Protecting Children From Lassa Fever

  • Victoria IyedualaWASSCE/NECO, Sciences, School Of Secondary Education (I.C.E) Auchi
  • Heather Hyde BS, Biomedical Science, University of Birmingham

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Introduction

Lassa fever is an infectious illness caused by a virus that affects people of all ages. It is one of the viral haemorrhagic fevers (VHF) which are common in parts of Africa but are rare in the UK. It is transmitted from rodents and infected people. Lassa fever is a lethal disease, even more so for children so it is crucial to protect children from this infection. This article will help you understand Lassa fever and how to prevent its occurrence in children. 

Understanding Lassa Fever

Definition and transmission

Lassa fever is a dangerous illness caused by a virus. It is a haemorrhagic illness which means it causes bleeding. According to the World Health Organisation (WHO), outbreaks are common in West African countries such as Nigeria, Benin, Guinea, Ghana, Liberia, Mali and Sierra Leone, with an estimated 100 to 300 thousand cases yearly. The Lassa fever virus is carried by the multimammate rat called Mastomys rats, native to western and central Africa.1,2

Infection occurs through contact with food, water, items, and surfaces contaminated with an infected Mastomys bodily fluids such as urine, blood, saliva, faeces, or semen, or other bodily secretions from an infected person (whether living or dead). Exposure to the virus may also happen when you breathe in tiny particles in the air that are contaminated with excretions from infected rats while sweeping or vacuuming, as per the Centers for Disease Control and Prevention (CDC).1,2,3

Although there is no study on the subject, it is not certain whether the Lassa fever virus is present in the breast milk of infected mothers. Per WHO, no evidence exists that you can contract the virus from an infected person through the air. You are unlikely to get infected if you live in an area that is not prone to Lassa fever, as it is rare for travellers from risk areas to carry the disease into other countries. In the UK, only 11 confirmed cases have been imported into the country from 1980–2022.1,2,3

Lassa fever can progress rapidly from a mild illness to a severe disease affecting many body organs such as the liver, kidneys and spleen. WHO says 20% of infected persons develop severe Lassa fever disease. Although 3 in 20 hospitalised severe Lassa fever cases die, the overall death rate for Lassa fever is 1%, and death may occur within 14 days of noticing symptoms due to multiple organ failure.1

Children and pregnant women are more vulnerable to Lassa fever. There are only a few reports and studies on Lassa fever in children, though these are mostly old. However, a newer study in Nigeria found that 5.4% of children with fever admitted to the Children’s Emergency Room of Irrua Specialist Teaching Hospital (Irrua, Edo State) over the course of one year had Lassa fever, with a rate of 3 deaths in 13 children. The study also mentioned that Lassa fever may be less severe in children.2,4 

Lassa fever is life-threatening in pregnant women, especially when infected in the third trimester, with more than 80% of cases resulting in the death of the mother, foetus, or newborn.1,5 

Symptoms of Lassa fever in children

Similar signs and symptoms of Lassa fever have been noticed in adults and children. They usually start about 6 - 21 days after you contract the virus. However, 4 in 5 infected people do not show symptoms. For those who get symptoms at the early stage, Lassa fever shows gradually with nonspecific symptoms:1,2,4,6

  • Fever
  • General weakness
  • A general feeling of unwellness

These may be followed by:

  • Headaches
  • Muscle pain
  • Chest pain
  • Sore throat
  • Cough
  • Nausea
  • Vomiting
  • Diarrhoea
  • Abdominal pain

In the severe stage, an infected person may experience:

  • Facial swelling
  • Low blood pressure 
  • Bleeding from the eyes, mouth, nose, stomach, intestines or vagina 
  • Impaired hearing
  • Seizures
  • Tremor
  • Confusion
  • Shock
  • Coma
  • Spontaneous abortion in pregnant women 

In severe cases in newborns, infants, and toddlers, there may be:2,3

High-risk areas and seasons of Lassa fever 

Risk areas for Lassa fever are endemic areas such as the West African countries of Nigeria, Benin, Guinea, Ghana, Liberia, Mali and Sierra Leone, especially during the dry season (November – April). Lassa fever may also be present in other African countries. Travel to these areas should be properly planned and made with caution, especially during a confirmed outbreak.1,2 

Prevention measures against Lassa fever

Although there is ongoing research for an effective vaccine, there is currently no approved vaccine for Lassa fever.1,7 Hence, you need to strictly adhere to the available preventive measures to protect yourself and the children around you from Lassa fever.

