A N A D A P T A T I O N F R O M C D C P R E S E N T A T I O N , W H O F A C T S H E E T S A N D N E M A E P I D E M I C S U P D A T E .

A N U G O M A . E M E K A

Lassa Fever Presentation.

Welcome & Introductions 2

Logistics Emergency exits

Restrooms

Agenda 3

Lassa fever Disease Importance of Topic. Clinical Signs and Symptoms. Diagnosis and Treatment Preventing Lassa fever

What is Lassa Fever? 4

A viral haemorrhagic fever caused by the Arenavirus Lassa. A single stranded RNA virus that is animal-borne. This was discovered following the death of two Nurses in Nigeria in 1969 and named after the town in Borno state, Nigeria, where it was first discovered.

Transmitted from rodents to humans.

The species of rats transmitting this disease is prevalent in West Africa. (‘The multimammate rat’, mastomys species-complex), and is spread via their urine and droppings.

What is Lassa Fever? 5

There is secondary human to human

transmission, via body fluids exchange or in hospitals, via reused needles or contaminated medical equipment

The virus can be transmitted through direct contact with these materials or via cuts and sores or via poorly stored food (as Mastomys rodents are home scavengers)

It can also be airborne via inhalation of tiny particles in air contaminated with rodents excreta.

Also since mastomys are consumed as food source, it may also occur via direct contact when they’re caught and prepared for food.

What is Lassa Fever?

6

It’s seasonal, with clusters in late

rainy and early dry season, affecting all age groups and both sexes.

Its is endemic in areas of West

Africa including Nigeria, Liberia, Sierra Leone and Guinea.

Annual incidence of 100,000 to 300,000 with approximately 5,000 deaths in West Africa.

Incubation period is 5-21 days

Importance of Topic. 7

There is a recent outbreak in

Nigeria over the past 7weeks, which has claimed 40 lives, with Edo state accounting for 22 of this.

11 of the 36 states in Nigeria have been affected by this and a total of 397 cases have been reported, out of which 87 have been confirmed.

397 cases 40 deaths 12 States

Map of States With Lassa fever Cases in Nigeria 8

Graphical Display of Prevalence in Nigeria 9

1

15

326

1 1 5

6 5 4

29

4

Prevalence of lassa Fever in Nigeria as at 12th Feb 2012

AnambraEbonyiEdoGombeLagosNasarawaOndoPlateauRiversTarabaYobe

Anambra 1 Ebonyi 15 Edo 326 Gombe 1 Lagos 1 Nasarawa 5 Ondo 6 Plateau 5 Rivers 4 Taraba 29 Yobe 4

Clinical Signs and Symptoms 10

Gradual fever onset Headache Malaise Other Non-specific symptoms Pharyngitis Myalgia, retro-sternal pain Cough Gastrointestinal symptoms Few have the Classic symptoms of : - Bleeding - Neck/facial swelling - Shock

Clinical Signs and Symptoms

0 10 20 30 40 50 60 70 80 90 100

Swollen Neck or Face

Bleeding

Deafness

Conjunctivitis/Subconjunctival Hemorrhage

Abdominal Pain/Tenderness

Cough

Dizziness

Retro-sternal Pain

Headache Fever

Arthralgias/Myalgias

Sore throat/Pharyngitis

Weakness

Vomiting

Diarrhea

Chills

Lymphadenopgathy

Confusion

Percent

Clinical Signs and Symptoms 12

Case fatality of Hospitalized cases:15-

20%

Its severe in pregnant women and their offspring.

-Increase 3rd Trimester mortality (>30%) -Increased fetal/neonatal mortality (>85%)

Deafness is a common sequela, not

related to severity of acute illness, maybe bilateral/unilateral and may persist for life in one-third of those affected.

Diagnosis and Treatment 13

Clinical diagnosis is often difficult ELISA (Enzyme-linked immunosorbent

assays) for antigen, IgM, and IgG Postmortem tissue

Immunohistochemistry Reverse trancription-PCR for reasearch. Supportive Measures Drug of Choice is: Ribavirin -Most effective when started within first

6days of illness. -It is presently contraindicated in

pregnancy but maybe warranted if mother is at risk)

-Doesn’t reduce incidence of severity of deafness.

-Side effects are: reversible mild hemolysis and suppression of erythropioesis

Preventing Lassa Fever 14

Avoid contact with Mastomy rodents

and bush burning Store food properly in rodent-proof

containers Keep homes clean and discourage

rodent entry. Using rodent as food source is

discouraged. Clean traps and dispose carcass neatly. Prevent person-person transmission

via use of PPEs (Masks,Gloves,Gowns and Goggles) especially for health workers

Sterilize equipment after use Isolate infected patients from contacts.

Questions 15