Dr. Chikwe Ihekweazu is an infectious disease epidemiologist and Director-General of the Nigeria Centre for Disease Control (NCDC). In this interview, Ihekweazu explains the recent outbreak of Lassa fever despite efforts by the agency; what is being done to contain the situation; what Nigerians must do to prevent getting infected; how the virus is contracted, symptoms and what should be done. He also updates the ongoing pilot study of a candidate vaccine in the country, while chronicling what the agency is doing to prevent a possible outbreak of the dreaded coronavirus in the country.

Why the recent outbreaks of Lassa fever despite efforts by NCDC? What went wrong?

Lassa fever is endemic in Nigeria and cases are recorded all year round. There is usually an increase in cases between November and May during the dry season. The Lassa fever virus is transmitted by rodents, which can be found in our environment. This contributes largely to the risk of spread that occurs in Nigeria and other countries with similar ecological factors.

We currently do not have a vaccine to protect against Lassa fever. Therefore, we rely on strengthening measures such as ensuring proper sanitation, good personal hygiene; standard care precautions by health workers etc. to prevent the spread of Lassa fever. These measures also depend on personal responsibility as we all have a role to play in preventing the spread of Lassa fever.

Over the last few years, we have strengthened our surveillance and diagnostics architecture as well as our ability to manage cases. Significantly, there has been a reduction in the number of deaths recorded from the disease. Therefore, we have increased our capacity to find and manage cases, compared to previous years.

What are the latest figures in terms of a number of cases, deaths, states affected and so on?

Between January 1 and 19, 2020, we have recorded 163 confirmed cases and 24 deaths from nine states across the country. Of the confirmed cases, 89 per cent are from three states – Edo, Ondo and Ebonyi. These numbers are updated at the end of every week and published on the NCDC website (www.ncdc.gov.ng).

What is being done to contain the situation?

NCDC is supporting states in responding to the increase in cases. Over the last three weeks, we have deployed Rapid Response Teams to four states. Our risk communications activities have been scaled up to ensure that Nigerians are aware of the risks of Lassa fever and measures to protect themselves. We have also supported states with medical supplies and other response commodities for the management of cases.

We continue to support treatment centres across the country, to develop the capacity of health care workers to effectively manage cases.

What most Nigerians do to prevent getting infected?

To minimise the risk of infection, we advise members of the public to ensure their environment is kept clean at all times to avoid contact with rodents. Members of the public are also advised to practice good personal hygiene and ensure proper storage of food to avoid contamination by rodents. Health care workers should maintain a high index of suspicion as Lassa fever can present with a fever just like malaria and other illnesses. It is very important that health care workers maintain standard care precautions when managing patients.

How is Lassa fever contracted, symptoms and what should be done?

Lassa fever is largely transmitted through contact with items or surfaces contaminated with urine, faeces, saliva or blood of infected rats. It can also be transmitted from person-to-person through contact with blood, urine, faeces and other body fluids of an infected person.

Lassa fever presents initially like any other febrile illness such as malaria. Early symptoms are fever, headache, diarrhoea, abdominal pain, sore throat etc. It is in very severe cases that the patient bleeds from body openings. If a patient does not respond to treatment for malaria or other febrile illnesses after 48 hours, it is important to test immediately for Lassa fever.

Importantly, health care workers must be vigilant and look out for Lassa fever symptoms as not all fevers are due to malaria. Health workers should protect themselves and ensure standard care precautions are in place when treating patients.

Are the vaccines ready? Have you started the pilot study?

The Government of Nigeria through the National Lassa fever Consortium is working closely with the World Health Organisation (WHO) and the Coalition for Epidemic Preparedness Innovations (CEPI) to contribute to progress for a Lassa fever vaccine. CEPI is a public-private coalition that aims to derail epidemics by speeding up the development of vaccines. Two-Phase I trials for a new Lassa fever vaccine have begun.

Before the end of the first quarter of 2020, NCDC and the three main treatment centres in the country-Irrua Specialist Teaching Hospital, Federal Medical Centre Owo and Alex Ekwueme Federal Teaching Hospital- will begin Lassa fever epidemiological studies. This will contribute greatly to our understanding of the efficacy of vaccine candidates.

One year after the Lassa fever conference, are we rising to the challenge?

About a year ago, nearly 700 people from 15 countries across the world gathered in Abuja for the first Lassa Fever International Conference in Nigeria. The NCDC and our partners hosted this two-day event on January 16 and 17, 2019, to mark 50 years since the Lassa fever virus was first discovered in Nigeria. Given the significance of the discovery and outbreaks that have occurred mostly in Nigeria and West Africa, our theme for the conference was 50 Years of Lassa fever: Rising to the Challenge.

