Following the level of anxiety being expressed by people all over the country on the epidemics of Lassa fever currently being experienced in various states of the federation, the Nigeria Medical Association has deemed it proper that we make a press statement for everyone in these regards. NMA fully commends the efforts of President Mohammadu BUHARI, GCFR for his moral, timely and financial support towards curtailing the unfortunate Lassa epidemic. We also commend and associate with the Honourable Ministers of Health for their tireless efforts towards nipping the Lassa epidemic in the bud. Their public enlightenment and proactiveness on this epidemic have been most heart warming. This is in addition, and without any prejudice whatsoever, to any other ones being made by the various governments, agencies and bodies in the country. In order to compliment the various efforts of the agencies of Government, the Nigerian Medical Association wish to make the following declarations:

1. Lassa fever is an endemic (locally common) disease discovered as one of the new or emerging diseases since the 1950s or so. The first episode from which the virus causing it was identified was that of missionary Christian health workers in Lassa town in present Borno State of Nigeria and from which town’s name the disease got its name in 1969.
2. Lassa fever is a zoonotic viral infection; in other words, a disease whose primary host is an animal, namely the multimammate rats (i.e., with double row of breasts under her female body) called Mastomys. These rats naturally live in bushes around human homes and visit such homes occasionally for extra food to eat
3. Human beings get infected with this virus from the contamination of their food or other edibles by the urine and other body excretions of these rats – on their foods, drinks, etc, – usually not properly hygienically stored; i.e., uncovered food!
4. The dry season (such as we now are in) is usually the highest season of Lassa fever because of bush burning that drive these rats from the bushes into the homes, preferably. Other local and cultural habits of drying foods on the roads, streets and even around houses, carelessly (e.g., yam, cassava, plantain and other chips for making local flours for eating or selling) also provide avenues for the spread of the virus.
5. Lassa fever, in the vast majority (some 80%) of cases, passes on un-noticed – with mild fevers, body aches, tiredness, loss of appetite, etc, as for many locally common diseases; and so, remain unnoticed. However in severe cases, these will progress with sore throat, cough, vomiting, diarrhoea and unexplained bleeding from different body openings such as nose, anus, vagina and many others as a result of damage of many body organs caused by this virus. In these cases, mortality (death) rates from the disease may rise rapidly to high levels of up to 50% or more. Late reporting or hiding cases of the disease at home and so multiplying the infection is usually the reason for these types of high mortality rates.
6. Hospital or other man-to-man transmission of the infection follow contamination with food or body fluid transfers, providing the reasons why home members and health workers wherever Lassa fever subjects exist or are taken for came must all practice the highest levels of personal and/or professional hygiene.
7. Outside of Bauchi, Kano, Nasarawa, Niger, Edo and the other states in which the current epidemics are noted, all should know that no state in Nigeria should relax that they are not involved or affected. Lassa fever is not exclusive to any state because of the random population-mixing pattern in the country. In fact ALL the states have the potential to be at risk of being affected if we neglect to observe basic personal and communal hygienic practices at the individual, family and community levels.

So we advise all and sundry in this country at this time as follows:
1. The Federal Government and her Minister and Ministry of Health have risen up and are performing up to task on this matter so far – since the notification of the disease came to their attention. Nobody needs to panic on the matter now!
2. Individual states, local governments, communities, societies, families and individuals should rise up and reciprocate these responses by doing the following:

To individuals
1. Listen to the radios, TV and other mass media and keep yourselves properly informed on the present Lassa situation in the country as well as especially what you should do in the interval.
2. Improve/increase in your personal hygiene along the lines outlined above as well as help your relatives, neighbours and friends to do the same.
3. Ensure that your house is free from rats, all foods and drinks properly covered and/or stored, as may be needed.
4. Encourage all cases of fevers to attend a medical and properly manned health facility very early.
5. Do not eat rats and improve rat control in your personal houses.

To families:
1. Ensure that everybody in your family improves on their personal and group hygiene as outlined above.
2. Do not partake in food drying in the streets, roads and such other places open for bush rat visitations.
3. Ensure that all fevers or illnesses with symptoms as described above are taken promptly to medical facilities for early diagnosis and treatment as appropriate.

To communities:
1. Encourage the cessation of free bush burning in your communities.
2. Discourage the drying of food materials in the open streets and roads.
3. Help to see that all cases of fevers (and other symptoms as listed above) are reported early to hospitals and that your village and LGA Health and Development Committees assist to ensure that your hospitals and health centres are equipped, staffed and made to run properly especially in regard of Lassa and other epidemic diseases.

To local governments:
1. Ensure that your health facilities are staffed, equipped and run properly in regard of Lassa and other such epidemic diseases
2. See to it that all rampant bush burning in the LGA are stopped or reasonably controlled.
3. Ensure that the drying or cassava, yam and other food chips on the roads and streets is stopped completely or at least reasonably controlled.
4. Help to see that all fevers in the LGA go to the health facilities very early and that all notifiable diseases are so notified by the health facilities in your LGA

To state governments:
1. Increase your public education especially in all state-owned mass media; increase disease notification and surveillance activities, especially in regard of Lassa and the other epidemic diseases
2. Endeavour to resuscitate your state hospital for infectious diseases – as Lagos State has at Yaba and which played such tremendous role in the curtailing of the Ebola epidemic of 2014 in the country.
3. Seek to establish your state Primary Health Care Agencies as soonest as possible, optimise them and seek to fully operationalise the ward-based PHC system with community nurse-midwives at these wards as well as the medical officer of health for each LGA, besides the other health facility-based health workers.

To the Federal Government:
1. Please continue in the good efforts that you have brought to the present epidemic.
2. Get the remaining three reported laboratories in the country that is able to identify the Lassa fever virus to full operation and/or establish new ones to augment these. This is very important in the Calabar-Enugu-Makurdi-Yola-Maiduguri axis of the country to augment the presently functioning ones in Lagos, Ibadan, Irrua, Port Harcourt, Abuja and Kano.

To health workers
1. Please remember that this is your vocation; and a challenge like this one is actually an opportunity to do your best and to shine
2. Revise your training in the infectious diseases and standard and universal precautions in these regards and do so all of the time and with every patient care.



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VERY INFORMATIVE PIECE! WELL DONE, OP.