Togo - Lassa fever 2022

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One fatal case of Lassa reported

A person has succumbed to the Lassa virus in a village in the Oti-Sud prefecture (North), the Ministry of Health said on Sunday.

Feb 27, 2022 Reading time: 1 min

A person has succumbed to the Lassa virus in a village in the Oti-Sud prefecture (North), the Ministry of Health said on Sunday.

This virus is seasonal.

Lassa fever is endemic in several West African countries, where it infects 100 to 300,000 people a year, 5 to 6,000 of whom die.

Lassa is manifested by high fever, headache, throat pain, nausea, vomiting and muscle pain, among others. If in doubt, it is prudent to consult a doctor.

The main reservoir of the virus is a small peri-domestic rodent. It is transmitted to humans through contact with animal excrement.

To date, there is only one molecule that has shown efficacy against Lassa. This is Ribavirin, a broad-spectrum antiviral against RNA viruses used in particular for the treatment of hepatitis C.

Health officials are working door to door to identify possible contact cases.

https://www.republicoftogo.com/toutes-les-rubriques/sante/un-cas-mortel-de-lassa-signale

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Health: Lassa fever kills one in northern Togo

POSTED ON MONDAY FEBRUARY 28TH, 2022

©AfreePress-(Lomé, February 28, 2022) - One person died of Lassa fever in the northern part of Togo. The alert was given on Sunday February 27, 2022, by the Ministry of Health, Public Hygiene and Universal Access to Care, Prof. Moustafa Mijiyawa.

According to a statement, the fatal case of this virus was reported in the Oti-Sud district.

“A case of Lassa virus disease was confirmed on February 26, 2022. This is a 35-year-old woman, residing in the Oti-Sud district, who died of complications from the disease”, inform the Minister of Health.

He also specifies that urgent measures have been taken to preserve the populations, in particular the intensification of investigations in the community for the search for possible cases or deaths and the tracing of contacts.

“Lassa virus disease is a viral hemorrhagic fever that can infect anyone. It is contagious and serious. Humans are generally contaminated by exposure to the urine or excrement of infected rodents (…)”, recalls the Minister of Health.

The populations are invited to be extra vigilant and to go to the health centers in case of suspicion.

It should be noted that Lassa fever is manifested by high fever, headache, throat pain, nausea, vomiting and muscle pain.

Raphael A.

https://afreepress.tg/2022/02/28/sante-la-fievre-lassa-fait-un-mort-dans-le-nord-du-togo/

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 10: 28 February – 6 March 2022
Data as reported by: 17:00; 6 March 2022
...

Lassa fever Togo

2 cases
1 Deaths
50.0% CFR

EVENT DESCRIPTION

On 26 February 2022, the Togolese authorities confirmed an outbreak
of Lassa fever in Oti-South health district situated in the Northern
part of the country.

The index case is a 35 year-old female resident of Takpamba, a town
bordering Ghana and located 96 kms away from Dapaong - the
capital city of the Savanna region¬ - which is 35 km to Burkina Faso.
She lived in the Djabata village in Benin and arrived in Takpamba on 4
February 2022 after crossing the Benin-Togo border. On 11 February
2022, she developed fever, abdominal pains and cough, after which
she consulted Takpamba health centre on 14 February 2022.

As no significant improvement was observed after three days of
oral treatment, she was taken to a Guerin Kouka health centre where
she was hospitalized for 24 hours and was later taken to Esperance
Hospital where she was managed as an out-patient. She returned
to this latter facility on 22 February 2022, following persistence of
the previous symptoms to which were added vomiting and bloody
diarrhea. As a result of her clinical picture, she was suspected as
a Lassa fever case and immediately isolated, notified and a sample
was drawn for laboratory confirmation.

On 26 February 2022, the case was confirmed positive for Lassa
fever, the same morning she had died. A safe and dignified burial was
organized 24 hours later, and an initial investigation was conducted
both in the health care facility and the hosting community.

As of 28 February 2022, 26 contacts had been listed around the
case, in two health districts of the Savanna region (13 in Oti and
13 in Oti-South), including 10 health care workers, one of whom
was symptomatic and isolated. This is a 38-year-old male health
care worker residing in Mango village and working in the Esperance
Hospital where he had a direct contact with the patient. Of all identified
contacts, 14 accepted to be sampled including the suspected case
and all their laboratory results were negative for Lassa fever.

PUBLIC HEALTH ACTIONS

On 27 February 2022, the Ministry of Health, Public Hygiene and
Universal Health Coverage declared the outbreak and indicated
preventive measures to be adopted by the Togolese population.
The incident management system located at the National
Emergency Operations Centre was activated. A response plan is
currently under development.

