- Lassa fever and yellow fever take their toll on Nigeria
The spread of Lassa fever and yellow fever across the country in recent months is a grim reminder of the urgent need for federal and state governments to step up their efforts to improve healthcare.
The current Lassa fever outbreak has been confirmed by the World Health Organization (WHO) to be the worst ever reported in Nigeria. Between January 1 and February 25, 2018, 1,081 suspected cases and 90 deaths have been recorded, and the fatalities rose to 110 in March. The disease has affected 18 states, including Anambra, Bauchi, Benue, Delta, Ebonyi, Edo, Ekiti, the Federal Capital Territory, Gombe, Imo, Kogi, Lagos, Nasarawa, Ondo, Osun, Plateau, Rivers, and Taraba.
Yellow fever has been wreaking havoc as well. Since the current outbreak in Kwara State in September 2017, 15 other states have reported suspected cases, including Abia, Borno, Kogi, Kebbi, Plateau, Zamfara, Enugu, Oyo, Anambra, Edo, Lagos, Kano, Nasarawa, Katsina and Niger. There were 358 suspected cases and 45 deaths as at January 2018.
It is tragic that these outbreaks are occurring in 21st century Nigeria. As virulent hemorrhagic fevers which thrive on dirty, congested environments in which mosquitoes and rats thrive, Lassa fever and yellow fever are a testimony to the country’s failure to improve general sanitation and hygiene, as well as its inability to ensure that preventive measures and treatment facilities are widely available.
In the particular case of yellow fever, the failure to carry out routine mass-vaccination exercises is especially galling, since a single dose guarantees lifetime protection from the disease. Immunisation rates are said to be well below acceptable immunity thresholds of between 60 per cent and 80 per cent. Filthy, overcrowded urban environments provide conducive breeding grounds for the Aedes and Haemogogus species of mosquito which transmit the disease.
Nigeria gave the world Lassa fever; the name originates from the town of Lassa in Borno State where it was first discovered in 1969. Given this unwelcome connection to the disease, it would have been expected that greater efforts would have been made to curtail the spread of the rodents which transmit it. The high number of deaths among healthcare workers is a worrying sign of the breakdown in infection prevention and control procedures in the country’s hospitals.
The fight against the recurrence of these diseases will involve a comprehensive effort that must incorporate effective prevention and treatment strategies. Sanitation must once again take the pride of place it occupied in the early days of independent nationhood. Communities must be taught how to maintain clean neighbourhoods and homes, with appropriate sanctions for any failure to do so. Attitudinal change is vital; the ignorant superstition with which many Nigerians respond to the possibility of disease cannot continue.
Enlightenment campaigns should be accompanied by nutritional interventions aimed at ensuring that the citizenry is properly-fed and thus better able to fight off infection. The school-feeding programme is a welcome step in this regard, but it must be complemented by similar programmes for indigent Nigerians.
The first cases of yellow fever could not be confirmed in Nigeria, but had to be taken to the regional reference laboratory, Institut Pasteur de Dakar (IPD) in Senegal. The delay occasioned by this process could not have helped in the fight to contain the disease. Nigeria should develop the capacity to confirm most of the diseases which occur within its borders, and must expand its ability to effectively treat them.
Healthcare facilities must be properly equipped and manned to enable them deal with outbreaks like these. Vaccination is a vital weapon in the fight against yellow fever, and measures must be taken to significantly increase infant immunisation, and to ensure that the current reactive immunisation campaigns reach the approved 80 per cent threshold.
Local vaccine production would significantly enhance such efforts; plans to restart local vaccine production at the Federal Vaccine Production Laboratory in Lagos must be implemented as quickly as possible.