Health workers risk their lives as Lassa fever spreads in Nigeria
It’s Lassa season again, and with PPE supplies occasionally running short in hard-hit places, doctors and nurses are unanimous in their hope for a vaccine against the deadly haemorrhagic fever.
- 27 February 2025
- 8 min read
- by Afeez Bolaji
The events of 17 February 2024, are etched into Dr Divine Njadze’s memory. He was on his usual ward rounds at the Federal Medical Centre, Jalingo, in Taraba State, northeast Nigeria, when his phone rang. It was a distress call from the Accident and Emergency Unit – he rushed over to attend to a female patient. In his hurry, he neglected to put on surgical gloves.
No sooner had Njadze placed his hands on the patient than he discovered she was bleeding into her skin. He sanitised his hands after the session, but it was rather late. The safety oversight would prove costly as Njadze came down with symptoms of Lassa fever – a viral haemorrhagic fever – days later.
“I had severe headaches, neck pain, high fever, itching, abdominal cramps and loss of appetite. My blood sample was collected, and after three days, the result returned positive [for Lassa fever],” Njadze recalled.
“I was placed on a high dose of ribavirin, which I couldn't commence immediately because I was having anuria, a low production of urine. After I was rehydrated, I was taking ribavirin two to three times daily for 10 days. Unfortunately, when the test was repeated, it was still positive and I continued receiving treatment,” he told VaccinesWork.
As days went by, Njadze's health condition worsened. The kidney function tests revealed he had renal derangement, he said, recounting the frightening moments he endured during his month-long hospital stay.
“Five [Lassa fever] patients were brought into the isolation ward on the first day I was admitted. Unfortunately, all of them died. The next day, four patients were brought in. They all died too. The patient from whom I contracted the disease died. Her father too contracted it and died after two weeks. Her elder brother also contracted it, but he survived.
“At a point, I was alone in the ward, but after some days, patients started coming. When the test was repeated the third time, it came out negative. I was discharged after a month and one week,” he explained.
Despite his eerily traumatic experience, Njadze’s commitment to treating Lassa fever patients remains unshaken. “I've seen more than six patients recently. Even while I was on admission by the third week, I was the one attending to most patients on the ward,” he added.
Facing down risk
The Nigeria Centre for Disease Control and Prevention (NCDC) in late December 2024 raised the alarm over a spike in Lassa fever infections, with 1,154 confirmed cases and 190 deaths recorded during the year. By the end of the year, the death toll had increased to 214 out of 1,309 confirmed cases. In the first six weeks of 2025, 1913 suspected cases, 413 confirmed cases and 80 deaths had been reported, according to NCDC data.
The viral disease usually peaks in the dry season, between October and May, a period during which frontliners like Ndjaze know they are liable to be at higher risk at work. The NCDC situation reports showed that at least 88 – representing 83% – out of 105 health workers infected with Lassa fever from January 2022 to December 2024 contracted it between January and March of those years.
As the current outbreak peaks, Njadze said he has doubled down on safety measures, always using personal protective equipment (PPE) available at the hospital.
“We may have up to 12 suspected Lassa fever cases in a day during the peak period. Different doctors see the patients at intervals, so the PPE is never enough. Sometimes we run out of PPE. At times, we ask the patient to buy gloves, face masks and so on, which is not ideal.
“Other times, we buy the PPE from our pockets. The National Association of Residents Doctors also provides packs of face masks for us. There's no prophylaxis for Lassa fever for now. The best thing is to maintain hygiene,” he said.
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The working conditions for frontliners are similar at Ayede-Ogbese Basic Health Centre in Ondo, a state in southwest Nigeria with one of the highest burdens of Lassa fever. Many patients who exhibit high fevers, vomiting and abdominal pain first visit this facility, before being transferred to a referral hospital when symptoms persist four days after receiving malaria treatment. The hospital matron, Osalusi Bamidele, said staff members make do with nose masks, gloves and some garments to attend to patients.
“Those are the few disposable PPE we have. We have no standard PPE. Most times, we buy gloves by ourselves. We are appealing to the authorities to get us boots and goggles. We are rationing gloves. Every time we lay hands on a patient, we quickly wash our hands. For patients with very high temperature, we wear gloves particularly during this season to attend to them,” she explained.