A deep investigation was conducted around the confirmed case,
which identified 26 contacts, one of whom became a suspected
case and was immediately isolated. More contacts are closely
being followed-up on a daily-basis.

Surveillance is being reinforced in all health care facilities of
the country, as well as infection prevention and control (IPC)
measures.

The health care facility that received the patient was
decontaminated and IPC measures reinforced. An isolation
unit was identified and arranged to receive and take care of
suspected and confirmed cases.

The communities are being sensitized and educated on the
benefits and acceptance of safe and dignified burials, early signs
and symptoms of the disease and preventive measures. As
such, a radio program was broadcast on two community radios
in the affected health district.

SITUATION INTERPRETATION

Lassa fever is endemic in several West African countries, including
Togo, which is often affected to a lesser extent. However since 2016,
outbreaks and sporadic cases have been reported in the country
every few years. The last notable outbreak in Togo was reported in
2017 in Oti district, the same district with an ongoing outbreak. The
Ministry of Health has proven to have adequate response capacity
to Lassa fever outbreaks in the past, however there is a current lack
of resources for case management such as insufficient number of
isolation rooms, shortage of antiviral treatment and supportive
therapy as well as delays in testing turnaround times.

PROPOSED ACTIONS

The early warning and alert system should be reinforced incountry, as
well as the event- and community-based surveillance.

This would help in detecting early any event of public health
concern. All relevant actors should be trained, accordingly.
Contact tracing and follow-up should be maintained and
reinforced. Deep investigations should be pursued to identify all
potentially missed contacts and chains of transmission.

Considering the proximity with Ghana and Burkina Faso,
surveillance at corresponding points of entry should be
reinforced.

Risk communication and community engagement activities
regarding Lassa fever should continue. Accordingly, all political,
administrative, and traditional authorities alongside community
leaders should strongly engage in educating their communities.

View/Open

OEW10-280206032022.pdf (2.035Mb)

https://apps.who.int/iris/handle/10665/352364

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Source: https://www.who.int/emergencies/dise...ssa-fever-togo


Lassa Fever – Togo

24 March 2022

Outbreak at a glance
WHO was notified of an outbreak of Lassa fever in Togo following the confirmation of a case on 26 February 2022. Active case finding, and contact tracing was conducted. The risk of transmission for this outbreak is assessed as low at the national and regional level given the experience of national authorities with past outbreaks and the cross-border communication with neighboring countries.
Description of outbreak
On 26 February 2022, the national authorities in Togo notified WHO of an outbreak of Lassa fever after a case, a 35-year-old female, from Takpamba town, Oti-South district, Savanes region was laboratory confirmed. The town borders Ghana and is located 96 kilometres from Dapaong - the capital city of the Savanes region. The case was previously living in a village in the Save commune in Benin, four kilometers from the Nigerian border, and arrived in Takpamba town, Togo, on 4 February prior to their symptom onset.

On 11 February, the case developed symptoms including fever, abdominal pain and cough, and consulted the local health care facility on 14 February. Following three days of oral treatment and no improvement, the case was taken to another health centre where she was hospitalised for 24 hours and was later referred to a hospital where she was managed as an outpatient. On 22 February, the case returned to the previously visited hospital following persistence of symptoms as well as having developed vomiting and bloody diarrhea. As a result of her clinical picture, Lassa fever was suspected, and the individual was isolated and notified to the health authorities. A sample was taken for laboratory analysis at the National Institute of Hygiene, Togo, and tested positive for Lassa fever on 26 February. The case died the same day, and a safe and dignified burial was performed.

A total of 26 contacts were identified from two health districts of the Savanes region, including 10 health care workers, one of which was symptomatic and isolated. The symptomatic health care worker was exposed through direct contact with the case but upon testing was negative for Lassa fever. As of 23 March, all contacts have completed the follow-up period, and none developed Lassa fever.

No outbreak has been reported from Benin or Ghana associated with this reported outbreak in Togo. There is an ongoing outbreak in Nigeria (for more details, please see the Disease outbreak news published on Lassa fever in Nigeria on 14 February 2022) , however, no epidemiological links have been elucidated as part of this investigation.


Figure-1. Confirmed case of Lassa fever in Togo, bordering Ghana and Benin

Epidemiology of Lassa fever
Lassa fever is an acute viral haemorrhagic fever that is primarily transmitted to humans through direct or indirect contact with food or household items contaminated with infected Mastomys rodents’ urine or faeces. Though to a lesser extent, person-to-person infections can occur during the acute febrile phase through virus particles present in blood and bodily fluids of the infected person. This includes transmission in the health care facility and laboratory; thus, health care workers should be among the risk groups targeted for prevention. Overall, the case fatality ratio is around 15% among hospitalized patients with severe presentation.

