Synopsis: Information regarding Lassa fever, an acute viral illness that is endemic in parts of west Africa.
Lassa fever or Lassa hemorrhagic fever (LHF) is an acute viral hemorrhagic fever caused by the Lassa virus and first described in 1969 in the town of Lassa, in Borno State, Nigeria. Lassa fever is a member of the Arenaviridae virus family. Similar to ebola, clinical cases of the disease had been known for over a decade but had not been connected with a viral pathogen.
Lassa fever is an acute viral illness that occurs in west Africa. The illness was discovered in the year 1969 when two missionary nurses died from it in Nigeria. The virus is named after the town in Nigeria where the illness first occurred. The virus is a member of the virus family, ‘Arenaviridae,’ and is a single- stranded RNA virus; it is, ‘zoonotic,’ or animal-borne. Lassa fever is endemic in parts of west Africa, to
include the following areas:
- Sierra Leone
Neighboring countries are also at risk due to the animal vector for Lassa virus. The animal is the,
‘Lassa Fever Blog,’ which is distributed throughout the region as a whole. In the year 2009, the first case from Mali was reported in a traveler who was living in southern Mali.
Ghana reported its first cases in the year 2011. Isolated cases have been reported in Cote d’Ivoire and Burkina Faso. There is also seismologic evidence of Lassa virus infection in Benin and Tongo.
The number of people who experience Lassa fever each year in west Africa is estimated to be between 100,000 and 300,000, with around 5,000 people dying from the virus. The estimates are crude because surveillance for cases of the disease is not performed uniformly. In some areas of Liberia and Sierra Leone, approximately 10-16% of those admitted to hospitals each year have Lassa fever, which indicates the serious impact of the virus on the population of these areas.
Signs and Symptoms of Lassa Fever.
The signs and symptoms of Lassa fever commonly happen 1-3 weeks after a person has come into contact with the virus. For most of those with a Lassa fever virus infection; around 80%, symptoms are mild and under-diagnosed. Mild symptoms include:
- Slight fever
- General malaise
Around 20% of infected people; however, the disease might progress to more serious symptoms that include hemorrhaging of the person’s eyes, gums, or nose – repeated vomiting, respiratory distress, pain in the back, chest and abdomen, facial swelling and shock. Neurological issues have also been described in relation to Lassa fever, to include tremors, hearing loss and encephalitis. An infected person may die within two weeks of their initial symptoms because of multi-organ failure. The most common complication of Lassa fever is deafness. Different degrees of deafness happen in around one-third of those who become infected. In many cases, the hearing loss is permanent. The severity of the disease does not affect this particular complication; deafness might develop in mild as well as severe cases.
Between 15-20% of people who are hospitalized for Lassa fever die from the illness. Only 1% of all Lassa virus infections; however, result in the person’s death. The death rates for women in the third trimester of pregnancy are exceptionally high. Spontaneous abortion is a very serious complication of the infection; an estimated 95% mortality rate in fetuses of infected mothers is an alarm sounding off.
Due to the fact that the symptoms of Lassa fever are so nonspecific and varied, clinical diagnosis is often times difficult. Lassa fever is also associated with occasional epidemics. During these epidemics, the fatality rate may reach as high as 50% in people who become hospitalized.
Diagnosing Lassa Fever
Lassa fever is most often diagnosed through the use of, ‘enzyme-linked immunosorbent serologic assays (ELISA), which detect IgM and IgG antibodies as well as Lassa antigen. Reverse transcription- polymerase chain reaction (RT-PCR) may be used in diagnosing people who are in the early stage of the disease. The Lassa virus itself may be cultured in 7-10 days, yet the procedure should only be performed in a high containment laboratory with good laboratory practices. Immunohistochemistry, performed on formalin-fixed tissue specimens, might be used to make a post-mortem diagnosis.
Treating Lassa Fever
‘Ribavirin,’ is an antiviral drug that has been used with success in people affected by Lassa fever. It has been shown to be most effective when it is administered early in the course of the illness. People should also receive supportive care that consists of maintenance of:
- Blood pressure
- Treatment of complicating infections
- Appropriate fluid and electrolyte balance
Preventing Lassa Fever
Primary transmission of the Lassa virus from its host to people may be prevented by avoiding contact with Mastomys rats – particularly in the geographic areas where outbreaks happen. Putting food away in rat-proof containers and keeping your home clean help with discouraging rats from entering your home.