Health workers pay the ultimate price
Dr Mansur Mohammed of the Federal Medical Centre, Azari in Bauchi State, was not as lucky as Dr Njadze when he got infected with Lassa fever five years ago. After three weeks of battling high fevers, diarrhoea, coughs and blood vomiting, 35-year-old Mohammed succumbed, leaving behind his young, pregnant wife and their one-year-old son.
“He had been treating Lassa fever patients. He came back from work one evening in February 2020, feeling sick. He tested positive and was admitted. He died within a month,” Mohammed’s widow, Khadijat Ibrahim, recalled. “Our marriage was barely two years then. Our two children are now six and three years old respectively. They are yet to know their father is dead.”
Dr Edeth Nkantah, a physician at the FMC, Jalingo and former chairman of the Nigerian Medical Association, told VaccinesWork he and his colleagues now take more safety precautions to drastically minimise the risk of getting infected, after the death of three doctors at the hospital last year.
“We observe standard precautions for all patients by wearing disposable gloves and face masks. If I want to take an oral procedure, which is a fluid blood test, I wear my goggles. The kind of protective wear I put on depends on the level of threat involved. I wear my full PPE to attend to patients in the isolation ward. But sometimes, there is a shortage of full PPE. I try as much as possible to bridge that gap by buying protective materials I can afford.
“When patients come to the hospital with high fever, we keep a metre distance while checking their temperature with a thermometer. Another important aspect of safety is sorting of waste. We sort out waste properly to avoid contact. The hospital provides hand sanitisers for us. The pipe-borne water is not functioning for now, but the management distributes water through tankers so we can wash our hands regularly.
“Also, all pregnant health workers have been asked to stay at home until the incidence of the disease comes down because Lassa fever is usually very severe in pregnant women. The hospital management recently conducted a workshop for the staff on Lassa fever management, and an infection prevention committee has been set up,” he explained. Nkantah further remarked that surgical gloves worn by hospital cleaners are insufficient, saying “they need industrial gloves to be safer”.
In its weekly Lassa fever situation report, the NCDC said it had distributed response commodities such as “PPEs, Ribavirin (injection and tablets) body-bags, thermometers, hypochloride hand sanitizers, and IEC (information, education and communication) materials to states and treatment centres.”
Sanni Datti, head of corporate communication at NCDC, said the centre regularly publishes advisories on the standards health workers must adhere to and organises periodic training for them on case management, infection prevention and control of Lassa fever.
“Those standards include use of personal protection equipment, hand wash, among others. The NCDC also provides updates on high burden local areas where highly skilled health workers are deployed for proper management.
“As regards insufficient PPE, state and local governments are expected to supplement whatever NCDC provides. We always identify gaps and come in. Our advisory tells the state and local governments what they need to do including provision of PPE,” he said.
Hope for a vaccine
Dr Fyne Akubueze has been at the forefront of managing Lassa fever at the Federal Medical Centre, Owo, in Ondo, for nearly five years. She said observing safety measures, such as those of Nkantah, protect her against the virus – but a vaccine would make a more reliable “shield.”
“We hope there will be a vaccine soon to protect everybody, including health workers. But in the meantime, maintaining a high level of hygiene is very important aside from using PPE. I have a bag at the entrance of my house where I put everything I wear when I return from work and wash them up. I do this to avoid putting my family in danger,” she stated.
Research for a Lassa fever vaccine is in progress. One possible vaccine candidate funded by Coalition for Epidemic Preparedness (CEPI) underwent Phase II clinical trial in Nigeria last year. Meanwhile, research has shown that deploying a safe and effective Lassa fever vaccine across 15 West African countries could save about 3,300 lives over ten years and save up to US$ 128 million in societal costs. https://cepi.net/lassa-fever
Health workers, who spoke to VaccinesWork were unanimous in their hope for an inoculation. “A Lassa fever vaccine will do us all good,” Nkantah said. ‘From January, we’ve lost about ten patients to Lassa fever at the FMC, Yola. A vaccine is the best means to reversing this sad situation,” he added