The incubation period of Lassa fever ranges from 6 to 21 days. The onset of the disease, when symptomatic, is gradual, starting with fever, general weakness, and malaise. After a few days, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and abdominal pain may follow. In severe cases, facial swelling, fluid in the lung cavity, bleeding from the mouth, nose, vagina or gastrointestinal tract and low blood pressure may develop.

The antiviral drug, ribavirin has been given as treatment for Lassa fever in recent years, however, recent systematic reviews showed there is no strong evidence about the efficacy of ribavirin treatment on the outcome of patients with Lassa fever as well as optimal dosing regimens, highlighting the need for further research, particularly in the form of randomized clinical trials. Therefore, if the decision is to use ribavirin, it should be made under clinical trial protocol to evaluate safety and efficacy of the drug and the dosage. There is currently no approved vaccine for Lassa fever, however, optimized supportive care provided as early as possible with rehydration and symptomatic treatment can increase the chance of survival.
Lassa fever is endemic in West Africa with cases frequently reported from Benin, Ghana, Guinea, Liberia, Mali, Nigeria and Sierra Leone. Togo is affected to a lesser extent, however, since 2016, outbreaks and sporadic cases have been reported in the country every few years. Notable Lassa fever outbreaks have occurred in Togo in 2016, 2017, and the most recent was in January 2019 when two imported cases from Nigeria were reported in the Central and Kara regions of Togo. No further cases were identified, and the Ministry of Health declared an end to the outbreak in February 2019.
Outbreaks of Lassa fever in Togo have involved importation and exportation of cases at various times to nearby countries requiring the need for cross-border communication. In both endemic regions and areas with sporadic cases in West Africa, the majority of cases are reported during the dry season from December to April.



Public health response

WHO is supporting the response activities in the country and assisted in conducting the safe and dignified burial of the patient.
Active case-finding and contact tracing activities are ongoing at the household and the affected health facilities. If contacts experience any Lassa fever symptoms, case management teams have been trained to ensure that these suspected cases receive adequate care in a dedicated ward.
Other response measures undertaken include sensitization of health care workers, taking stock inventory of ribavirin, preparing a minimum capacity for case management at district level, providing risk communication messages to the public, and reinforcing infection prevention and control measures in health facilities.

WHO risk assessment

The country has proven to have adequate response capacity to Lassa fever outbreaks in the past, however, several challenges including lack of resources for case management such as insufficient number of isolation rooms, stock shortages of antiviral treatment and supportive therapy, lack of reinforcement of infection prevention and control measures in health facilities, as well as delays in sample testing turnaround times have been noted in the country during the current outbreak.
Additionally, the borders are very porous in this area with constant cross-border movement which poses a risk for transmission to neighbouring countries. However, given the management of past outbreaks and the experience with cross-border communication between national health ministries regarding Lassa fever outbreaks, the risk of transmission remains low at the national and regional level.

WHO advice

Prevention: Prevention of Lassa fever in endemic countries relies on community engagement and promoting hygienic conditions to discourage rodents from entering homes. Family members and health care workers should always be careful to avoid contact with blood and body fluids while caring for sick individuals.
Infection prevention and control:

• In health care settings, staff should consistently implement standard infection prevention and control (IPC) measures when caring for patients, regardless of their presumed diagnosis to prevent healthcare-acquired infections.
• Standard infection and control precautions comprise appropriate hand hygiene, rational use of personal protective equipment (PPE), environmental cleaning, isolation and safe injections practices.
• In order to avoid any direct contact with blood and body fluids and/or splashes onto facial mucosa (eyes, nose, mouth) when providing direct care for a patient with suspected or confirmed Lassa virus, personal protective equipment should include:

• clean non-sterile gloves;
• clean, non-sterile fluid resistant gown; and
• protection of facial mucosa against splashes (mask and eye protection, or a face shield).

International travel and trade:

• WHO advises against the application of any travel or trade restrictions on Togo based on the currently available information on this outbreak.
• Exportation of Lassa fever can occur via travellers from areas where the disease is endemic to non-affected areas. The diagnosis of Lassa fever should be considered in febrile patients who have travelled within West Africa, especially if they have been in rural areas or hospitals in countries where Lassa fever is endemic.

Further information

• WHO Lassa fever fact sheet
• AFRO Weekly bulletin on outbreaks and other emergencies Citable reference: World Health Organization (24 March 2022). Disease Outbreak News; Lassa fever – Togo.Available at:https://www.who.int/emergencies/dise...ssa-fever-togo