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Rapid Responses: Rapid Responses published:
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Nigeria is the best place to study Lassa fever
- Dr. Ahmed Ahidjo (1 December 2003)
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Fever! The Hunt for a Killer Virus
- Colin D Butler (8 December 2003)
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Rat eating, sexual transmission and the burden of Lassa fever disease
- Babafemi A Oshin (9 December 2003)
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More information on Lassa fever
- Dr Haruna Yusuph (10 December 2003)
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Dr. Ahmed Ahidjo, Consultant Radiologist University of Maiduguri Teaching Hospital, Nigeria
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I am happy to see this article.This is mainly because I came from Askira/Uba local Government council of Borno State, Nigeria, where Lassa village is situated. When I was a child Lassa general Hospital where the missionary nurses died of the disease was the only hospital we obtain medical treatment. In my own opinion Lassa is the best place to study the actual disease. University of Maiduguri Teaching Hospital, Borno State is the closest Tertiary Health Institusion in the locality. It is equiped with a good virology Laboratory and the required medical staff. Competing interests: None declared |
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Colin D Butler, Research Fellow NCEPH, ANU 0200, Australia
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In 1985 I spent 3 months based at Evangel Hospital, in Jos, Plateau State, Nigeria. While there I learned the story of Lassa fever, including from a still practising nurse, (Penny), whose dramatic trip (I think with her name given but perhaps we should not write the surname, ethics may have changed) to New York after she developed symptoms of Lassa fever is well told in a book called Fever! The hunt for a new killer virus, by John Fuller. Two of Penny's colleagues, including a doctor performing an autopsy, had already died, which was what made everyone panic. I think the flight to NY was on Pan Am, and the only precaution against infection was an extra seat or two for the near comatose patient. In NY, I think at least one person, a lab technician, also died. As far as I can recall, Lassa is a village or town very close to the border with Cameroon. Competing interests: None declared |
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Babafemi A Oshin, Country Medical Coordinator, Merlin Sierra Leone Freetown, Sierra Leone
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Eating Lassa virus infected rats and sexual intercourse could definitely transmit infection but I think both methods have a limited role as an important mechanism in sustaining the endemicity of the disease in the population as described by sero-prevalence surveys and the clinical disease burden. The reason for this is that the subsequent disease from eating rats will almost certainly cause rapidly fatal disease as a direct result of the delivery of a very high dose of the virus into the person – a lethal dose (LD) and so such persons will not contribute to the pool of sero- positive persons detected during a sero-prevalence survey. With sexual transmission, the presence of Lassa virus in seminal fluid definitely suggests increased risk of transmission through sexual intercourse but here I think the viral dose that the person is exposed to might not be enough to cause clinical infection often enough to contribute significantly to the burden of the clinical disease in these populations. If these assumptions are found not to hold then I’ll suspect that persons who survive an attack of Lassa after eating rats or persons that succumb to much lower infecting doses (ID) of Lassa virus will be our window into understanding the immunogenetics of surviving a LD of Lassa and possibly the wider phenomenon of variable clinical response to Lassa fever infection in the population. Competing interests: Babafemi Oshin currently works for Merlin as Country Medical Coordinator in Sierra Leone |
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Dr Haruna Yusuph, Consultant Physician (Immunology/Infectious diseases ) University of Maiduguri Teaching Hospital PMB 1414 Maiduguri, Nigeria
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I cannot agree more with the author of this interesting article on the fact that the need to understand Lassa fever is increasing. The disease has not caused major epidemics in Nigeria in recent times, but it is a well-known fact that it is endemic and might rear its ugly head when least expected. The diagnosis of Lassa fever can be very confusing, more especially in non-epidemic period, in view of the fact that the features coincide with those of other infectious diseases encountered in the tropics. However, the federal government of Nigeria, through the Ministry of health, has set out some criteria for the detection of Lassa fever. These are outlined below: Signs and symptoms include: 1.Major criteria
2.Minor criteria
Diagnosis
Probable Lassa fever: Persistent of fever with any of the major criteria. Possible Lassa: Persistent fever with 2 or more minor criteria and known contact with Lassa fever cases. The author wrote: "Humans are infected by contact with the rats or by eating them......" I would like to suggest that this statement may not be true as merely eating the rats has not been shown to cause the disease. This is because the virus has not been shown to withstand high temperature required to prepare the delicacy. Rather, humans are infected by ingesting foods contaminated by rat urine or saliva containing the virus. This implies that unless the rat delicacy is contaminated by rat urine or saliva it is not likely for the infection to occur. The bottom line remains that the major health problems encountered in sub-Saharan Africa are HIV, TB, and malaria. The University of Maiduguri Teaching Hospital where I work as a consultant Physician (Immunology and Infectious Diseases), Nigeria's Center of Excellence in Immunology and Infectious Diseases is situated about two hundred and fifty kilometers from Lassa village. This article has once again ignited our interest and reminded us of the fact that we should not relegate Lassa fever to the background because we are overwhelmed with HIV-positive patients. Competing interests: None declared |
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