**6. Laboratory diagnosis**

Lassa fever is most often diagnosed using ELISAs. The virus can also be detected by reverse transcription PCR (RT-PCR) in all patients by the third day of illness, but immunofluorescence identifies only 52% of the patients.

#### **6.1 Treatment**

Ribavirin, an antiviral drug, is the current treatment of Lassa fever. The drug is to be administered in a volume of 50-100 ml of normal saline to be infused over 30-40 minutes.


Supportive treatment is usually carried out with intravenous fluids, and treatment of complications such as renal failure and infections may be necessary.

Although Lassa fever can be treated with ribavirin, early diagnosis and treatment is essential in all cases of Lassa fever. Ribavirin is most effective when given within 6 days of illness. Self-diagnosis and treatment is common in the tropics because of ignorance and poverty. It is only when there is no remission of fever that the patient seeks treatment in a health-care facility. However, many health-care providers are unable to make early


Table 1. Case fatality rates of common Diseases among Medical inpatients in ISTH, Irrua, Nigeria.  Lassa Fever in the Tropics 115

diagnosis, and are very likely to make a diagnosis of resistant malaria or typhoid. Besides most health care providers have no access to diagnostic facilities, which are only available in tertiary health centers. This allows the patient to get to terminal stages before they are transferred to a tertiary center. Sometimes the life of the health-care provider is claimed

Prognosis depends on how early a patient presents at the clinic. Most patients recover completely if diagnosed early and when treatment with ribavirin is commenced within 6 days of illness. In studies carried out in special referral centers in Nigeria and Sierra Leone, Lassa fever was responsible for 13% and 30% of adult deaths respectively. The death rates were in adult medical wards where only 7% and 10-16 % respectively of the total number of admissions were for Lassa fever. Prognosis is probably better in males who may acquire partial immunity due to the habit of patronizing food vendors. In a study done in Nigeria, the case fatality rate in males was 23% compared to women with 44%, though males were

The affected person should be admitted to a special center for the treatment of Lassa fever. Where this is not possible, the patient should be barrier-nursed. Health care providers and close associates of the patient should wear protective clothing, masks and gloves.

Legislation is needed to prevent widowhood rites, traditional autopsies, bush burning and unhygienic preparation of garri and other staple foods. Animal husbandry and fisheries should be encouraged in order to provide alternative sources of first-class proteins for rat eaters. Regular and sustainable environmental sanitation is needed to prevent rat breeding. The public should be made aware of the mode of contact of Lassa fever and its high casefatality rate using print and electronic media. Community involvement and participation is necessary to provide sustainable Lassa fever control. Food vendors should be educated on the need to prevent food contamination with Lassa fever virus. Grains, flours and left-over foods should be adequately covered to prevent contamination by rats. Rodenticides should be used for the destruction of rats in homes, and development of Lassa fever vaccine should be facilitated. Regular seminars should be held for health-care providers on early diagnosis and treatment of Lassa fever, while diagnostic kits should be made available in district hospitals. Affected people should be referred early to the special center in order to prevent or limit disability, while those with disabilities should be rehabilitated functionally, socially

Though vaccines are not currently available for Lassa fever, there is evidence that they will be produced in the near future. Research done with non-human primates have revealed that

along with that of the patient.

four times more commonly affected than females.

Excrements from affected persons should be properly disposed.

and psychologically so that they can be gainfully employed.

survivors exhibit fewer lesions and a **lower** viral load than non-survivors.

**7. Prognosis** 

**8. Control** 

**8.1 The individual** 

**8.2 The community** 

**9. Prospects** 

diagnosis, and are very likely to make a diagnosis of resistant malaria or typhoid. Besides most health care providers have no access to diagnostic facilities, which are only available in tertiary health centers. This allows the patient to get to terminal stages before they are transferred to a tertiary center. Sometimes the life of the health-care provider is claimed along with that of the patient.
