For years, Lassa fever in Nigeria followed a familiar pattern: cases surging during the dry season, with health care workers bracing for an influx of patients; the outbreak easung off when the rains arrive. At the Federal Medical Centre (FMC), Owo, Ondo State, one of Nigeria’s foremost treatment centres for Lassa fever, doctors and nurses noted that the disease no longer followed seasonal trends, as patients now pour in throughout the year, stretching already limited resources and placing enormous pressure on frontline health workers.
A visit by Weekend Trust to the facility, where Dr Ihinmikaye Isaac is a consultant public health physician and Lassa fever case manager and Oyebimpe Oyegunle is a nurse and Assistant Director of Nursing Services, revealed a troubling reality: Ondo State remains at the epicentre of Nigeria’s Lassa fever burden, with health care workers battling rising infections, shortage of critical supplies and persistent public misconceptions about the disease.
A disease that refuses to disappear
For Dr Isaac, the outbreak has evolved into a year-round public health emergency. ‘What we knew traditionally about Lassa fever was that it was seasonal. Cases usually increased during the dry season because of environmental factors and human activities. But now, we are seeing cases throughout the year,’ he explained.
According to him, the rainy season, which previously brought relief as rodents retreated to their burrows no longer guarantees a decline in infections. He said, ‘Lassa fever is no longer limited to a particular season. We now see consistent cases all-year-round. There is hardly any opportunity to rest because the cases keep coming.’
The burden is particularly pronounced in Akure South and Kajola axis, where health officials have recorded a significant concentration of cases.
‘The stress that comes with managing an outbreak, coupled with limited health care workers and a growing number of patients, has been significant,’ he added.
Nursing professionals working in the isolation ward shared similar concerns.
Mrs Oyebimpe Oyegunle, an Assistant Director of Nursing Services at FMC, Owo, said the current outbreak was unlike what obtained in previous years.
‘Normally, we observe a predictable pattern where the number of patients rise significantly during certain periods and gradually decline afterwards. This time around, the pattern has been irregular. Instead of following the usual trend, the number of patients has fluctuated. Cases increased unexpectedly and remained high. It has been like a zigzag pattern,’ she noted.
According to him, even experts are still trying to understand why the dynamics changed so dramatically.
Symptoms often mistaken for malaria
One of the greatest dangers associated with Lassa fever is that its early symptoms closely resemble those of malaria and other common illnesses. Dr Isaac explained that many patients initially show signs of fever, weakness, cough, sore throat, abdominal pain, vomiting and diarrhoea.
‘The challenge is that these symptoms are common to several infectious diseases,’ he said, and advised that any patient who does not improve after proper malaria treatment should be evaluated for Lassa fever.
‘One thing that should raise suspicion is when someone has been treated for malaria but does not improve. Lassa fever should then be considered.
‘As the disease progresses, more severe symptoms may emerge. Patients may begin to pass unusually dark urine, blood in urine, blood in stool, vomit blood or bleed from injection sites. By then, the disease is often advanced,’ he added.
Nurse Oyegunle also noted that in recent cases, health care workers noticed some unusual symptoms.
She said: ‘Many patients present abdominal pain. Some female patients have come with breast engorgement, while hearing impairment has become increasingly common among patients.’
Inside isolation wards
Behind the walls of the treatment centre, health care workers battle the disease while simultaneously protecting themselves from infection. Dressed in layers of personal protective equipment (PPE), doctors and nurses spend hours inside isolation wards, where temperatures can become unbearable.
Dr Isaac further said: ‘When properly dressed in PPE, every part of the body is covered. Regular hand-washing, decontamination of surfaces and strict infection prevention measures are critical.’
He also noted: ‘Lassa fever does not discriminate. It does not respect doctors or nurses. Once you let your guard down, you become vulnerable.’
But despite the risk, frontline workers continue to report for duty daily. ‘What keeps me motivated is passion. Seeing patients recover and return to their families provides a strong sense of fulfillment,’ he said.
For Mrs Oyegunle, moments of recovery make the sacrifices worthwhile. ‘We recently discharged a newborn baby who had been critically ill. There were moments when it seemed the child might not survive, but after receiving care, the baby recovered and went home safely. Moments like that keep me motivated,’ she said.
Human cost of the outbreak
Weekend Trust reports that the emotional toll on health care workers is immense. Dr Isaac acknowledged that long hours and repeated deaths could be psychologically exhausting.
‘There are times you become so busy attending to patients that you forget to eat. Sometimes you spend several hours inside the isolation ward. By the time you come out, your body is soaked with sweat because of the protective equipment,’ he explained.
According to him, even more painful is losing patients who arrived too late for effective intervention. ‘When you struggle to save a life and still lose that person, it affects you emotionally,’ he noted.
Mrs Oyegunle agreed: ‘Seeing patients you have cared for die despite your best efforts can be very difficult, emotionally and psychologically.’
A survivor’s story
Among those receiving treatment at the FMC, Owo is Mr Olabode Fatoyinbo, an Akure resident whose journey began with what appeared to be a simple fever. Like many Nigerians, he initially treated himself for malaria.
He said, ‘I thought it was just the regular thing, so I took some regular malaria medications, but it was not working.’
After visiting multiple health facilities and undergoing tests, he was eventually referred to the FMC, where laboratory results confirmed Lassa fever.
