The document summarizes Nigeria's 2016 Lassa fever epidemic. It describes the epidemiology and transmission of Lassa virus, symptoms and treatment of Lassa fever, and the response efforts. Key points include: (1) Lassa fever is endemic in West Africa and causes annual outbreaks in Nigeria, with the multimammate mouse being the primary host; (2) person-to-person transmission can occur in hospitals lacking infection control; (3) the case fatality rate was 1% historically but rose to 34.31% in the 2016 Nigeria outbreak; (4) supportive care and ribavirin treatment improve survival rates.

1. 2016 Lassa Fever Epidemic
By Dr. Chinedu Ibeh, Dept of Community medicine, UPTH
Wednesday, 3rd February 2015

2. Outline
 Introduction
 Epidemiology
 Transmission
 Symptoms and signs
 Laboratory diagnoses
 Treatment
 Prognosis
 Prevention
 Federal and state govt response
 Identified gaps
 recommendations

3. INTRODUCTION
Lassa fever is an acute viral
hemorrhagic fever caused by a single
stranded RNA virus known as Lassa
virus- a member of the Arenaviridae
family.
It was first described in the 1950s but
the virus causing Lassa disease was
identified in1969 in the town of Lassa,
in Borno State, Nigeria.

4. Lassa virus

5. INTRODUCTION CONTD
 Outbreak is common in sub-Saharan
Africa infecting about 300,000 to 500,000
cases annually and causing about 5,000
deaths each year giving an average case
fatality rate of about 1%.
 Cases of the disease have been observed
in Nigeria, Liberia, Sierra Leone and
Guinea.

7. EPIDEMIOLOGY
 Lassa fever is a zoonotic disease transmissible to humans
from infected rodents under natural conditions.
 The primary animal host of the Lassa virus is the
multimammate mouse(Mastomys natalensis)
 It is endemic in Nigeria and causes outbreaks almost
every year in different parts of the country, with yearly
peaks observed between December and February
 Humans usually become infected with Lassa virus from
exposure to urine or faeces of infected Mastomys rats

8. MULTIMMAMATE MICE

9. EPIDEMIOLOGY CONTINUED
The dissemination of the infection
can be assessed by prevalence of
antibodies to the virus in country
populations.
For instance we have for:
Nigeria - 21%
Sierra Leone - 8–52%
Guinea - 4–55%

10. MODE OF TRANSMISSION
 Infection in humans typically occurs by
exposure to rodents excrement through the
respiratory or gastrointestinal tracts.
 Inhalation of tiny particles of infectious material
(aerosol) is believed to be the most significant
means of exposure.
 Lassa virus may also be spread between
humans through direct contact with the blood,
urine, faeces, or other bodily secretions of a
person infected with Lassa fever
 Sexual transmission of Lassa virus has been
reported.

11. TRANSMISSION CONTD
 There is no epidemiological evidence
supporting airborne spread between humans.
 Person-to-person transmission occurs in both
community and health-care settings, where the
virus may be spread by contaminated medical
equipment, such as re-used needles.
 Lassa fever occurs in all age groups and both
sexes.

12. RISK OF TRANSMISSION
 Persons at greatest risk are those living in
rural areas,
urban slums,
communities with poor sanitation
crowded living conditions and
Health workers in the absence of proper barrier
nursing and infection control practices

13. SIGNS AND SYMPTOMS
 The disease is asymptomatic in 80% of
cases but takes a complicated course in
the remaining 20%.
 After a 6 to 21 days incubation period, an
acute illness with multi-organ involvement
develops.
 Initial non specific symptoms of fever,
facial swelling, and muscle fatigue, as well
as conjunctivitis and mucosal bleeding
develops.

15. OTHER SYMPTOMS AND SIGNS
 The other symptoms arising from the affected
organs are:
 GIT: nausea, vomiting(bloody), diarrhea,
abdominal ache, constipation, dysphagia,
abdominal pain
 CVS: chest pains, hypertension, hypotension,
palpitation
 RS: cough, chest pain, dyspnea
 CNS: seizures, hearing deficit, tremor,
disorientation, and coma may be seen in the
later stages

16. SYMPTOMS OF LASSA CONTD
 Transient hair loss and gait disturbance may
occur during recovery.
 The disease is especially severe in late
pregnancy, with maternal death and fetal loss
occurring in greater than 80% of cases.
 Death usually occurs within 14 days of onset in
fatal cases.

17. LABORATORY DIAGNOSES
 Lassa virus infections can only be
diagnosed definitively using the following
tests:
reverse transcriptase polymerase chain
reaction (RT-PCR) assay
antibody enzyme-linked immunosorbent
assay (ELISA)
antigen detection tests
virus isolation by cell culture.