WHO advises people in Lassa fever risk areas to practise personal and community hygiene to prevent rodents from entering their homes and protect themselves against contamination. Some practical ways to do this include:1

  • Storing food (cooked or uncooked) in containers and places where rodents cannot access it. 
  • Disposing of garbage regularly and far from your house. 
  • Keeping your house and its surroundings clean at all times.
  • Keeping cats.
  • Washing your hands regularly.
  • Avoiding contact with blood and other body fluids while caring for a sick person. 
  • Healthcare workers should always practise good hospital and patient care hygiene

How do you ensure children are protected from Lassa fever as much as possible?

  • Handwashing: Handwashing is a fundamental personal hygiene practice crucial in preventing Lassa fever. The virus can be transmitted through contact with contaminated surfaces or bodily fluids, making regular handwashing a simple yet powerful preventive measure. Encourage your children to always wash their hands with soap and water for at least 20 seconds, ensuring thorough cleaning of hands, fingers, and nails after using the restroom, before meals and after being in public spaces.
  • Avoiding contact with rodents: Discourage children living in or visiting high-risk areas such as West Africa from chasing, touching, and eating rodents. This is because it may be possible to contract the Lassa fever virus from rats, or while preparing rats for cooking. Also, it cannot be guaranteed that the rat caught is not infected simply because it is not a Mastomys rat. Although Mastomys rats are the primary hosts of the Lassa fever virus, research indicates that other types of rodents carry the virus.2,5,8 Check out this CDC page for more information on rodent control. 
  • Know your travel destination: Since Lassa fever is rare in the UK, you can only contract it when you visit risk areas. However, the risk of getting infected is high for medical workers and aides working in risk areas. Tourists have a very low risk of getting infected. Nevertheless, ensure you have all the necessary information about your destination, especially West African countries, before making travel plans with your kids. Check your country's travel guide website for information about your destination to ensure you are not going at a high-risk period or during an outbreak.3  
  • Seek immediate medical care: You should immediately seek medical care if you suspect you may be infected. This will help protect your children and others around you from getting infected. 

Early detection and treatment of Lassa fever 

Lassa fever, especially in its early stage, is difficult to diagnose because 

  • Symptoms vary for different people.
  • It can be mistaken for other viral haemorrhagic fevers such as Ebola or yellow fever, and other fever-causing illnesses like malaria and typhoid. 

Experts use a number of laboratory tests, usually in specialised labs, to diagnose Lassa fever.1,4 

Recognising Lassa fever symptoms in children

Recognising symptoms of Lassa fever in children is crucial for early detection and prompt medical intervention. Here is how to identify potential signs:

  • Fever: Persistent high fever is a common early symptom of Lassa fever in children. Regularly monitoring your child’s body temperature is essential to detect any health changes quickly.
  • Fatigue: Noticeable tiredness and weakness beyond normal fatigue may indicate an underlying health issue, prompting further investigation.
  • Headaches: Children may complain of persistent headaches. Frequent or severe headaches warrant attention, especially in combination with other symptoms.
  • Sore throat: Throat discomfort or pain can be a symptom. If your child complains of a sore throat, particularly if it persists, it should be evaluated.
  • Cough: A persistent cough should be monitored and investigated further, especially if it worsens over time.
  • Abdominal pain: Unexplained abdominal pain or discomfort may indicate Lassa fever. Pay attention to any complaints of stomach aches.
  • Vomiting: Nausea and vomiting are potential symptoms. If your child vomits repeatedly, especially in association with other symptoms, medical attention is necessary.
  • Diarrhoea: Digestive issues, including diarrhoea, can occur. You should promptly address persistent or severe diarrhoea.
  • Facial Swelling: Swelling of the face, neck or other areas may be a late symptom of severe Lassa Fever. Monitor for any unusual swelling, especially around the eyes or face.
  • Bleeding: In severe cases, bleeding tendencies such as nosebleeds or gum bleeding may occur. Black vomit and blood in poop is a sign of stomach bleeding. Any unexplained bleeding should be treated as an urgent medical concern. 