Using these rats as a source of food is definitely not recommended. Trapping around and in homes may help to reduce rat populations. Yet the wide distribution of Mastomys rats in Africa makes complete control of these rats impractical. While providing care for people with Lassa fever, further transmission of the disease through person-to- person contact or other routes may be avoided by taking preventative precautions against contact with secretions from infected persons called, ‘VHG isolation precautions,’ or barrier nursing methods. The precautions include wearing protective clothing such as masks, gowns, gloves and goggles; using infection control measures such as the sterilization of equipment. It is vital to isolate infected people from contact with unprotected persons until the disease has run its course.
In addition, educating people who live in high-risk areas about ways to lower the rat populations in their homes will help to control and prevent Lassa fever. Other challenges include the development of quicker diagnostic tests and increasing the availability of the one drug known for treatment of Lassa fever – ribavirin. Research is currently being performed in regards to the development of a vaccine for the illness.
Facts: Lassa Fever
While most humans are infected either from contact with an infected rat or inhalation of air contaminated with rat excretions, like other hemorrhagic fevers, Lassa fever can be transmitted directly from one human to another. It can be contracted through direct contact with infected human blood excretions and secretions, including through sexual contact. No evidence of airborne transmission person-to-person is seen. Transmission through breast milk has also been observed.
Statistics: Lassa Fever
- The number of Lassa virus infections per year in West Africa is estimated at 100,000 to 300,000, with approximately 5,000 deaths.
- In 80% of cases, the disease is asymptomatic, but in the remaining 20%, it takes a complicated course. The virus is estimated to be responsible for about 5,000 deaths annually. The fever accounts for up to one third of deaths in hospitals within the affected regions and 10 to 16% of total cases.
The dissemination of the infection can be assessed by prevalence of antibodies to the virus in populations of:
- Sierra Leone – 8 to52%
- Guinea – 4 to 55%
- Nigeria – about 21
Culled from: Disability World (online)
Stampede, of late has emerged as one of the major risks in any mass gathering, be it religious or political or cultural in our country. Whether the event organizers take sufficient preventive measures to prevent stampedes or not, we are on our own when it comes to saving our life and of others in such situations. Though prevention of disasters like stampedes may seem foolish once they start happening, surviving such accidents is very much possible if you observe the following tips :
- The first and most important thing is to consciously make yourself familiar with your surroundings and mentally notice alternate exits. No matter where you are, make sure you always know how to get out.
- Make yourself aware of the type of ground you are standing on: in a moving crowd wet or uneven ground can be slippery or hazardous.
- Do not stand near or climb on chairs, benches, and barricades, temporary structures, such as the Dias/stage, the start/finish points in marathons, which could collapse under too much weight or pressure. Do not forget, if you do such things, hundred others would follow you in mass gatherings.
- Be aware of the general atmosphere of the event, as panic situations can often be easily anticipated. When in danger, few seconds can make all the difference, giving you the possibility of taking advantage of your escaping route. Stay always closer to the escape route.
- Panicked crowds move fast and release an incredible amount of energy, usually compared to the energy generated by a running train: once a crowd gets moving it is very hard to stop, and the flow of people could literally sweep you off your feet.
- So, if you find yourself in the middle of a moving crowd do notfight against the pressure, do not stand still or sit down, because you could easily get trampled.
- Instead, move in the same directionof the crowd; take advantage of any space that may open up to move sideways to the crowd movement where the flow is weaker.
- If you fall, get up quickly. If you can’t get up because you are injured, get someone to pull you back up. If you have kids, lift them up.
- Because the noise level in a crowd could be too loud for shouting to be effective, use gestures to communicateto each other. Always remember, in stampedes everyone will be running scared to get out of the place.
- Grab your friend’s hand or shoulder to remain together. Alternatively, decide on a gathering point where you will meet and account for each other, should you get separated.
- If you fall and cannot get up, keep moving by crawling in the same direction of the crowd, or if that is not possible, then cover your head with your arms and curl up into the fetal position(do not lay on your stomach or back, as this dangerously exposes your lungs).
- The worst scenario is to be pushed by the crowd against an immovable object. Try to stay away from walls, fences or barricades, as the crowd pressure can build up rapidly. On the other hand, if you are at the back of a crowd that looks jammed, do not push it, as it could pose a threat to someone else safety.
- If you are visiting a pilgrim place in its peak season, reserve your tickets early. Know whether there were any stampedes earlier, talk to the people who just returned from the place about arrangements, whether the authorities taken extra measures etc.
- Avoid moving in huge crowds especially in the small hours of day (between 3AM and 6AM) as many volunteers and police personnel are not expected to be active during that period which eventually leaves the crowd to take decision on their own.
- Visit and enjoy only the places where adequate crowd control measures are in place. Remember! You have only one life to live.