18. LABORATORY DIAGNOSES
CONTD
 Other laboratory test & findings in Lassa fever
include
FBC (lymphocytopenia & thrombocytopenia),
and
LFT(elevated AST)

19. LABORATORY DIAGNOSIS
Diagnosis needs biosafety level 3/4 laboratory
We have only 7 laboratories with the capacity to
diagnose Lassa fever in Nigeria located in:,
University of Maiduguri Teaching Hospital,
Maiduguri,
Aminu Kano Teaching Hospital, Kano,
University College Hospital, Ibadan
Irrua Specialist Hospital Edo State,
Lagos University Teaching Hospital, Lagos ,
National Centre for Disease Control, Asokoro,
Abuja.
National Centre for Disease Control Regional

20. TREATMENT
 Admit persons suspected of Lassa fever
infection into isolation facilities.
 Early and aggressive treatment using
Ribavirin.
 Supportive treatment using Fluid replacement
and blood transfusion.
 Induction of labour for infected pregnant women
in their 3rd trimester to improve the mother’s

21. TREATMENT
 There is no evidence to support the role of
ribavirin as post-exposure prophylactic
treatment for Lassa fever.

22. PROGNOSIS
 About 15-20% of hospitalized Lassa fever
patients will die from the illness.
 The overall mortality rate is estimated to be 1%,
but during epidemics, mortality can climb as
high as 50%.
 The mortality rate is greater than 80% when it
occurs in pregnant women during their third
trimester; fetal death also occurs in nearly all
those cases.
 Termination of pregnancy decreases the risk of
death to the mother.

23. PREVENTION
 Community health education on
 Community/Personal Hygiene
 Preservation of food items in rats proof bags
 Blocking of rat holes/using traps /cats to hunt rats
 High index of suspicion among health workers and prompt
reporting and referral of suspected cases
 Isolation of infected patients, good infection protection and
control practices and rigorous contact tracing can stop
outbreaks.
 PPE like Gloves, masks, laboratory coats, and goggles are
advised while in contact with an infected person.
 There is currently no vaccine that protects against Lassa
fever

25. PREVENTION IN THE
COMMUNITY
 Community hygiene should be promoted to
discourage rodents from entering homes.
 Grains and other foodstuffs should be stored in
rodent-proof containers.
 Garbage should be disposed far from home
 Clean households should be maintained and
keeping of domestic cats as pets to prey on rats
may be encouraged.
 Family members should avoid contact with
blood and body fluids while caring for sick
persons.
 Safe burial practices should be encouraged and

26. IN HEALTH CARE SETTINGS
 Staff should always apply standard infection
prevention and control precautions when caring
for patients, regardless of their presumed
diagnosis.
 These include
basic hand hygiene,
respiratory hygiene,
use of personal protective equipment (to block
splashes or other contact with infected
materials),

30. FEDERAL GOVERNMENT
RESPONSE TO THE CURRENT
EPIDEMIC
 FG Inaugurates 19 man Lassa Fever
Eradication Committee chaired by Prof.
Oyewale Tomori, President Nigeria Academy of
Science
 Other members are :
2. Prof. A. Nasidi, NCDC, Secretary/Member
3. Prof. Sunday Omilabu, CMUL, Member

31. LASSA FEVER ERADICATION
COMMITTEE
 4. Prof. George Akpede, Member
5. Prof. Clara Ejembi, ABUTH, Member
6. Prof. Zubairu Ilyasu, Member
7. Dr. Pelumi Adebiyi, UCH, Member
8. Prof. Christopher Obionu, UNTH, Member
9. Prof. Innocent Ujah, NIMR, Member
10. Prof. Dennis Agboulahoe, Member
11. Dr. (Mrs) Egejuru Eze, Federal Ministry of
Agriculture, Member
12. Representative, Federal Ministry of
Environment, Federal Ministry of Environment,
Member

32. LASSA FEVER ERADICATION
COMMITTEE
13. Dr. Daniel Iya, Commissioner for Health
Nasarawa State, Member
14. Mrs Gold Idehen R.I, Federal Ministry of
Education, Member
15.Emmanuel Agbegir, Federal Ministry of
Information and Culture, Member
16. Director, Public Health (Rep. by Dr. E.
Ngige), Federal Ministry of Health, Member
17. Abonyi Dominic, Environmental Health
Officer, Registration Council, Member
18. Dr. Sunny Asogun, Head Lassa Fever
Research, Irua Specialist Hospital, Member
19. Mr. Akin Fadeyi, Media Consultant, Member

33. LFEC TERMS OF REFERENCE
 To appraise the current epidemiological
situation of the past and current Lassa Fever
Epidemics in Nigeria
 To develop jointly with FMoH and NCDC an
effective response plan for fighting and
preventing the spread of Lassa Fever in Nigeria
while availing professional advise to NCDC and
FMoH to arrest current and future Lassa Fever
outbreak.

