 Welcome back to the breakfast and plus CV Africa. We had straight to us a conversation Well, we look at the outbreak of LASA fever the Nigerian government has issued an alert on the LASA fever outbreak That has taken, you know, the lives of 102 persons in a dough Bouchie among all this this morning We're being joined with a public health physician a member of The public health physician of Nigeria Lagos chapter dr. Ghani you jammy you it's good to have you join us this morning Good morning. Nice to see you to have you to this morning. That's all right So with the case right now, let's quickly share your thoughts Do you think that we might just be experiencing a health crisis? We have LASA fever We also have you know the corona virus with different variants among other diseases Can you please tell us what you know the case might be for the Nigerian health sector? Okay. Well, nobody and we say that Realizing the fact that we are currently back there with COVID-19 However, I would like to share my thoughts regarding the fact that LASA fever has been with us for a long time. It is it has become an endemic disease It does occasionally usually during the summer Research have shown that during dry season some are said during rainy season when sometime we just have a spike Dr. Jami Yes, go ahead System People miss it when somebody presented as a facility Attempts people and the virus is been diagnosed after some of them that maybe do not option also The issue has to do with the diagnosis because it mimics that a lot of differentials that is Diagnosis that's associated with the virus like Somebody may assume that somebody presenting with fever Not Well, why because you've described this as Endemic here in Nigeria. Why has it been difficult for Nigeria to deal with LASA fever? It keeps going and coming back and of course we failed to also mention that the Fatality figures with LASA fever fever in Nigeria are staggering We still have not been able to deal with it. So, so what's the biggest challenge? Bigger chance is diagnosis at presentation because most of times the size and symptoms are not specific for LASA fever So a patient can present with symptoms Suggests of malaria or a terrible fever or any fever in us you know, probably the fact that our Infection prevention and control in some facilities are not too impressive and you also agree with me for the fact that You will expect that any point that you'll present fever Or any other maybe Diarrhea vomiting the first thing that's which I know is that is surfacing of malaria or any So usually people don't take caution You find that because dealing with LASA fever will require wearing Equipment and so on. So most of times some people assume it does malaria or the tariff evil So so it takes it to require index of suspicion for somebody to think that a person presenting Actually Fever for instance, let me give you example What happened in a natural state sometimes in November where we lost two of our colleagues What happened was that this woman Delivered and presented with postpartum hemorrhage, you know, bleeding following Anybody would believe that okay, it could be as a result of maybe a Conviction following delivery. I think of the this one was operated on in the B2 a kind of control the place Intiquid was postpartum hemorrhage at the end of the day it was a case of LASA fever So the issue is this is that this part we having the case definition In terms of is he a suspected case for people case is only one we have a confirmation case that somebody may and At times most of time anything will have been done, you know with the patient Vomit is all Secretions and so so before it may be a Suspicious or LASA fever would be made but usually people normally miss it at the beginning because of the nature It doesn't really present you Only occasional where somebody come, you know, I'm a high source of issues or somebody call with bleeding and Fever with other symptoms, but on many occasions only 20% presents with bleeding So this is some of the challenge. So I maybe as we go around the subject what we think we can do Which I believe we are currently doing each other will not be able to achieve the result. Thank you Okay, so Do you think that you know, we have done enough since 2016? I mean when we had this outbreak of LASA fever Do you think we have done enough as a country and what can we do? You know to ensure that we reduce the death rate and of course we improve and prevent all of this Okay, yes, we really don't wear in terms of surveillance But I've said this is a disease whereby you can be specific as to the size of symptoms for Easter Let me give an example. It's a specific case now. It's somebody that may be fever within 32 21 days, which may be Degrees and a both with symptoms such as nausea vomitting, you know diarrhea, the lice body pain, muzzle pain Abnormal bleeding that is bleeding from that. As I've said bleeding, you can only see that in 20% of days So the issue with the only way for which I don't want to stay as part of prevention is for all to have a vaccine for it It's unfortunate that since the discovery of LASA fever since 1969 We're here to get vaccine, but there's a lot of work Currently ongoing, but the only thing we are we advise is especially