‘The result came back positive and I was referred to the isolation ward. As soon as I got here, treatment started immediately,’ he said.
Fatoyinbo described the fear that gripped his family when they learnt of the diagnosis. ‘When people hear Lassa fever, it is very scary. My wife, my brother and family members were all worried because I was very weak and couldn’t even speak,’ he said.
However, he praised the treatment and support provided by health care workers, saying: ‘From feeding to treatment and even laundry, everything has been free. We have not paid a dime since I came here.’
His experience also transformed his perception of the disease. He noted, ‘Before now, hearing about Lassa fever felt like something extremely terrible. But being here, I have seen many people treated and discharged. The biggest misconception is the fear people have about it.’
Speaking on what the government should prioritise, Olabode advocated massive advertisements about Lassa fever.
‘I think the messages in those advertisements should not only focus on the disease itself. They should also emphasise prompt action and encourage people not to see it as a stigma. People need to know that if they begin to experience symptoms that are unusual or persistent, they should seek medical help immediately.
‘People should not stigmatise anyone who has Lassa fever. That stigma is one reason some people delay seeking treatment and turn to other alternatives’.
Passing a vital message to Nigerians, Olabode said: ‘First, we need to be very careful about how we manage our environment. We should ensure that our food is not exposed and we do not eat in places we do not trust.
‘One of the questions I was asked when I got here was whether I had attended a burial recently, eaten in a public place or had rats in my house. For me, there are no rats in my house, not a single one. I don’t even eat bush-meat. So I can’t really place exactly where I got infected. It could actually be through contact with someone.
‘We need to be very careful and protective of our environment. I also noticed that a lot of people who develop complications are people who take alcohol or smoke. It affects the kidneys and can complicate treatment. I have seen people undergo dialysis several times because of that.
‘Lastly, if you observe that you are not feeling well and the treatment you are taking is not working, don’t just rely on prayers alone or herbal remedies. It is good to pray, but immediately go for proper medical tests to know what is happening.’
Persistent challenges
While health care workers continue their battle against the disease, several obstacles remain.
Dr Isaac identified shortage of Ribavirin, the primary medication used in treating Lassa fever, as a major concern. He said, ‘For decades, we have relied largely on one major drug for treatment. Availability remains a challenge because shortages occur.’
He also highlighted recurring shortages of PPE and laboratory reagents needed for diagnosis and monitoring, saying: ‘Improvements are needed in several areas. First, we need a regular supply of laboratory reagents and testing kits. Without them, diagnosis becomes difficult, and delays can increase mortality.
‘Secondly, we need adequate supply of consumables, such as gloves, masks, coveralls, aprons and other PPE used in isolation wards and laboratories.
‘The government should organise regular training and retraining programmes for health care workers and intensify public awareness campaigns. Public education is important because it helps address misconceptions and encourages early presentation. Environmental health officers and other frontline workers should also be protected and supported while carrying out their duties. In addition, frontline health care workers should receive incentives and support.
‘Working in a Lassa fever treatment centre is demanding and hazardous. Many people are reluctant to work in such environments because of the risks involved. Those who serve on the frontline deserve recognition, protection and support.’
According to him, delayed diagnosis also contributes to poor outcomes. He explained: ‘Some patients are initially treated for malaria, typhoid or other illnesses before Lassa fever is considered. That delay can be costly. We have lost health workers in the Process.
Dr Isaac informed that they had lost health workers during the course of outbreaks. ‘We have recorded health care worker infections and unfortunately lost some colleagues. Many of those cases were linked to delayed diagnosis and late presentation. Some health care workers did not initially suspect Lassa fever, and by the time the diagnosis was made, the disease had already caused severe complications, including kidney failure and bleeding.
‘In recent times, we also recorded health care worker infections among doctors and nurses, but fortunately, those affected received treatment and recovered,’ he added.
Nurse Oyegunle believes that stronger government ownership of Lassa fever management is necessary. She said: ‘We have relied heavily on non-governmental organisations for support. While their support has been invaluable, there should be a sustainable framework that allows the government to manage these cases effectively.’
Fight against misinformation
Perhaps one of the most difficult battles is not against the virus itself but against misinformation. Both health care workers and survivors say myths and misconceptions continue to discourage people from seeking treatment.
Nurse Oyegunle said, ‘Lassa fever is real. People should stop assuming that it is not real or spreading rumours that people are being deliberately infected.’
What must be done
Experts said reducing deaths from Lassa fever would require sustained investments in health care infrastructure and public awareness.
Dr Isaac called for increased supplies of diagnostic kits, laboratory reagents, PPE and treatment drugs, alongside regular training for health care workers.
‘Frontline health care workers should receive incentives and support. Working in a Lassa fever treatment centre is demanding and hazardous.’ he said.
A continuing battle
As Nigeria continues to grapple with recurrent outbreaks, FMC, Owo remains one of the country’s critical lines of defence. Inside its isolation wards, health care workers continue their daily fight against a disease that has become increasingly unpredictable.
For Dr Isaac, the mission remains clear despite the risks. ‘Seeing patients recover and return to their families is what keeps me going,’ he stressed.
And for survivors like Fatoyinbo, recovery itself has become a powerful message. He said: ‘The earlier the diagnosis, the better. Recovery is possible.’