34. THE TERMS OF REFERENCE OF THE
COMMITTEE
 To galvanize financial support and good will
from other stakeholders and development
partners.
 To implement the Strategic Plan under the
guidance of the Honorable Minister of Health
 To advise the Hon Minister of Health on the
Emergency operation and activities carried out
in the affected states.

35. FEDERAL GOVERNMENT RESPONSE
TO THE CURRENT EPIDEMIC
 Designation of six additional diagnostic centers
for Lassa Fever by the health minister which
brings to 12 the total number diagnostic
Centres in the Country.
 The six new diagnostic centres are to be
situated at the highly infected states of Bauchi,
Niger, Taraba, Plateau, Nasarawa and Ondo.

36. FEDERAL GOVERNMENT RESPONSE
TO THE CURRENT EPIDEMIC
 Designation of hotlines to either access Nigeria
Centre for Disease Control or Federal Ministry
of Health when a case of Lassa fever is
suspected: 08093810105, 08163215251,
08031571667 and 08135050005
 Immediate supply of adequate quantities of
Ribavarin to all the affected states

37. RIVERS STATE EXPERIENCE
 Confirmed cases in Rivers State is 3, and
number of deaths is also 3.
 2 LGAs (OBALGA and PHALGA) are affected.
 As at 1st February 2016, about 100 persons
were under watch and will be discharged after
completing the 21 days(4/02/16) of observation
without symptom (ie 21 days after the death of
the
last case).
 The contact tracing teams (13 teams) are still
on, meeting and monitoring contacts with
infected case every day.

38. RIVERS STATE EXPERIENCE 2
 Three holding centers had been set-up in the state to care for
patients of the Lassa disease.
 They are Potts Johnson, VIP ward of BMSH and ‘a space’ in UPTH..
 Efforts to renovate the treatment centre at Oduoha in Emohua Local
government that was used in 2014 during the Ebola outbreak is
underway
 Adequate stock of Ribavirin is available
 Lassa fever Local Government sensitization programme in the State
is ongoing from LGA to LGA
 The Rivers state Government has launched ‘Operation kill all Rats’.

39. RIVERS RESPONSE TEAM
The Response team has 3 units
Case Management/Decontamination unit:
They are responsible for managing patients in
the isolation centers.
They are also in charge of decontaminating
contaminated areas.
Epidemiology/Surveillance unit:
The do the active case search and contact
tracing.
Contact tracing is done twice daily via face to
face visits or by phone calls.

40. RIVERS RESPONSE TEAM
Social Mobilization, Communications And
Training Unit.
The are responsible for the massive
sensitization campaigns, advocacies, public
health enlightenment through the media and
training of other categories of health care
workers

41. IDENTIFIED GAPS
 Poor Synergy:
Promotion of inter-sectoral, inter-professional and
multi-disciplinary collaboration should be
encouraged.
The scourge should not be seen as Health
Ministry or Federal or Doctors affair only.
 Knee Jerk Response
The seeming lack of epidemic preparedness for LF
affected the early containment of the outbreak.
Therefore, a need for an established response
strategy in event of any hemorrhagic fever

42. IDENTIFIED GAPS
 Insufficient Laboratory Capacity
There is need to scale up the provision of
diagnostic centres with capacity to diagnose
emerging and reemerging diseases.
We should build at least one public health
laboratory in each of the states of the
federation, so that people can easily be referred
to those centers for proper diagnosis.

43. IDENTIFIED GAPS
 Poor Information Management
Government should on daily basis update us
with the efforts being made to contain the
spread; the number of reported and confirmed
cases; symptoms; Isolation and treatment
centers; and preventive actions that should be
taken by individuals.
Relevant jingles and posters should be all over.

44. IDENTIFIED GAPS
 Poorly Trained, Poorly Remunerated And
Poorly Insured Health Workers
Empowerment of health workers on knowledge
and preventative measures of LF
Addressing the legal issues, especially in
relation to health workers and others involved in
outbreak control, in terms of insurance and
compensation of health workers who contract
the disease
 Ensuring that active surveillance, a high index
of suspicion, and infection control measures are
emphasized on hospital wards and in surgical

45. Recap
 Lassa fever is an acute viral haemorrhagic illness of 1-4
weeks duration that occurs in West Africa.
 The Lassa virus is transmitted to humans via contact
with food or household items contaminated with rodent
urine or faeces.
 Person-to-person infections and laboratory transmission
can also occur, particularly in hospitals lacking adequate
infection prevention and control measures.
 Lassa fever is known to be endemic in west Africa and is
currently a National epidemic in Nigeria.
 The overall case-fatality rate is 1% but in epidemic, CFR
may rise to 50%, CFR in 2016 epidemic in Nigeria is
34.31%
 Early supportive care with rehydration and symptomatic
treatment with IV Ribavirin improves survival.

46. Thank you for Listening
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