Editor’s Note: The Nigeria Centre for Disease Control has just announced a new outbreak of Lassa Fever among health care workers in Ebonyi State and Nasarawa State. As our “disease detectives” work to investigate the case, we thought that this provides a great opportunity to publish a story that we stumbled on recently. We could not resist the opportunity of inviting Ibrahim Mamadu, an epidemiologist working with the World Health Organisation (WHO) to share his fascinating tale of the Lassa virus, how it defined his hometown and how he is working hard to stop its further spread.
By Ibrahim Mamadu MD, MPH
Viruses have always been part of my life story. My home town has a virus named after it: LASSA! The story started with a missionary nurse- Ms. Laura Wine, posted by the Church of the Brethren in the USA, to the local hospital in Lassa town, in the south of what is now Borno state in 1969. She had retired from a nursing career in Chicago and in Lassa became the head of obstetrics at the Lassa Mission hospital. She went home to the USA on leave, but on return to her station in Lassa, she started having a troublesome fever which just wouldn’t go away.
My father’s cousin, Hamidu Gadzama was the attending nurse in the hospital who managed her illness. He treated her with the conventional treatments for fever, assuming that it was probably malaria. She did not respond and he started to suspect that this was no ordinary fever. He quickly radioed the missionary headquarters in Jos to explain the situation. He was asked to prepare her for travel, while an airplane was sent to pick her up at Mubi airstrip and take her to Jos in the middle belt of Nigeria. In Jos she was then transported to SIM/ECWA Evangelist hospital Jan Kwano, (presently Bingham University Teaching Hospital); a much bigger and better equipped health centre where she could get better medical attention.
She did not improve, rather her symptoms worsened. Samples had been taken and sent to the laboratory and also to the United States where she came from. Her travel history revealed that she had travelled through another west African country (probably Sierra Leone), came to Nigeria via Lagos and had a stop-over in Jos on her way to Borno state. She did not recover and eventually died. It was soon clear that they were dealing with an illness they had never encountered before. This new contagion was obviously highly transmissible and virulent as not long after, the doctor and nurse that treated her in Jos also fell ill and died. Results from the U.S.A. Centre for Disease Control (CDC) indicated that this was a previously unknown arenavirus.
The virus was named “Lassa Fever” after my hometown where it was believed she must have acquired the infection. However, my uncle, who treated her initially, did not fall ill from the disease. He died at a ripe old age and very few cases of this infection have not been reported in the village and state since then.
My father, Professor Emeritus Njidda Mamadu Gadzama (OFR, FAS), now of University of Maiduguri, was doing his undergraduate and postgraduate training in the United States at the time and had heard that the new virus was named after our home town. He thought that this was very unfair. On returning to Nigeria, he decided to do something about it and interviewed several virology experts at the University College Hospital in Ibadan, Nigeria’s foremost medical school, to explore if there was any evidence from their research that the virus originated in Lassa. The experts indicated that it was unlikely that the virus had originated there. My father wrote an article published in the now defunct New Nigerian newspaper which was an extremely widely read paper at the time. He listed reasons why naming the virus after our town and Nigeria was a mistake. He argued that the most logical thing to do was to name it after the doctor that had managed the index case: Dr. Cassels1 or after Ms. Wine. His argument was that the nomenclature would be stigmatizing to the village and the country.
Former Minister of Health, late Mallam Aminu Kano. Photo source: dailytrust.com.ng
The Health Minister at the time, Mallam Aminu Kano, read this article and agreed that something needed to be done to change this name. The country had just come out of a civil war and he didn’t want any other negative story which would prevent foreigners from visiting the country. He quickly sent a ticket to my father to come down to Lagos, the nation’s capital at the time, and brief him on what could be done. In Lagos, following his discussion with the minister, they agreed that the best line of action would be for the minister to prepare and take this argument to the next World Health Assembly of the World Health Organization, which is the annual meeting of all health ministers of member states.
The minister argued the case for Nigeria at the assembly vigorously but in the end, it was unsuccessful. It was clear that once an organism is named in the scientific literature it is very difficult to change that name. However, a positive outcome from the argument to rename the virus was that the Assembly agreed that it is stigmatizing to name infectious agents after locations like Ebola in then Zaire or West Nile and resolved that the practice would be discouraged.
My village, Lassa, however suffered immensely from this stigma. For instance, doctors started refusing postings there, visitors stopped coming and even missionaries were not as keen to work there. The town’s hospital which patients used to visit from Northern Cameroun and even as far as Central African Republic due to the fame of the specialist missionary doctors that were previously there, became a shadow of itself.
Today as a doctor/epidemiologist working with the World Health Organization supporting Nigeria and also pursuing viruses like Monkey-pox, Polio and Yellow fever, I look back at my town and country and ask myself critically, what has changed in the country’s ability to prevent, detect and respond to outbreaks since those days in the sixties and seventies? Well, quite a lot. We have grown exponentially in population and have seen several initiatives to improve the health sector, notably the Alma-ata declaration, the Abuja declaration, Prof. Olikoye Ransome-Kuti’s drive to invigorate primary health in the 80s, the signing into law of the National Health Act, to name a few.
More recently the National Centre for Disease Control (NCDC) was created to coordinate the nation’s surveillance and response to all outbreaks. The NCDC performed well in its first major challenge in 2014 when the threat of the West African Ebola outbreak landed on Nigeria’s shores. In 2017 it was at the forefront of the response to a major outbreak of Cerebrospinal Meningitis in Nigeria that at the end had 14,473 suspected cases and 1,155 deaths. It has subsequently responded to several other outbreaks like Yellow Fever, Cholera, Hepatitis E and yes indeed, our own Lassa Fever.
The new leadership of NCDC has reactivated the National Reference Laboratory, Abuja and is working to strengthen the public health laboratory network for the whole country including collaborating to provide much needed support for the Lassa Fever research institute in Irrua, Edo state. With respect to training and capacity building the NCDC has become the hub for the Nigeria Field Epidemiology and Lab Training Program (NFELTP) program for training of epidemiology residents. It is also training and retraining health care workers in the Integrated Disease Surveillance and Response (IDSR) strategy with support from WHO and other partners. It recently launched its 5-year strategy (2017-2021). Given my personal and professional history, I am extremely proud of the leadership role that the NCDC is assuming in the battle against all outbreaks.
These are very exciting times in the field of communicable diseases in Nigeria and the future looks promising, although work needs to continue to embed these initiatives sustainably.
As Nigeria continues to struggle in the detection and response to Lassa fever, this is the time to pull together and align all the resources at our disposal to turn the story of Lassa into a positive one, by reducing its transmission and impact on the health of Nigerians.
- Call it “Cassel’s virus” not “Lassa Fever;” Describing the events and circumstances that surrounded the occurrence of the so-called “Lassa fever”. Gadzama, New Nigerian; 2nd May, 1974
- CSM Situation report 2nd June 2017, NCDC Website, www.NCDC.gov.ng