Since its discovery in 1969, several countries in West Africa have continued to record outbreaks of Lassa fever. In 2018, Nigeria recorded an unprecedented outbreak affecting 21 states. Although there were more cases of Lassa fever recorded in 2019, we also saw a decrease in the number of deaths among confirmed cases and fewer health care workers infected. This may be linked to improved awareness, patients presenting earlier and better case management. One year after the first Lassa fever International Conference, this is a good opportunity to review our progress in Nigeria and ask, ‘Are we really rising to the challenge?’

The Lassa fever International Conference presented an opportunity for the scientific community to reflect on what is known about the Lassa virus, identify gaps that exist and prioritise a research agenda for the control of Lassa fever. For us at NCDC, the conference was also an avenue to set targets for Nigeria’s prevention, preparedness and response to Lassa fever outbreaks and other public health emergencies.

Since the conference, we have been working very hard to strengthen our capacity for Lassa fever control. Significantly, our surveillance, data collection, analysis and management for Lassa fever have improved. We have developed a harmonised database, which did not exist previously, using our Surveillance Outbreak Response Management Analysis System (SORMAS) tool. We are committed to working in partnership with other agencies and organisations to ensure that the response to Lassa fever is informed by the best available research evidence and data.

Another area, which we have focused on strengthening in the last one year, is Lassa fever research. Following the conference, we announced the development of the National Lassa Fever Research Plan. Since then, we have begun the implementation of aspects of the plan. On the sideline of the conference, the National Lassa fever Research Consortium was inaugurated. This consortium, which includes the three main treatment centres- Irrua Specialist Teaching Hospital, Federal Medical Centre, Owo and Alex Ekwueme Federal Teaching Hospital, Abakaliki- and partners, is coordinated by NCDC. This has allowed us to provide a unified and well-organised structure for Lassa fever research in Nigeria. Also, we are about to begin one of the largest epidemiological studies for the disease ever carried out. This is sponsored by the Coalition for Epidemic Preparedness Innovations (CEPI).

While we are yet to begin clinical trials for Lassa fever vaccines in Nigeria, we are much closer than we were a year ago. We are also better involved in discussions with vaccine developers on how to accelerate the development of their vaccine candidates. Many of the vaccine developers attended the conference in 2019. This is one area of progress that we are very proud of.

Over the last one year, we have added one laboratory to the national Lassa fever/Viral Haemorrhagic Fevers laboratory network. NCDC in partnership with the Foundation for Innovative New Diagnostics (FIND) and with support from the WHO and Alliance for International Medical Action (ALIMA) supported the Federal Medical Centre Owo, Ondo to establish a laboratory in the hospital. This new laboratory will be critical to reducing the turnaround time and improving response activities for the State. In addition, we utilised peer-to-peer support for this activity, by embedding staff from the Irrua Specialist Teaching Hospital, Edo State, to train and mentor laboratory staff of FMC Owo.

Is Nigeria ready to contain the spread of any case of coronavirus in the country?

At the NCDC, our mandate is to lead the prevention, detection, and control of communicable diseases. To reduce the risk of spread of the new virus to Nigeria, we are working closely with the Port Health Services of the Federal Ministry of Health, who have heightened screening at all points of entry particularly for passengers coming from already infected countries. As this is a new strain of the coronavirus (nCoV), a standardised diagnostic test is still being developed. We are working closely with WHO to access reagents molecular diagnosis in the NCDC National Reference Laboratory. As the situation evolves, we will know more.

Is the virus a death sentence? Does it have a cure?

As at the 20th of this month, of the 278 laboratory-confirmed cases reported to WHO, six deaths were recorded among patients with pre-existing clinical illnesses. If detected and reported early, the disease can be managed to prevent escalation and infected patients can benefit from supportive care.

Has coronavirus or similar viruses been isolated in the country before?

This is a new virus not previously detected in humans. Known coronaviruses such as Middle East Respiratory Syndrome (MERS) and Severely Acute Respiratory Syndrome (SARS) have also not been detected in Nigeria. This new coronavirus appears to cause mild to severe respiratory symptoms like cough and breathing difficulties.

Why should Nigerians not panic?

The NCDC is currently coordinating a multisectoral technical group that is assessing the risk of importation to Nigeria with guidance from WHO. Today, we released a public health advisory for the general public. The Port Health Services of the Federal Ministry of Health in Nigeria has been placed on alert and has heightened screening measures at the points of entry. We continue to build our capacity to respond and control the coronavirus. (The Guardian)

Update news