Lassa fever: not only a neglected disease, but neglected patients too

The purpose of my visit was to provide support in the preparation and implementation of the study looking into point of care diagnostic for Lassa fever. As Operational Research advisor in LuxOR, it's important to maintain proximity with the project and work together to generate evidence in tackling this deadly disease. 

"Currently, there is no vaccine for Lassa fever and the only available treatment is not optimal. Early detection, which is crucial to improve patients' outcomes, are hampered by limited availability and accessibility of diagnostics. Confirmation of Lassa fever can only be done by PCR in several specialised laboratories.

"Furthermore, the large genetic diversity of the virus also limits the possibility of universal testing so far. In short, there is a clear lack of safe and effective tools to tackle Lassa fever, and more Research and Development (R&D) to improve Lassa detection and management is definitely needed." 

Temmy Sunyoto, member of LuxOR

“Everything felt strange,” says 14-year-old Nneoma Okonogha, who was treated for Lassa fever – a virus transmitted to humans through contact with food or household items that have been contaminated by rodents. “I thought I was really in a nightmare.”

Once a person is ill with Lassa fever, they can pass it on to others should they contact the infected person's body fluids. Nneoma, along with her sister, Ukamaka and their mother, Priscilla, caught the viral haemorrhagic fever at the same time. All three of them were treated at the Alex Ekweme University Teaching Hospital in Abakiliki (AE-FUTHA), Ebonyi State, Nigeria.

It was so severe that when the children were shouting in pain, I couldn’t help them because I was also down with pain,” says Priscilla, who also works at the hospital as a civil servant.

In Nigeria, Lassa fever is endemic – cases are found and reported almost every year. But after a severe outbreak in 2018, when more than 600 people were confirmed to be infected, and 171 people died, the World Health Organization deployed a team of specialists from the Nigerian Centre for Disease Control (NCDC) and Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) to several states including Ebonyi.

In March 2018, Médecins sans Frontières (MSF) started supporting the Lassa treatment centre at AE-FUTHA. Since then, our teams have been working closely with the Ministry of Health (MoH) to treat patients suffering from Lassa fever.

The treatment has proven pertinent for the community, with over 15 patients treated for Lassa fever at the Abakaliki project in the first month of 2022 alone. Across Nigeria, there have been a total of 115 confirmed cases and 26 deaths throughout 30 local government areas in 11 states of the country.

“I contracted Lassa fever in February 2021. When I tested positive, I was shocked to the bone,” says Anastasia, a Lassa survivor from Abakaliki. “It came like malaria, and I bought anti-malaria drugs from a pharmaceutical shop. When I took it for three days, I was still sick. In fact, my situation was worse.”

Anastasia had Lassa fever, but thankfully she was able to access the anti-viral treatment she needed to recover. However, her first assumption that she had malaria is a common one.

Lassa fever symptoms are very similar to malaria, making it difficult to diagnose. Many medical staff don’t have specific training on the detection and treatment of Lassa. As a result, patients often only receive an accurate diagnosis once they are at a severe stage of the disease, which is more challenging to manage.

Since the beginning of our operations on Lassa fever in partnership with the MoH in Ebonyi state, the goal has been to tackle the root causes of Lassa fever and its broad spread impact on infected individuals. A trial of a rapid diagnostic testing (RDT) for Lassa fever is currently at the core of research at AE-FUTHA. If an RDT proves effective, it could help drastically reduce the waiting time for results from a laboratory test.

“We want to see if the RDT could be a substitute in the management or diagnosis of Lassa fever,” says Okereke Michael Uche, MSF medical doctor.

Timing is important; a patient moves from a mild condition to severe. And when it becomes severe, it is more difficult to manage,” he says.

To ensure continued progress in the fight against Lassa fever, our teams keep a continuous provision of drugs, lab supplies, and personal protective equipment (PPE). We also train AE-FUTHA staff on clinical management and Infection Prevention Control (IPC) for Lassa fever. And to alleviate the psychological impact of the viral disease on infected or suspected patients and their families, mental health support is also provided.

Stigma can be a heavy burden on Lassa fever patients. Some people have lost their jobs, been chased out of their own community, or even lost relationships because they were associated with Lassa fever, as a patient or a caregiver.

We work to educate and sensitise communities through a team of health promotors. The team organises community meetings, health talks and awareness campaigns in villages and rural areas across seven local government areas in Ebonyi state.

The purpose of all this is to foster behavioural change; we talk to people one at a time to ensure that everybody gets the message and understands the causes and cures for Lassa,” says Benjamin Uzoma, MSF health promotion supervisor.

Five survivors of Lassa fever also work alongside the health promotion teams to educate people about the disease directly from their own experiences with it. “What I did was to share my story,” says Anastasia, a Lassa fever survivor. “This helps other people know that Lassa fever is real, but that it can be cured if you are diagnosed and treated on time,” says Anastasia.

“Lassa fever is a serious disease, but when the medical community and the communities are fully engaged and empowered with accurate information, then not only is the stigma reduced – but we can get people timely access to care and they can recover more quickly,” says Luigi Sportelli, MSF project medical referent.