Lassa Fever Treatment in Nigeria: What You Need to Know

Lassa fever is an illness that is quite common in West African countries. It is a type of viral hemorrhagic fever, caused by a type of virus that can cause uncontrolled bleeding. Most people who are affected by Lassa fever will have mild symptoms like fever, headaches and fatigue, but around 20% of people who are affected get seriously sick. Pregnant women who are affected are at especially high risk for miscarriage and other serious complications. The disease is spread through the droppings and urine of infected rats. It can also be passed by contact with the bodily fluids of affected people. Around 100-300 thousand cases are reported in West African countries each year; there have not been any reported cases in other areas of the world.

What causes Lassa fever?

The causative agent of the disease is the Lassa fever virus. The agent is carried by multimammate rats, which are found in West African countries. The virus can lead to the damage of blood vessels and impair the clotting abilities of the individual, causing uncontrolled bleeding. An individual can get Lassa fever after ingesting food or contact with surfaces that have been contaminated by the droppings or urine from infected rats. An individual can also get the disease from contact with the body fluids of people infected with the Lassa fever virus. This includes sexual intercourse, exposure to urine, poop or the blood of an infected person.

The virus can remain in the urine of an affected animal or person for a while after they are infected with the Lassa fever virus. The virus can also be spread in healthcare facilities, especially if there are no good sanitation practices, there are lack of personal protective equipment, or when they are not used.

What are the risk factors for Lassa fever?

A person is at risk for the disease if they live in or travel to areas in West Africa where it is endemic or common. These countries include:

• Benin
• Nigeria
• Guinea
• Liberia
• Mali
• Sierra Leone

What are the symptoms of the disease?

The majority of people, around 80%, with Lassa fever have mild symptoms. Some of the symptoms include:

• Fever
• Headache
• Cough
• Sore throat
• Tiredness

A minority, around 20%, have severe symptoms. Some of these include:

• Confusion
• Chest, neck or stomach pains
• Difficulty in breathing
• Severe vomiting or diarrhoea
• Seizures
• Bleeding from the nose, the mouth, eyes and other mucous membranes.

What are the complications of Lassa fever?

Even in the mild cases of Lassa fever, around a third of the affected people have partial or complete hearing loss, temporary or permanent. The people affected by the severe form of the disease may have life-threatening complications. Some of these include:

• Pleural effusion
• Acute kidney injury leading to sudden kidney failure
• Pericarditis
• Encephalopathy
• Sepsis
• Low platelets which can cause uncontrolled bleeding
• Infection and inflammation of some organs like the liver
• Pregnancy loss
• Acute respiratory distress syndrome
• Disseminated intravascular coagulation (DIC)

How is the disease diagnosed?

In the absence of laboratory tests, Lassa fever is difficult to differentiate from other infections that are common in West Africa. The confirmation requires specialized laboratories and special precautions for handling the specimens.

• Laboratory tests include enzyme-linked immunosorbent serologic assays (ELISA) for the Lassa IgM and IgG antibodies and Lassa antigen. For definitive testing, the virus can be grown in culture in about 7-10 days. A reverse transcriptase polymerase chain reaction (RT-PCR) assay is also available but limited to research.
• Immunohistochemistry stains on tissue specimens can also be used to make a postmortem diagnosis.

What is the treatment for Lassa fever?

Ribavirin, an antiviral medication, is frequently used to treat Lassa fever. Depending on the condition of the patient, the provider will also administer symptomatic treatments. Some of the treatments include:

• Dialysis for kidney damage
• Supplementary oxygen to help the individual breathe
• IV fluids, medications or supplements to correct the electrolyte imbalances

Pregnant people need special attention when they are infected with the disease. Most of the time, the fetus cannot survive the infection. The healthcare provider will monitor the patient for any signs of miscarriage. They will have to remove any fetal tissues as soon as possible if a miscarriage occurs. This will increase the chances of the patient recovering from the disease. Also, depending on how far along the pregnancy is and the health of the patient and the fetus’s health, the doctors can improve the chances of survival for both of them.

Can the condition be prevented?

An individual can reduce their risk of Lassa fever by keeping their living space free of rodents and protecting themselves when they are around an infected person. Things that can be done to reduce the risk include:

• Contact with rodents should be avoided, especially in areas where Lassa fever is common. Keep their living spaces clean and sanitary, and keep food in closed containers to keep rats and other pests away.
• Wear protective coverings when tending to someone who has or might have Lassa fever. This includes a mask, gloves, gowns, non-fogging goggles, and boots. It is vital to find out from a healthcare provider what precautions they need to take.
• If an individual is infected with the Lassa virus, they should isolate away from others to prevent spreading it.

What can be expected if a person has Lassa fever?

To avoid getting infected, healthcare providers and others caring for the patient will need to take precautions if an individual has Lassa fever. This will include wearing protective gear and clothing and isolating the patient from others. Pregnant women would need to be administered antivirals immediately; their health will also be closely monitored. Most cases of Lassa fever are mild, and the affected patient will usually recover in about a week or so. About half of the people with hearing loss usually regain their hearing within a few weeks. Since most people are affected with the mild form of the disease, the survival rate is good. The mortality rate depends on how severely ill the person gets.