Relatively in the eye endemic area is for us while I saw eye in this or suspicion Especially if somebody's coming fever, we don't just have this malaria. Actually, there are a kind of a Management protocol with gas to be for instance when you suspect somebody Maybe presented a fever With all those symptoms I just mentioned. Maybe you try to commence and think it as anti-malaria when the person does not respond Within maybe 48 to 12 hours. I've been suspicious whether it is not malaria So but unfortunately before you get to that point of people thinking that in the likelihood of the malaria You'll have freedom with that patient normal contact and so on. I want all that you know All to say is that you don't expect for every patient coming fever a physician should be very All the gadgets, you know, because this is a very high virulent virus I expect it to wear the normal PPE and so on and see, you know These are some of the challenges. So the only way forward as part of this in case we miss This is for us to develop vaccine, which I think the National Center for Disease and Control Nigeria has been in In charge of ensuring that we have a vaccine for it because if you look at it, they've done a lot We have about five centers and so I think the way forward is that is to develop medical vaccine It will go along with a kind of reducing all these miscellaneous which are the end of they get complicated More people involved and so on and so forth. Thank you very much How are transmissible is LASA fever, you know, and of course, what's also the Fatality statistics, how many people get to survive LASA fever and also talk about Nigeria's health care system currently We are still dealing with COVID-19. Do you think we can handle a full outbreak of LASA fever? Is this something we should be worried about? Yeah, okay Case fatality Wanted out to say is that For every Case of LASA fever only about 20% end of getting signs and symptoms 20% And among these the case fatality has been between 10% 15 The only situation about we get high case fatality People that are high risk like pregnant women children people are both 40 years and other people people with Comorbidities, I may be hypertension and other diseases. Those are people that are more in pregnancy The case fatality may reach up to about 50 55% from 45% and above So it's more that's why if a pregnant woman Presented in the hospital with complications and if LASA fever is not diagnosed on time The risk is really higher because in terms of even the outcome of pregnancy the woman or so So these are some of the The issue as a regards to that we don't pray for us to have a kind of company tell me because it will be a company It's already the our assistance already over stretch So having this adulting will not be healthy for the assistant So the best thing that we need to do as quick as possible nipping the board and I think the AC this is doing a lot of work and I promise it even the states they now the capacity No, so I do that as you can about you have the isolation center where they are taking care of them So the only thing that is that since we are witnessing a kind of spike in this in cases of LASA fever I think now in where that such are not being you know discovered or Established what we need is that for every fever we need to very careful as regards to how we manage anybody present Especially if they are coming from high endemic areas like Nassar Rawa, Bainway State, Tarraba So now we're but it was all used to know as one of the Endemic area I body have been now we are witnessing things like that. So at this moment I think about for the COVID-19 which will normally, you know, this Come suspicious point the temperature of about 18 degrees and above. I think with the current situation I think we also need to rule out fever especially on explained fever with all without beating We need to add a high index of suspicions and we need to work in transfer Infection prevention and control in IFA. We don't just assume everybody call me with fever Is this a highly transmissible infection From person to person Yeah, okay, you say For person to person is more because usually, you know Very carry out that infection is Is is rats. We have a class of virus called mastomins Especially that is mermaid rat. That is why you see them all in the in the urine in their feces That is in that dropping. So that is there actually to resolve of that virus But usually when there is man interface with rats I thought you know, not coming out food very well With the urine or with the droppings or try to make it as a meal, you know, all team for them and so on And so anything that will make us to have a contact with any of the droppings I can actually cause an infection in women, but it seems that man to man, you know true Maybe Bring our secretions and so on can actually, you know, post a more risk as that's a Transmission of last a fever. That is why if there is any case of loss of blood at his babies in their facility At times it can lead to a lot a very very You know, pretty So that is why it's actually my left for man to man Man to man. Yes. Thank you. Okay. Can you kindly take us through? The preventives are there measures that can be taken to ensure that this doesn't happen I mean for COVID-19 