Credit: Hyderabad City Police
TRIBUTE TO A STAR
It was a Friday like any Friday. The weather did not give any suggestion that it was going to be a black day or that it was going to set in tears. The day before my boss had called to say she had just arrived from her well deserved rest abroad. She sounded refreshed and raring to go. We talked about the plans for the 10th anniversary of the NGO, Handicapped Education Foundation that we all called HANDEF.
I expressed anxiety over the tardiness of a sponsor we had been waiting to respond, and she kindly said I should not worry so much, that we should depend on the Almighty about how the anniversary would be celebrated. However, she might be paying a visit to the centre soon, in a week or thereabouts. Anyway I should let her have the sample letter I was planning for schools.
I promised to send her an update of activities since she had been away, to bring things up to the minute. A few more chit chat and the conversation ended with me in an upbeat mood which carried me into the next day Friday the 13th of September.
Report up to date, I called her and informed her that it was now in her email. The day ended peacefully enough and I went home. Then came the phone call. I was already half way to dream state when the call came and the caller in deep anxiety called to ask if the news was true. My boss had lost her best friend, confidant, role model and husband of more than three decades.
My heart hammered against my rib cage and I wondered if I was about to reach to the cold beyond to yank him back. I felt very sad. The phone calls kept flooding in thereafter so I abruptly switched off. Dr, Olusegun Agagu had passed on. The man who seemed indestructible from the numerous betrayals of close associates had been felled by the cold hands of death.
I wondered how my boss would be feeling and shuddered in real pain, at what I sensed would be the huge black hole she would be gazing at. My memory took leaps as I recollected the close bond that held them together. I remember these stories that had made me to respect him.
I remember his passion to showcase only the virtues and abundant resources of the state to anyone who cared to listen. A practical and pragmatic person, he was under no illusion about anything, but had a will to change things. Once when I took him up on the granite tiles that he had used for the government house, because I had like many other people assumed he imported those beautiful tiles, he had smiled and invited me to visit the state ministry of commerce so they could take me to the granite sites of the state so I could see things for myself. There was justified pride in his mien and voice as he said Ondo state had the best granite in the world. He could say that, for he was on familiar grounds.
I worked for his wife, but gradually learned the personality of Dr Agagu. He was always courteous, dignified with an unfailing smile each time I met him. I always felt there was a lot he kept under control behind those smiles.
My husband and I are like two peas in a pod as we go everywhere together, and I felt we were not strange as I saw the bond between Dr. and his wife. Over time, I had learned to see a lot of virtues in this dignified man. He was a rare breed who conducted his political affair with a deft brilliance that angered his enemies and left some of his aides frustrated because they could not match his moral ground.
I am sure Dr. Agagu was not exactly a perfect man, he was aware of his foibles. Some faux pas he committed, particularly his naïve acceptance that it was okay to surround himself with very ambitious men. This naivete cost him dear politically but I think he simply shrugged and moved on to the next step, next rung of his experiencing.
I understood his focused understanding of his people and what would seem best for them. His attitude was sometimes patriarchal, with a benevolence that tended to make me wish he would just for once look around him. I always felt he had no business being in Nigerian politics with its cut throat viciousness. He was like an eagle amongst hawks.
I have an understanding that long association begets familiarity and could bring about a transfer of virtues and behavioral change. For most of the time I knew the couple , they were a constant study for me.
Mrs. Olufunke Agagu created HANDEF and she carried the same attitude as her husband. I remember asking her the first day I met her if the NGO she formed was really sincere and if it will last the distance. Her answer was just as simple as herself. She gave me a smile, and said she hoped the NGO will outlive her existence.
Well it outlived their tenure in office and we were making plans to have a fairly grand 10th anniversary of the NGO come December 18th. Obviously that plan has bit dust now.
We are devastated by this loss of one we saw as a mentor, role model and Patriach. Dr. Olusegun Agagu infected us through his wife and our boss Mrs. Olufunke Agagu with his disciplined approach, compassion and generous spirit. It was thus not surprising to have an NGO headed by a personality like Mrs. Olufunke Agagu with a vision for a better world for persons with disabilities. A vision of constant distribution of wheel chairs in their hundreds, training and giving persons with disabilities dignity,, through vocational skills training, and avenues to succeed and be self reliant. Like two streams Dr. Olusegun Agagu and his wife flowed individually and jointly towards a common goal…..to serve humanity in gratitude to the Creator.
At HANDEF, we salute Dr. Olusegun Agagu, and send our thoughts to his wife our boss and hope that as the Eagle soars above, may his spirit find his path lit with the Divine Love and he soars to human kingdom of paradise.