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LuxOR Operational Research Highlights 2018/2019

Understanding Lassa Fever and Improving Patient Care

MSF health promotors Ikechukwu Christopher Nwali, Joseph Ibeabuchi, and Nnenna Nnachi talk with the mother, Cecilial Okorie Nweke, and brother, Anayochi Okorie, of a lassa fever patient at FETHA II. Nigeria. © Brienne Prusak/MSF

Understanding Lassa Fever and Improving Patient Care

    In 2018, Nigeria experienced one of the largest outbreaks of Lassa fever in its history. Almost 3,500 suspected cases were reported, and 27% of patients infected with Lassa died.

    A CHALLENGING INFECTIOUS DISEASE

    Lassa fever is a hemorrhagic fever occurring in West Africa, particularly Nigeria, Sierra  Leone, Guinea, Liberia, and neighboring countries. The  disease is caused by a virus carried by multimammate rats, and people become infected after being exposed to the urine or feces of infected rats, or through direct contact with the blood or body fluids of an infected person. Approximately 80% of patients have mild symptoms, which are often not diagnosed correctly. Patients often experience fever, muscle and chest pain, vomiting, diarrhea, seizures, and hearing loss, while deafness occurs in one-third of patients and can be permanent.

    MSF joined the response to the outbreak in March 2018, and continues to support the Federal Teaching Hospital, Abakaliki (FETHA) in Ebonyi state, which was the third most affected region during the outbreak. 

    PREVENTING INFECTION, BETTER UNDERSTANDING LASSA

    To support Ebonyi state be better prepared for future outbreaks, MSF helped to upgrade protective equipment for medical and laboratory staff, provide tools and guidelines for case identification and management, improve infection and prevention control standards such as promoting hand hygiene, build an incinerator at the Abakaliki hospital to safely dispose of infectious waste, and inform communities about the risk of Lassa fever.

    At the Abakaliki hospital, LuxOR is helping assess and improve the systematic and timely collection of crucial patient data. As there are no standard forms or databases available to collect patient information to date, a comprehensive collection and analysis of data is missing. The different efforts to document Lassa disease are expected to contribute to closing this knowledge gap on how Lassa fever is transmitted  between rats and humans, obtaining more accurate estimates of confirmed Lassa cases, as well as supporting the development of a vaccine.

    Julita Gil Cuesta

    LuxOR Researcher

    In partnership with other Nigerian hospitals, national, and international partners, the first step of MSF’s Lassa research agenda in Ebonyi state is to initiate a study to determine which clinical symptoms and laboratory results are related to the survival of infected patients. This research is expected to provide valuable insights to guide the design of future clinical trials.

     

    In an infectious disease outbreak, correctly diagnosing patients is key to treat affected populations and stop the disease from spreading. During the 2014-16 West Africa Ebola epidemic, several MSF treatment centers at first had to rely on off-site laboratories to diagnose patients. This caused severe delays in reliably identifying and treating patients.

    To streamline the process, MSF developed a laboratory consisting of a metal shipping container. Allowing on-site diagnosis of Ebola and offering biochemical and hematological monitoring tests for improved patient management, these container laboratories can be used in other high-lethality, high-infectivity disease outbreaks requiring patient isolation.

    Building on the experience from West Africa and supported by an operational research study documenting the approach, a similar mobile laboratory prototype using a tent instead of a container was deployed by MSF during the 2018 Ebola outbreak in Equateur Province, DRC.