we're being asked to, you know, wear the nose masks wash your hands and Just constantly respect the social distancing and the malaria You'll be asked to clear the bushes and clean the quarters So are there things that, you know, persons can actually engage in practices to ensure that we don't get to this point Where they contract or the contact, you know this fever Okay, since at this moment we are having Outbreak in some selected states The first thing that will start based on our level of prevention light is at the primary level Immunity we need to eat well Because immunity also play a role. This is a viral infection Good nutrition and try that we eat well I don't like the normal COVID will normally encourage people to also eat well, you know good It's helping building our immunity Then I did also this level or in terms of prevention We need to ensure that we cover our Our food anything that is edible. We need to cover it But we don't expose our, you know, foodstuff at home. We should learn to cover them because of Counter with rats. Then another thing that We need to do is that for those that aren't rats all those hunters and so on at this point in time We need to they need to desist from it In the rural areas, they need to stop speaking a real food item on or by the roadside or the an open surface where that can be Contact with with with rats. Then another Thing I would like to also say So that's what I that we should avoid making direct contact with maybe touching maybe when you cure rats You know, somebody you don't be able to pick it all those things are higher in terms of the practices Then another that we need to do is Our mental sanitation very key because by telling our home is clean It's gone wherever reduce contact a little movement of right to our homes as well So proper environmental housekeeping is also very very very important at this point in time Then another thing is at the facility level. We need to have a high index of suspicion at this Point Send in anybody that call if you want to ask money, especially if the we're having about a temperature about 30 degrees and above We need to because it's not cases of master people that present with beating So we need to avoid that in case of situation in situ that effectively our Special provision and control our protection is I appear to be more relatively severe because I had making contact with a Dissecretion of an infected person. We could be blood to be urine That's also we need to be at the effort to need to be very that idea suspiciously to be there So that the moment maybe We institute the appropriate, you know, investigation if it's my weekly to our normal I don't want to go into the test so that people They know what to do in terms of trying to ask today when I As quick as possible with proper official provision and control to see whether that person's money So that And then that can come out in the calm, you know, present with Fever in our in our setting so after which And again if there's suspicions of money that because that can be money that will last of your way Together so in the case somebody is not in responding based on the protocol of instituting a standard medication for malaria that should be I That should also serve as a pointer to something then they can take the patient sample and you know, you know Send the sample to appropriate Diagnosis centers. We have about five. We are one federal medical center of war We have one in the Iroha specialty teaching hospital. We have another one in legal university teaching hospital Those are there. So there we have any abuja the SEDC laboratory Facility reference laboratory in in abuja. Then we have one in a point that is in federal teaching hospital So usually we have a protocol that is we call that's what's going to get a Disease surveillance and response Starts changing we have in the country. So usually there is an alert Processes of reporting when there's ideas of suspicion from the hospital of particular government to the state So they know the right thing to do. We have all the structures of ground at all level But they will inform the national the state to be involved and all the appropriate, you know Alerts and incident Response will be put in place to ensure that other people are you know are prevented from getting contact for those who would already You know Thank you. So in terms of isolation and making sure that properly treated we have all those Protocols are grinding you want you to ensure that we take care of that. Thank you. All right There's a public health physician and member of the association of public health physicians of Nigeria Legacy chapter dr. Ghani you jam you. Thank you very much for your time and for speaking with us this morning It's important information concerning lasafi vine. I think everyone should be aware Thank you once again Absolutely, and of course a big story there for me would be that bush midsellers need to be checkmated I Guess it's something we're not saying but this is what we call it a wrap Thank you so much for being part of the conversation The show would definitely return tomorrow and the time again is seven o'clock In the meantime, you can be sad on any part of the conversation. 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