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Lassa Fever :

Lassa Fever A 37 years experience at a Mission Hospital in Nigeria Dr Sule (FWACP)

Outline :

Outline ECWA Evangel Hospital History Lessons learnt Our experience Challenges suggestions

ECWA Evangel Hospital :

ECWA Evangel Hospital 150 bed space, owned by ECWA, started in 1959 by SIM, Offeringprimary, secondary and tertiary care in Paediatrics, Surgery, O/G, Medicine, ENT,

Ophthalmology Accredited centre for training in Family medicine by National and West African

Postgraduate Colleges

History :

History Lassa mission hospital in Lassa village,Northeastern Nigeria, about 1000 inhabitants,

Date19th January 1969 Laura Wine, 65 year old female nurse in the hospital became acutely

ill, she had been in Lassa for four years Had fever, back pain, sore throat

History (cont) :

History (cont) Dr Hamer the only doctor at the station became worried over her deterioratingcondition Had petechiae, anuria. Had CQ, procaine penicillin but no improvement She startedconvulsing, decision to move to Jos Flown to Jos, Evangel hospital formerly Bingham Memorial

hospital

History :

History In Jos under the care of Dr Jeanette Troup who reviewed her, investigations showed she

had internal haemorrhage, went into shock and died Charlotte Shaw, nurse at the hospital in Jos

nursed Laura, had a finger prick at home, used gauze swab wrapped over finger to clean Laurasthroat She became ill, died 11th day of illness

History :

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History Post-mortem done by Dr Troup assisted by Penny Pinneo the head Nurse. Blood samples

and tissues taken for studies A week later Penny Pinneo became ill, condition deteriorated 2weeks later was flown to New York Specimen taken to Yale arbovirus research laboratory

History :

History Virus isolated by team of scientist Drs Downs, Jordi Casals, Sonja Buckley Dr JordiCasals came down with Lassa infection and was given anti serum from Penny Pinneo, he

survived Penny Pinneo survived A member of the team of scientist died of Lassa fever.

1970 Outbreak :

1970 Outbreak Tamalama sale from Bassa near Jos became ill and was taken to Evangel, in

hospital for 10 days and eventually survived Her mother and daughter became ill Soon more

Nigerians became ill, total of 12, four of them hospital staff, two died Dr Troup did autopsy onone of the staff, accidentally cut herself

Jos outbreak :

Jos outbreak Virus research lab UI informed of Jos outbreak New cases continued to arrive at the

hospital, total 19 with 10 deaths Dr Troup became ill and died after 10 days Intensive contact

tracing done Outbreak abated

Jos outbreak :

Jos outbreak Plasmapheresis was done in conjunction with the Federal ministry and virus

research lab UI Serum from this was given to patients who had the infection and they had

remarkable improvement. This continued till the late 1970s

Lessons learnt :

Lessons learnt Take action no matter how small Need for a focal person in the institution who to

call on, more experience Even expired ribavirin is useful! Useful clinical symptoms and signs

Keep good records

Our experience :

Our experience On average 4-6 cases per year March 1989, suspected case seen, specimen sent

to Canada, presence of IgM antibody specific for Lassa, patient survived January 1991, T.M fell

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ill and died, suspected of Lassa, specimen sent to Canada, result positive for Lassa IgM 1:128,

IgG 1:16

Our experience (cont) :

Our experience (cont) March 1993 an outbreak in Lafia, CDC, FMOH, EEH team April 2000,

three samples of suspected cases sent to CDC M.L died 20th day of illness, wife had died a weekearlier, IgM, IgG negative, antigen detection result was borderline, Lassa virus isolate from

serum

Our experience :

Our experience 2. M.G fell ill, given ribavirin survived, IgM borderline, IgG and antigen

negative, low virus isolate titre 3. H.M fell ill, 5 pregnant, IUFD, aborted, subsequently died,

antigen strongly positive, IgG, IgM negative, Lassa virus from serum

Experience :

Experience February 2007 two cases reported to the Epid Unit of the State Ministry of HealthJ.G 50 yr with fever, epigastric pain, haematemesis, died same day of admission, contact tracing

done, 15 contacts none had similar illness, sample for virologic confirmation

Our experience :

Our experience 2. M.J 20 yr old, 7 month pregnant, had premature labour, IUFD, subsequentlydied, contact tracing done no infection, result confirmed for Lassa Between August and

November 2007 we had three suspected cases

Challenges :

Challenges Reportingavenues for reporting, slow response, no feedback, Infection controlnoproper isolation room Inadequate supply of safety equipments DrugsNo supply of

ribavirin,had to use old stock Partnershipprivate sector left out, poor health system

Suggestions for progress :

Suggestions for progress Develop better, efficient systems for reporting and response Reliablesupply of ribavirin Capacity development in infection control Public private sector partnership

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Acknowledgements :

Acknowledgements Dr B Truxton Dr Musa Dankyau Dr M Blyth Dr Lengmang

www.ecwaevangel.org :

www.ecwaevangel.org Thank you