Symptoms of Lassa fever can vary, and not all children will exhibit the same signs. If your child shows any combination of the mentioned symptoms, especially if you are residing in an area prone to Lassa Fever, seeking immediate medical attention is crucial. Early detection and timely intervention significantly improve the chances of a positive outcome.

Treatment and supportive care for Lassa fever 

Once diagnosed, treatment begins with an antiviral drug called ribavirin, alongside supportive care to ease symptoms. It is crucial to detect Lassa fever early because treatment with ribavirin, which seems to be the only effective medication for now, works best when started in the early stages of the illness. However, no studies are showing its efficacy in children.1,2 

Supportive care for Lassa fever involves:2,3,7

  • Treatment for fever
  • Rehydration 
  • Management of low blood volume (hypovolemia) like blood transfusion 
  • Monitoring and treatment of a bacterial infection
  • Monitoring of the blood pressure and clotting process (coagulation)
  • Respiratory assistance 

Recovery may be bumpy as 1 in 4 patients who survive Lassa fever may develop partial or complete deafness. Recovering patients may also experience tiredness for several weeks, temporary hair loss, unsteady gait, or difficulty maintaining balance.1,3

Summary

Lassa fever is a rodent-borne viral haemorrhagic fever common in West Africa that can also be transmitted from one person to another, either at home, in the community, or the hospital. Symptoms can develop rapidly from mild to severe, and can cause death. Children are among the most vulnerable to Lassa fever. Doing and encouraging hygiene practices such as regular hand washing, proper waste management, general cleanliness, and avoiding contact with rodents are excellent ways to protect yourself and the children around you against Lassa fever infection.

References

  1. Lassa fever [Internet]. [cited 2024 Feb 16]. Available from: https://www.who.int/news-room/fact-sheets/detail/lassa-fever.
  2. Greenky D, Knust B, Dziuban EJ. What Pediatricians Should Know About Lassa Virus. JAMA Pediatr [Internet]. 2018 [cited 2024 Feb 16]; 172(5):407–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970952/.
  3. Lassa fever: origins, reservoirs, transmission and guidelines. GOV.UK [Internet]. 2023 [cited 2024 Feb 16]. Available from: https://www.gov.uk/guidance/lassa-fever-origins-reservoirs-transmission-and-guidelines.
  4. Akhuemokhan OC, Ewah-Odiase RO, Akpede N, Ehimuan J, Adomeh DI, Odia I, et al. Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area. PLoS Negl Trop Dis [Internet]. 2017 [cited 2024 Feb 16]; 11(7):e0005711. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510890/.
  5. Aloke C, Obasi NA, Aja PM, Emelike CU, Egwu CO, Jeje O, et al. Combating Lassa Fever in West African Sub-Region: Progress, Challenges, and Future Perspectives. Viruses [Internet]. 2023 [cited 2024 Feb 16]; 15(1):146. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864412/.
  6. Lassa haemorrhagic fever | Epidemic Control Toolkit [Internet]. [cited 2024 Feb 16]. Available from: https://epidemics.ifrc.org/manager/disease/lassa-haemorrhagic-fever.
  7. Lassa Fever | CDC [Internet]. 2022 [cited 2024 Feb 16]. Available from: https://www.cdc.gov/vhf/lassa/index.html.
  8. Douno M, Asampong E, Magassouba N, Fichet-Calvet E, Almudena MS. Hunting and consumption of rodents by children in the Lassa fever endemic area of Faranah, Guinea. PLOS Neglected Tropical Diseases [Internet]. 2021 [cited 2024 Feb 16]; 15(3):e0009212. Available from: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0009212.

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Victoria Iyeduala

WASSCE/NECO, Sciences, School Of Secondary Education (I.C.E) Auchi

Victoria is a health and wellness writer who spends her days creating audience-satisfying content for health brands to build a loyal reader base and hit prime marketing goals. She has years of experience in health content writing and has written dozens of articles and blogs, with many ranking high on search engine result pages for multiple keywords. She has a passion for health education and healthcare, which fuels her drive to become a healthcare professional against all odds.

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