, apply standard infection prevention and control precautions – basic hand hygiene, respiratory hygiene, use of PPE and apply safe injection practices.
While in the laboratory, samples taken from humans and animals for investigation of Lassa virus infection should be handled by trained staff and processed in suitably equipped laboratories.
Similarly, while at home, ensure safe practices for burying dead people.
To conclude, governments at the at state and federal levels need to do more on the issue of disease surveillance and laboratory diagnosis, not just for Lassa fever, but also for other diseases. We have the resources to do this, but we will not because we value the health and life of our people much less than the health and life of cows.