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Lassa fever: 'No magic bullet'

Zipporah Nyambura
February 3, 2018

At least 21 people died from Lassa fever in Nigeria last month. DW talks to the head of the Nigeria Centre for Disease Control (NCDC) about what is being done to prevent more fatalities.

Nigeria |hospital in Abuja
Image: Getty Images/AFP/Stringer

DW: Why is it so hard to fight Lassa fever, given that it was first identified in Nigeria in 1969? 

Chikwe Ihekweazu: Lassa fever has been endemic in our country for many years. What has changed in the last two years is our ability to detect it. At NCDC (Nigeria Centre for Disease Control) and our collaborating labs across the country, over the last two years, we have strengthened our surveillance infrastructure, we have strengthened our laboratories. We have increased people's awareness of the need to use primary health care services. In a way, what has changed is our ability to detect an illness that has been there all along.

You've beefed up all these measures, so that's why it's now being detected. But why is it still killing people, instead of preventing further cases of Lassa fever? 

Lassa fever is a viral hemorrhagic disease. It does have a lower case-fatality ratio than things like Ebola, but it's still a fairly bad disease. We have one medicine available that is not very effective, especially when people don't come to the hospital early. We don't have too many tools in our arsenal, which is why it's vital that we mobilize the entire international community. We have to increase our efforts around research and get support for the work that we've been doing.

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It's been a deplorable situation that we've had this number of deaths within the first few weeks of January. But, we are doing everything possible to avert even more cases. The fatality ratio we've tried to keep as low as possible, but there is no magic bullet for Lassa. I think it's time to raise this internationally, and bring in the resources that we need to support the country in addressing this disease.

Is the problem that you don't have enough medical facilities and resources to fight it?

Resources and medical facilities are part of the problem. But, there's no single problem, and there's no single solution. So we need to do a lot of work ourselves, which we are, such as increasing access to primary health care, making sure we're able to diagnose other causes of fever like malaria to rule them out. And then going into secondary things like increasing the laboratory capacity for the diagnosis of Lassa.

For instance, we have only three laboratories in Nigeria at the moment that can make that diagnosis. So every time we collect a sample, we have to fly it across many kilometers to the three labs that have that capacity.

What measures have you put in place to prevent future outbreaks of Lassa fever?

One thing has been educating the public and healthcare workers about the disease and how to prevent it. Secondly, we've been supporting all the states in Nigeria, especially those affected, with personal protection equipment, and whatever else they need in the hospitals to care for these patients. Thirdly, we have strengthened our surveillance system, so that new cases are identified immediately and we are able to respond quickly. Lastly, we're really pushing our colleagues working in the international space. It's time to invest more in research that will take us to a vaccine or new drugs.

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For a disease with a fatality ratio of twenty to thirty percent, we have simply not invested enough in research.

You said Lassa is a deadly virus, like Ebola. What else do we need to know about the disease?

One of the differences with Ebola is that the host for the Ebola virus is not known. It's thought most likely to be a bat, but we really don't know. But we know that the host for Lassa is a species of rodent called the multimammate rate. We know that if we protect our food and ourselves to the excreta of rats, that we can prevent the infection. We also know that we can develop a vaccine if we focus on it. 

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Only a few countries have this disease, just a small cluster in West Africa, mostly in Sierra Leone but also Liberia and Guinea. And also a significant number in Nigeria. Because of the limited geographical spread, we don't think this disease gets the attention it deserves, for the mortality that it causes. It is simply not acceptable that so many people die of this disease.

In 2016 more than 100 people were killed because of Lassa fever in Lagos and Abuja. Do we have to wait for so many deaths to take action? 

We don't, but as I said, we don't have many tools against Lassa. We don't have a vaccine; there's no magic bullet. The work that we do in public health is often not easy. So we have to keep at it, even when success seems far. We have to keep driving home those messages about prevention. About keeping over environment free and not attractive to rats. Make sure we wear gloves all the time when we're managing patients and using tests for malaria.

So you see the response to Lassa is a multi-pronged attack. In public health, there are often no quick solutions. I know its frustrating for all of us. But we will not give up.

Dr. Chikwe Ihekweazu is the CEO of the Nigeria Centre for Disease Control.

This interview was conducted by Zipporah Nyambura. It has been edited for clarity.