Lassa Fever: Not Only A Neglected Disease But Neglected Patients Too – MSF

Misdiagnosis of Lassa fever in patients, and stigma arising from diagnosis, hinder efforts to contain the disease in Nigeria, Doctors Without Borders/Médicins Sans Frontiers (MSF), a medical charity, has said, warning that the disease is now endemic in Nigeria.

Lassa fever is an acute viral haemorrhagic illness belonging to the virus family Arenaviridae, that lasts between two and 21 days, according to the World Health Organisation (WHO).

In 2018, the country reported a severe disease outbreak that killed more than 171 people, with over 600 cases that year. Though the disease was first detected in Borno in the Northeast region more than five decades ago, the outbreak is now concentrated in the nation’s Southeast and South-south. 

According to MSF, contact tracing has been made difficult because the disease is often misdiagnosed as malaria fever despite the deployment of a team of specialists from the Nigeria Centre for Disease Control (NCDC) by WHO in 2018.

Former Lassa fever patients like Anastasia told MSF how she had contracted Lassa fever in Feb. 2021,  treated it as malaria and remained sick.

“When I tested positive, I was shocked to the bone,” Anastasia said. 

Because Lassa fever symptoms are similar to malaria or flu, the disease is often misdiagnosed in rural communities with no rapid diagnostic test kit. This, WHO says, delays responses.

MSF also corroborated this, saying many medical staff do not have specific training on the detection and treatment of Lassa. “As a result, patients often only receive an accurate diagnosis once they are at a severe stage of the disease, which is more challenging to manage,” it said in a statement on Tuesday.

The virus is transmitted to humans through contact with food or household items that have been contacted by rodent faeces and urine, according to WHO. Once a person is ill with Lassa fever, they can pass it on to others should they contact the infected person’s bodily fluids, MSF said.

Another survivor, 14-year-old Nneoma, narrated how “everything felt strange” when she contracted the disease with her sister Ukamaka, and their mother, Priscilla.

“I thought I was really in a nightmare,” Nneoma said.

All three were treated at the Alex Ekwueme University Teaching Hospital in Abakaliki (AE-FUTHA), Ebonyi State, Southeast Nigeria. 

Nneoma’s mother, Priscilla, who also works at the hospital, said the sickness was so severe that “when the children were shouting in pain, I couldn’t help them because I was also down with pain.” 

Although there is no vaccine or definitive cure, an antiviral drug, ribavirin, can be helpful if given early, WHO has said.

Since 2018, MSF has been supporting the Lassa treatment centre at AE-FUTHA and working closely with the Ministry of Health (MoH) to treat patients.

According to MSF, treatment has proven pertinent for the community, with over 15 patients treated for Lassa fever at the Abakaliki in the first month of 2022 alone. 

Across Nigeria, there have been 115 confirmed cases and 26 deaths throughout 30 local government areas in 11 states of the country. MSF said it has been working with health agencies to tackle the root causes of Lassa fever and its broad spread impact on infected individuals. 

The medical charity added that a trial of rapid diagnostic testing (RDT) for Lassa fever is currently being researched at the AE-FUTHA. If an RDT proves effective, it said, this could help drastically reduce the waiting time for results from a laboratory test. 

“We want to see if the RDT could be a substitute in the management or diagnosis of Lassa fever,” Okereke Michael Uche, MSF medical doctor, said. 

“Timing is important; a patient moves from a mild condition to severe. And when it becomes severe, it is more difficult to manage.” 

The medical group said it has also been providing drugs, lab supplies, and personal protective equipment (PPE), as well as training AE-FUTHA staff on clinical management and Infection Prevention Control (IPC) for Lassa fever. 

It also provides psycho-social support to infected or suspected patients and their families facing stigmatisation from their diagnosis.

Stigmatisation

Some people have lost their jobs, been chased out of their community, or even lost relationships because they were associated with Lassa fever as a patient or a caregiver, MSF said.

The group is educating and sensitising communities through a team of health promoters which then organises community meetings, health talks, and awareness campaigns in villages and rural areas across seven local government areas in Ebonyi state.  

“The purpose of all this is to foster behavioural change; we talk to people one at a time to ensure that everybody gets the message and understands the causes and cures for Lassa,” Benjamin Uzoma, MSF health promotion supervisor, said. 

Anatasia, who is among the five survivors working with health promoters, said sharing her story has helped other people to know that Lassa fever is real, “but that it can be cured if you are diagnosed and treated on time.” 

Luigi Sportelli, MSF project medical referent, also emphasised the need for the medical community and the communities to be fully engaged and empowered with accurate information, to reduce the stigma and to get people to timely access care for quick recovery. 

As Lassa fever becomes endemic in Nigeria, spreading to other West African countries like Benin, Guinea, Liberia and Sierra Leone, MSF held a workshop to create a partnership for a research, development and production of drugs through the West African Lassa Fever Consortium between Feb. 15 and 17.