By Beti Baiye and Ibukun Oguntola
The driveway in the grounds of the Irrua Specialist Teaching Hospital (ISTH) is large and welcoming and as you enter the hospital premises, the hospital’s motto: ‘Patient is Supreme’ catches the eye. The hospital was founded in 1993 to manage viral haemorrhagic fever including Lassa fever and over the years, it has since grown in capacity and expertise. This has been mainly achieved through the Institute of Lassa Fever Research and Control (ILFRC) — first of its kind in Nigeria and the West African sub region — which was founded in January 2007 for the purpose of ‘halting and reversing’ the high morbidity and mortality statistics linked to Lassa fever in Nigeria, the West African sub-region and beyond. The institute now oversees the management of Lassa fever cases.
Following what was reported to be the largest Lassa fever outbreak in 2018, in 2020, Nigeria recorded 1,178 laboratory confirmed Lassa fever cases, the largest documented number of confirmed cases since 2006. There were several discussions about the reasons for the increase in Lassa fever cases: Was there an increase in Nigeria’s rodent population resulting from poor environmental sanitation? Was it the effects of climate change? Or had Nigeria simply improved disease surveillance and response? Over the years, deliberate efforts have been made to improve Nigeria’s Lassa fever diagnostic capacity and in 2020, Nigeria’s COVID-19 pandemic response ensured that disease surveillance was strengthened by the Nigeria Centre for Disease Control (NCDC) and the sub-national surveillance teams.
Building Nigeria’s Lassa fever Diagnostic Capacity
The institute has been at the forefront of research into Lassa fever and community intervention as they have built up local capacity and strength in the areas of clinical and laboratory management of Lassa fever and other infectious diseases.
Their actions have always been driven by the desire to build Nigeria’s capacity to respond to Lassa fever and other disease outbreaks. “The philosophy to indigenise capacity is clearly written in the policy statement; we want indigenous capacity to be built for an aggregate response to Lassa fever and other diseases,” Professor Sylvanus Okogbenin, Chief Medical Director, ISTH, clearly stated.
Leveraging on strategic partnerships
While ISTH has partnered with several organisations over the years, its longest lasting partnership has been with the Bernhard-Nocht Institute of Tropical Medicine, Hamburg, Germany (BNITM), spanning over 15 years. This led to the establishment of a state-of-the-art molecular research and diagnostic laboratory, local and international training for staff of the institute on research and clinical management of infection, prevention and control of Lassa fever and continued collaboration on the management of other disease outbreaks. Some ISTH staff members were able to take part in specialist courses on core case management in areas like paediatric, adult and obstetric Lassa.
According to Dr. Cyril Erameh, Director of ILFRC, previously, the mortality rate for pregnant women who become infected with the virus was 100%, however “because of this institute and the research coming out of this institute, we have been able to reduce the mortality rate to less than 20% for pregnant women”. Also, as a testament of the capacity built, clinicians and scientists from both institutions came together to carry out a two-year study on the persistence of the Lassa fever virus in patients after recovery from acute Lassa fever in Nigeria, and its impact on public health. The study results were published in November 2021.
The institute is also a supporting partner on the ‘Enable’ research programme; the largest ever Lassa fever research programme in West Africa, funded by the Coalition for Epidemic Preparedness Innovations (CEPI). The two-year research study started in 2020 in five outbreak prone countries — Nigeria, Benin, Guinea, Liberia and Sierra Leone. Dr. Ekaete Tobi, Consultant Public Health Physician with ILFRC said, when the programme started in December 2019, they enrolled 5000 people in Ondo, Edo and Ebonyi States. “Today we have confirmed about 14 Lassa fever patients, from these 5,000. It is possible we may have missed some because we found out that when they are sick, they don’t want to go to the hospital…Because we are catching them early, we hardly have Lassa patients whose case is very bad, in fact there was only one who got to the stage where he was almost vomiting blood,” she added. In Nigeria the programme has been named the Nigeria Lassa Epidemiology, or NiLE study.
Tackling viral hemorrhagic fevers and emergent pathogens
ILFRC has contributed to more than just the Lassa fever response. They helped develop policy, provided technical advice and helped plan and implement Nigeria’s COVID-19 pandemic response activities. At the onset of the pandemic, the institute set-up an isolation and treatment centre accreditation team (ITCAT). The team developed guidelines for establishing isolation centres and what was needed to scale them up in different parts of the country. They also helped accredit several isolation centres in Nigeria.
In keeping with their desire to be of strategic importance, not only to the country but to the world at large, the institute deployed a mobile lab to Sierra Leone to help with the diagnosis and community surveillance of the Ebola epidemic. They have also developed capacity to diagnose Monkeypox, yellow fever, dengue fever and other infectious diseases.
Professor Okogbenin said, having a clear vision — and being protective of that vision — purposeful leadership and courage, all contribute to the success of the institute. “They see it as us being stubborn, but it is because we want it better done here than we have seen it done in other countries,” he added.
The Way forward
Dr. Erameh is grateful for the collaborations with international partners as these have helped them build capacity for diagnosis and case management because “building isolation wards might be counterproductive if we have a pandemic or a new disease. So, we are learning to plan and build capacity ahead of future outbreaks”.
The institute is funded by the Federal Government and partners such as BNITM and Harvard who support diagnosis and trainings. But to be able to realise its goals, the institute requires more funding and support than it currently receives.
For Professor Okogbenin, the future of Lassa fever research and control in Nigeria is good. “We will definitely go into vaccine studies, and we will get a vaccine for Lassa fever. That is the next step as far as Lassa is concerned. As far as the institute is concerned, Nigerians should be proud of what they have because we are focusing on going beyond Lassa to other viral haemorrhagic fevers and emergent pathogens”. He added that the Institute’s board has recently given approval to change the name of the institute, from the Institute of Lassa Fever Research and Control to Institute of Viral Hemorrhagic Fevers and Emergent Pathogens.
Dr. Tobi believes that it is imperative to inform people that “there is going to be a Lassa vaccine in the very near future so that there is hope”. She revealed that her team sometimes encounters people who have never heard of Lassa fever. She has therefore found out that while jingles and other forms of communication are effective, the power of one-on-one engagement should never be overlooked as it is quite effective in helping educate people about Lassa fever.